Recommend the right contact lens
By gathering key information, we can take advantage of the array of available technologies to make the best choice.
Patients are generally pretty savvy about contact lenses, but the specific advantages of new technology lenses usually come as a pleasant surprise.
There is rarely a need to discontinue wearing contact lenses. If someone has dry eyes, there are lenses that can help. If their eyes are tired after a long day at the computer, we have lenses that can assist with that as well. The keys for me as a doctor are to gather all the information I need, select the appropriate lens technology and help patients understand why the technology was selected then experience their new lenses.
In determining which lens to recommend for each patient, I consider many factors. It is imperative to examine the ocular surface prior to a contact lens fitting. I examine the eyelids, eyelashes and conjunctiva for signs of ocular surface disease, which may be exacerbated by some types of contact lenses. Corneal conditions such as scarring, keratoconus or a history of a corneal transplant affect the recommendation as well. Refractive error, astigmatism and presbyopia are certainly key for lens selection.
It is also important to consider the patient’s history of ocular and systemic diseases that can affect the ocular surface, such as glaucoma, diabetes, Sjögren’s disease or Stevens-Johnson syndrome. Chronic use of certain systemic medications such as antidepressants or antihistamines can also contribute to dryness and irritation of the ocular surface.
In addition to this clinical knowledge, I gather a great deal more information in conversation with my patients. If they currently wear contact lenses or have worn them in the past, I want to know what works and what doesn’t. I ask about their vision with contacts, including sensitivity to light, difficulty with computer use and reading, and problems with glare or night driving. I want to know if their contact lenses are comfortable throughout the day and if they have had any difficulties with contact lens handling when putting them in or out. I ask about their experiences with solutions so I can recommend a specific solution that is both effective and provides the convenience they need.
Finally, I simply need to ask what patients want. Occasional or full-time wear? Cosmetic colors? Disposable or reusable? Lenses that provide relief when using digital devices or transitioning between different light conditions? What occupation and daily activities do the contact lenses need to support? Many patients spend long hours using their computers, phones and tablets, as well as reading, driving, playing sports or doing other tasks. The choice of contact lens can help optimize their vision and comfort for those activities.
Recommending the right lens
Armed with all of our clinical data and information about the patient’s lifestyle and requirements, I am ready to make a well-tailored recommendation. In addition to lenses that are daily replacement or correct for astigmatism and presbyopia, there are many features from which to choose:
- Moisture-enhancing options: Patients with dry eye require management solutions such as omega supplements like HydroEye (Science Based Health), preservative-free artificial tears, eyelid cleaners and prescription medications like lifitegrast (Xiidra, Novartis) or cyclosporine (Cequa, Sun Pharma or Restasis, Allergan). These patients benefit from daily replacement contact lenses to get a clean, healthy lens each day. Choices like Dailies Total 1 (Alcon), myDay (CooperVision) or Acuvue Oasys 1 day (Johnson & Johnson Vision) are convenient, have minimal risk for infection, and benefit patients who say their lenses feel dry, gritty or uncomfortable at the end of the day.
- Lenses that automatically adjust to light conditions: I recommend lenses with “light intelligent technology,” Acuvue Oasys with Transitions (Johnson & Johnson Vision), to fit a range of needs. These lenses are particularly useful in patients who are on the computer all day, because they are always “on” and adjust both indoors and outdoors. They filter up to 15% of light including the high-energy visible light/blue range in the indoors or inactive state and 55% outdoors in the fully activated state. The lenses protect against indoor light, squinting and fatigue. Some patients with dry eyes report an improvement in their dry eyes with these lenses, possibly due to more natural blinking. Patients who are bothered by light and glare both indoors or outdoors are good candidates, and my patients with headaches and migraines have found relief with these lenses. For night driving, the lenses reduce glare and halos, which my patients with mild to moderate cataracts especially appreciate. Finally, although they are not designed as a substitute for sunglasses, athletes appreciate the automatic adjustment to different lighting conditions.
- Lenses that offer multifocal or presbyopia correction: New technology lenses allow patients to continue wearing contact lenses for many years with age, which means many of them need presbyopia or multifocal correction. In our discussion, I explain that contact lenses can be worn all the time or occasionally. Multifocal lenses like 1-Day Acuvue Moist multifocal (Johnson & Johnson Vision), Dailies Total 1 Multifocal (Alcon), Clariti 1 Day Multifocal (CooperVision) and Bausch + Lomb Ultra for Presbyopia are all good options. Most of my patients prefer multifocal contact lenses, which correct for distance, mid-range and near and provide freedom from reading glasses.
- Lenses that make handling and care regimens easier: The wear schedule and cleaning regimen need to be convenient. For example, I might suggest a daily disposable for those who want the convenience of a fresh lens each day and prefer to not clean their lenses or a lens approved for extended wear like Air Optix Night & Day Aqua (Alcon) or Acuvue Oasys (Johnson & Johnson Vision) if a patient likes to occasionally nap in lenses. For patients who want a convenient care solution, I recommend a hydrogen peroxide solution such as Clear Care or Clear Care Plus (Alcon) or a specific multipurpose solution such as Revitalens (Johnson & Johnson Vision), Optifree PureMoist (Alcon) or Biotrue (Bausch + Lomb).
- Lenses that provide cosmetic enhancement: Some patients are interested in changing or enhancing their eye color. In our conversation, I ask all patients if they are interested in colored lenses, since not all contact lenses come with a color option. Some patients want colored lens options that change or enhance their natural color, like Air Optix Colors (Alcon), 1-Day Acuvue Define (Johnson & Johnson Vision Care) or Dailies Colors (Alcon).
- Specialty lenses: Patients with a history of corneal scarring, keratoconus or a corneal transplant may need special lenses, such as custom soft, gas permeable, hybrid or scleral lenses to have effective vision correction and to enhance comfort.
Contact lens discussion
When making a recommendation, I explain the lens technology in straightforward yet detailed terms, and patients are very receptive. For example, I recently recommended AcuVue Oasys with Transitions lenses to a patient. I generally do not lead off with the word “Transitions” because I think patients can immediately jump to the idea of Transitions lenses in glasses. Instead, I say, “Since you are interested in contact lenses and you mentioned that your eyes get tired after 14 hours of computer use and also that you enjoy tennis, I recommend a contact lens with Light Intelligent Technology. They not only protect your eyes from blue light, which you said was a concern for you, but they also protect you from the fatiguing effects of all indoor light. These are actually Acuvue Oasys with Transitions contact lenses, which are about 15% activated indoors, and then they darken up to 70% when you go outside or play tennis.”
For whatever lens I recommend, I suggest a 10- to 14-day trial period, after which I see the patient back to evaluate vision, comfort and ocular physiology. At that time I ask how the lenses are working. With Acuvue Oasys with Transitions lenses, I ask patients to wear the lenses for the trial period and then switch back to their clear lenses for a day or two before the appointment. This allows them to realize the positive effects of the lens technology.
At the follow-up visit, patients usually choose the lens I recommended. It is really rewarding to have an array of lenses that provide good vision and comfort and allow me to solve a particular problem or fulfill a need — or do both.
- For more information: Melissa Barnett, OD, FAAO, FSLS, FBCLA,
- is the principal optometrist at UC Davis Eye Center, Sacramento, Calif. She can be reached at firstname.lastname@example.org.