Tapping into the massive potential of multifocal contact lens wear has proved an elusive goal for the contact lens companies. Johnson & Johnson is the latest to throw its hat into the ring and it’s not with a Silicone Hydrogel.
Today’s 40 somethings are very much the contact lens generation. The daily lens came of age when they were in their teens and twenties and now, as they reach presbyopia, they are seamlessly transitioning into multifocal lenses right? Wrong, multifocal contact lens wear continues to make up a tiny percentage of the market.
Last month Johnson & Johnson gave a select band of lucky practitioners the opportunity to fit, and trial, the latest entrant into this market, the I-Day Acuvue Moist Multifocal contact lens (news 03.04.15). When asked if Johnson and Johnson’s entry into this, potentially lucrative sector, has been somewhat tardy, David Ruston, director of professional affairs for Johnson & Johnson Vision Care Western Europe, gave a somewhat bullish response.
‘We want to bring out products that outperform existing products,’ he says. ‘That’s what we have always done in the past. We always aim to bring out something that takes performance to a new level and that takes time. ’He cites the recent launch of 1-Day Acuvue Define in the beauty sector as an example of J&J’s ‘rich pipeline of products.’
‘The multifocal category in the UK is not exactly large, I believe it’s about five per cent of the overall but it’s been growing quite quickly and practitioners are gaining the confidence to use them. We think we have a product that can outperform on comfort and a product that can outperform on vision. We have been pleasantly surprised by the reactions that we have had when fitting this product.’
He says understanding of the change in pupil size with age is nothing new but there are new insights in variation with refractive error. However, some designs are optimised for a -3.0 correction and this leads to unsatisfactory optical performance across the power range. ‘We have a unique front surface design so every single SKU has a different optical design. In the hyperope designs the power falls off more quickly than the myopes and the high add power fall off more quickly than the power for the low add. That, of course, is greatly simplified but nobody else does that. That was part of the design process to give an extra edge in performance and an extra level of sophistication.’
While Ruston clearly has confidence in Moist Multifocal, the material the lens is based on and a simplified fitting guide which back it up, are designed to increase confidence and proactivity among practitioners. ‘We built it on the Moist platform because we think that is the best material to keep patients comfortable through their presbyopic years. The wettability is second to none,’ he says.
When it comes to multifocal practitioner concerns are around vision and chair time. ‘Are they going to work, do you want to go through all that hassle for something that might not work. The chair time. Some practitioners feel if it doesn’t work the patient will think I’m not very good.’ To combat this he says the company is supporting practitioners as much as it can. ‘A lot of thought has gone into the design of the fitting guide to make it as simple as possible and at the same time makes it as likely to lead to success as possible.’ He highlights the rigour of the science behind the 21 centre 275 person study in the US. ‘That helped validate the fitting guide. We are very confident that if practitioners follow the guide they will get to an end point quicker and more reliably than if they just follow their normal practice.’
The early adopting practitioners invited to The Vision Care Institute were among the first in the world to try out 1-Day Acuvue Moist Multifocal. These are just the type of practitioner that may be inclined to follow their own fitting routines but none had issues with the guide. After lens choice, says Ruston, a quick tweak is made which puts the whole fitting into a single appointment. ‘Leave the lens to settle down for ten minutes so its comes up to eye temperature and stabilises, give the patient ten minutes to go out into the real world, see some real things, choose some glasses maybe and then ask them what they think about the quality of their vision. If they are happy then fantastic if they say: “I can’t see my phone so well”, then you do a tweak then and there.’ This process has also gone through the evaluation process, he says. For a younger patient with a low add in both eyes the target time for the fit would be as little as ten to twenty minutes. In a busy practice this might mean fitting a patient and then fitting another patient while the first allows their lenses to settle down. ’One would hope it can be incorporated into a busy practice quite successfully.’
Having a multifocal contact lens that performs for both patient and practitioner opens up the massive opportunity of contact lenses for presbyopes. ‘The great news for all practitioners, especially independents, who tend to attract the more mature patients, is that those patients are sitting in their practices right now. How many presbyopes do they see each day? We know contact lens wearers spend more on glasses we know if presbyopic glasses wearers try contact lenses they want both – 80 per cent in a study. So it’s a huge practice growth opportunity.’
‘If you look at people getting into contacts there’s a huge entry in the teenage and 20s, it starts going down in the 30s age group. The research shows that’s largely to do with dryness. Wearing then starts going down very fast in the 40s and that’s to do with vision. We knew we had to address both things. We think you can put someone in their 20s or 30s into Moist sphere they are going to enjoy great comfort. You then transition them into Moist Multifocal in their 40s the visual consistency between the adds is very good, having three adds is great so you can keep somebody in contact lenses for longer and happier.’
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