In the second of two articles on the new Acuvue Advance with Hydraclear lens from Johnson & Johnson Vision Care, Cristina Schnider and Robert Steffen describe the development of the lens, its clinical benefits and positioning in your practice

Over the past two decades there have been many improvements in the comfort and convenience of contact lens wear, achieved primarily from the benefits of more frequent replacement. Yet although new wearers are constantly being introduced to the benefits of contact lenses, large numbers of patients are also dropping out. For every three contact lens wearers in the UK there are said to be two who have given up.1 If current lenses are already providing high levels of performance, why should this be? In developing the first of a next generation of silicone hydrogel lenses, the challenges Johnson & Johnson Vision Care faced were threefold. First, it was necessary to understand consumer needs and address the drivers and barriers to consumers entering the category. Second, practitioner prescribing habits and patient usage practices needed to be evaluated. The third challenge was to identify 'need gaps' in traditional hydrogels and in other silicone hydrogel lenses. Research has shown that comfort and vision are the most critical features of contact lens wear both for existing wearers and for those considering trying contact lenses.2 This research found that the desire for comfortable contact lens wear is common to all user groups, but attitudes differ according to lens-wearing experience. Non-wearers are often aware of discomfort issues through family or friends and want to avoid any sensation of having something in their eyes. Drop-outs may have experienced poor comfort with previous lenses and are looking for significant improvements to how the lens feels on the eye. Current wearers may be tolerating discomfort with their lenses, particularly at the end of the day or in certain environments, believing there is no better alternative. Some may limit their wearing time or remove the lenses due to tired, red eyes, but still say they are happy on follow-up. When practitioner prescribing habits are examined, the dominance of the daily wear modality is clear; in the UK, 95 per cent of new soft lens fits are currently for daily wear.3 Although first-generation silicone hydrogel lenses are approved for up to 30 nights' continuous wear, a survey of European practitioners recently found that more than one in four (26 per cent) were instructing patients to use the lenses on a daily wear, re-usable basis.4 One of the considerations in developing the next generation of silicone hydrogels was to recognise that current daily wear was less than perfect; a majority of patients were not able to wear their lenses comfortably all day, let alone want to sleep in them. The goal, then, was to solve patients' remaining problems with daily wear and improve contact lens wear for a majority, rather than a minority of wearers. If this can be achieved, there may well be more interest in sleeping in lenses. By addressing the issue of end of day comfort, Acuvue Advance with Hydraclear has an opportunity to prepare the market for the next evolution in soft lenses, which may well be some form of silicone hydrogel continuous wear with improved performance. Market research also suggests that patients' desire to wear lenses overnight may have been overestimated.5 A recent survey put the proportion of those interested in contact lenses that can be worn overnight at 64 per cent among existing wearers and 68 per cent among spectacle wearers considering contact lenses ('considerers'). Interest in sleeping in lenses for a month at a time was lower, at 60 per cent and 59 per cent respectively.2 In addition, practitioner endorsement of overnight wear to the existing wearer or considerer is more critical than with daily wear modalities. Practitioner and patient attitudes to lens replacement frequency were also considered. Although monthly lenses continue to be the most commonly prescribed,3 many studies support the choice of two-weekly over monthly replacement on clinical performance and patient satisfaction grounds.6-10 A survey of more than 1,000 soft lens wearers found that symptoms of dryness, end of day comfort and vision were all better with daily and two-weekly replacement lenses than with monthly replacement lenses.11 Patient acceptance among existing monthly wearers and new wearers prescribed two-weekly lenses is high and practitioner attitudes to two-weekly replacement are also very positive.12 The final challenge was to create a new material for daily wear lenses that would combine the best features of traditional frequent replacement hydrogels and the first-generation silicone hydrogels, and deliver new levels of patient comfort and satisfaction that would set new standards for daily wear clinical performance. The lenses also needed to be manufactured to a consistent and reproducible quality and be easy to fit with a high success rate. Part 1 of this article (optician, June 7) described the material properties of Acuvue Advance with Hydraclear. In this second part, we describe some of the results of the many clinical studies carried out with the lens and provide guidance on product positioning and marketing.