Upgrading, uptaking and avoiding drop-out

Dr Ian Moss reviews the factors to consider when upgrading contact lens wearers to silicone hydrogel lenses

  View PDF

THIS ARTICLE IS BEST READ ON A PDF OF THE ORIGINAL ARTICLE. REFERENCES, HOWEVER, ARE ONLY AVAILABLE BELOW IN THIS HTML FORMAT

In other lifestyle areas we are constantly being given the opportunity to try new services or new products. For example, the iPod has dramatically changed the way music is purchased, exchanged and listened to in the past few years. We may soon also be watching TV using our mobile phones.

Airline seats are a classic example of how travel has improved and developed, reflecting our desire to be more comfortable, have better service and reach our destination more relaxed (Figure 1). It could also be argued that improvements in seat design have reduced the health risks of air travel for some people.

For the benefit of using these new products and services, consumers are prepared to pay more, within reason, to feel comfortable or have a product that suits their lifestyle. With airline seats, the cost of upgrading to a better service may still be prohibitive other than for the select few. But new developments in contact lenses and silicone hydrogel (SiH) materials do not command such dramatic differences in retail cost. Why should upgrades not be offered to all your patients and not just the chosen few?

This article will explore the opportunities to upgrade all categories of patient into new lens technology and benefit from this exciting phase in contact lens development.


MARKET TRENDS

The trend towards increased prescribing of SiH lens types in the UK has been well documented over recent years.1

The manufacturers of the 'first generation' silicone hydrogels (Figure 2) can be congratulated for the drive towards enhanced ocular health and oxygen performance. Extended wear (EW) was predicted to be the modality of the future, described as, 'An opportunity for semi-permanent vision correction; an option instead of refractive surgery'.

However, the availability of these first-generation lenses has not substantially increased the proportion of people wearing contact lenses in the UK, which <2212> at below 10 per cent2 <2212> remains low compared to other countries. Until 2004, any increased prescribing rate for SiH fits was being driven mainly by upgrading existing contact lens wearers.

Over the past two years, the fitting of these lens types on an EW modality has grown steadily but is now being outpaced by daily wear (DW).1 In fact, EW prescribing may even be reaching a plateau.3 What must be true, however, is that patients wearing SiH lenses have the advantage of improved corneal physiology and other benefits compared to their previous lenses,4-7 although
there are other reported disadvantages (Table 1).8-11


EARLY STRATEGIES

Six years on from the introduction of SiH lenses, fitting strategies have changed. Historically, using first-generation materials marketed for EW, there was an opportunity to upgrade existing daily wearers to a more oxygen-permeable material but also to offer increased convenience. However, the limited growth of this modality has been attributed to the practitioner's fear of fitting EW.11 For new wearers, EW was often not recommended as 'first choice' since a period of trouble-free daily wear was essential first.

A variety of other fitting scenarios were adopted in practice for existing wearers; sometimes SiH lenses were seen as 'problem solving' lenses and were offered to patients who had tried everything else. For a proportion of these problem wearers, satisfaction increased but some were still not satisfied due to comfort issues.12 For some practitioners, SiH lenses were seen not as a mainstream product but more as a premium offering at a premium price. Others rapidly switched large numbers of wearers to these lens types and a daily wear modality, on the basis of oxygen benefits. Commonly however, unless hypoxic signs were evident, SiHs were not discussed as readily if DW was still the modality preferred by the practitioner and patient.

It is clear that for existing soft lens wearers, there was no clear strategy for using SiH lenses and they were still not considered to be 'first choice' or mainstream products. Also, the increased rigidity/stiffness of these materials, and the potential impact on comfort, may not help resolve the issue of contact lens drop-outs and may even contribute to the problem.


CURRENT APPROACH

Improvements in SiH materials have led to the introduction of second-generation products: Acuvue Advance, Acuvue Oasys and Acuvue Advance for Astigmatism (Johnson and Johnson), O2 Optix (CIBA Vision) (Figure 3) and a selection of others to follow, such as Biofinity (CooperVision) and O2 Optix Toric (CIBA Vision), all primarily for DW wear, some allowing 'flexi-wear' or EW.

Trends in prescribing for 2006 are likely to demonstrate a further increase in the use of SiH products. Whether these new products will increase the total number of contact lens wearers in the UK remains to be seen, but the improved comfort and better ocular health provided by the latest materials is a hugely positive step to offer to patients requiring vision correction. Given the recent introduction of so-called moisture-rich daily disposable lenses, there has never been a better time to offer contact lenses that are comfortable more of the time. This is surely an opportunity not to be missed for your practice.

There must be a clear change in your strategic thinking towards contact lens fitting and acceptance that these second-generation SiH lenses have to become your 'first choice' fit compared to hydrogel lenses when worn on a daily wear basis. This is further helped by the expanding range of parameters and fitting options and will undoubtedly bring about the demise of hydrogel materials as we know them for the reusable sector.

I would suggest that in 2006-2007 the majority of re-usable lens wearers should have been given the opportunity to try a SiH product, assuming prescription and parameter ranges are available. Indeed the recent announcements that SofLens 66 (Bausch & Lomb) and Surevue (Johnson & Johnson) are to be discontinued suggest the start of an ongoing trend.

The use of conventional hydrogel materials for daily disposable wear will still remain strong until the introduction of daily disposable silicone hydrogel lenses.


TARGET GROUPS

With the present options of products it is important to look again at your contact lens fitting strategies - which is in the best interests of your patient base and, ultimately, your business. Broadly speaking the ability to offer new products is aimed at three key groups: