The past few years have seen important developments in the contact lens field designed to improve soft contact lens comfort. Comfort is a key feature of contact lens wear for patients, with discomfort the primary reason for discontinuing lens use.1,2
There tend to be two specific times during contact lens wear when comfort performance is taken into account both for contact lens manufacturers and eye care practitioners (ECPs): initial comfort on application and end-of-day (EOD) comfort. For example, ECPs often question their patients about EOD contact lens performance complaints, while specific moments in between can be overlooked.
A closer look at what happens not only on application of a contact lens and end-of-day removal but at the moments between, would uncover a more varied set of experiences that wearers go through.
This deeper understanding and empathy for the various challenges CL wearers face during the day could lead to improved lens materials, designs and fitting procedures. Hence a study was done to map and understand performance throughout the whole day from a CL wearer’s point of view in real time.
Study methodology
Independent market research specialist Kadence International conducted a quantitative, longitudinal study of soft CL wearers to better understand the lens-wearing experience during the day.
To participate in the study, soft, spherical contact lens wearers, between the ages of 18 and 39, had to wear their lenses at least four days a week, and be able to wear them for a full day on the day of the study. The market representative sample of wearers was recruited in the US via an online panel and data collection took place in July and August 2014.
The research used mobile research techniques to chronicle the wear day in real time. Subjects were asked to respond to short (five-minute) surveys pushed to their smartphones every two hours during the day via a mobile app, beginning with application and ending just after they removed their CLs. Each mini-survey asked the same set of questions in order to track responses throughout the day.
The surveys asked about lens comfort, satisfaction and vision quality (on a five-point scale), activities and environments experienced within the previous two hours, and symptoms and moods over the same time frame. The activities, environments and symptoms in the survey came from a list of clinically validated measures comprising the wearers’ CL experience.
Activities were selected from a list of 18 including ‘using a computer or laptop’, ‘typing a message/email on a smart phone’ and ‘exercising’. Environments were chosen from a list of eight such as ‘outside on a humid day’ and ‘inside in air conditioning’, and symptoms experienced in the past two hours from a list of 14 such as ‘eye tiredness feeling’, ‘eye dryness feeling’ and ‘fluctuating vision’.
The first three metrics (comfort, satisfaction, and vision quality) were combined with equal weight to create a single performance metric that summarises the experience of the patient at each moment throughout the day.
A statistical construct of ‘performance’ was created by combining comfort, vision and satisfaction scores, and then comparing them with time of day, duration of wear, activities and environments.
Results
A total of 243 soft spherical contact lens wearers (101 daily disposable (DD) and 142 reusable (two-weekly or monthly replacement) participated. Their mean age was 30.2 years (range 18-39) and 81% were female. The survey showed a general downward trend on all three measures of lens performance (comfort, satisfaction, and vision quality) from application to end of day (Figure 1).
[CaptionComponent="2436"]However, not all lens wearers had the same experience. Two main CL wearer groups were identified: those whose performance was maintained across the entire day (‘maintainers’, 41%) and others who experienced an overall performance decline throughout the day (‘decliners’, 59%) (Figure 2).
[CaptionComponent="2437"]The proportion of maintainers compared to decliners was the same irrespective of modality, demonstrating that DD wearers are as susceptible to CL performance declines as reusable lens wearers.
The way wearers experienced performance decline was not the same for all respondents. In the decliner group, four unique experiences were deduced. The most common performance decay pattern was one of fluctuating decline, affecting one in every four CL wearers or nearly half of the decliners, where good moments were interjected with not so good.
One in every five CL wearers, or 31% of decliners, experienced a continuous decline in lens performance from application to end of day. Smaller percentages of wearers experienced a slight decline in performance (14% of decliners) or a sharp drop at end of day (13% of decliners) (Figure 3).
[CaptionComponent="2438"]When looking within each modality, DD wearers were significantly more likely (p<0.05) to experience fluctuating than continuous or slight decline or end of day drop (Table 1). Reusable lens wearers were significantly more likely to experience fluctuating or continuous decline compared with slight decline/end of day drop.
The two most common symptoms articulated by the 59% of wearers who experienced a performance decline over the day were feelings of tired eyes and eye dryness (Figure 4). Moreover, these symptoms were also the most highly correlated with lens performance.
[CaptionComponent="2439"]So as a CL wear day progresses, those with a decline in performance report a corresponding increase in dryness and tired eye symptoms.
[CaptionComponent="2440"]According to the study data, there was no specific ‘tipping point’ or activity that caused CL performance to decline. However, decliners were more likely to engage in 10 or more activities throughout the course of the day, such as working on their laptop or PC, sending emails from their phone, using apps or doing homework.
Over a third (36%) of decliners experienced 10 or more activities throughout the day compared with 21 per cent of Maintainers (p<0.05, Figure 5).
[CaptionComponent="2441"]Decliners were also more likely to shift between different environments during the day, experiencing 7.3 shifts (on average) in environment throughout day compared to 5.8 for maintainers.
Conclusions
This work highlights that, regardless of CL modality, six in 10 wearers experience a decline in performance over the course of a day’s wear. Although the trend is a downward one, actual performance is often non-linear and fluctuates considerably throughout the day. Many patients, namely DD wearers, may be ‘silent sufferers’ from fluctuating decline who under-report problems to their ECPs and potentially drop out of CL wear. Therefore, it is important to understand the experience of each patient and how it may change throughout the day – and not just at the end of the day.
Given wearers most commonly report feelings of ‘tired eyes’ and ‘dryness symptoms’ with CL performance decline, when assessing CL performance eye care practitioners should ask whether patients experience these symptoms throughout the whole day. Also, digging deeper into the environments and variety of activities patients are exposed to can uncover a need for a change. When discussing patient needs, consider whether wearers are likely to put high demands on their CLs through numerous activities and environments during the day, as they may then experience performance decline.
Practitioners have an opportunity to offer better solutions to these patients before they lapse from wear with small tweaks in how lens performance questions are asked.
Kieron Mathews and Ben Daigle are insight managers at independent market research firm Kadence International. Jordin Alford is senior manager and Anne Marie Jedraszczak is manager global strategic insights, global strategic marketing at Johnson & Johnson Vision Care Inc in the USA. This article is based on a scientific poster presentation from the authors at the American Academy of Optometry meeting, October 2015.
References
1 Dumbleton K, Woods CA, Jones LW et al. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens 2013; 39:1 93-9.
2 Richdale K, Sinnott LT, Skadahl E et al. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea 2007; 26:168-74.