Use caution with sensitive eyes
Glenda B. Secor, OD, FAAO: Every contact lens practitioner worth his or her weight in saline knows the value of care products when it comes to successful contact lens wear. Unfortunately, patients aren’t quite as aware of the effect of their actions on their day-to-day success. As practitioners have felt the effects of alternate delivery channels, some have attempted to maintain control by incorporating private label lenses and ultimately private label solutions as a bundled incentive to keep patients replacing lenses through the practice.
One can only assume successful compatibility has been verified when manufacturers offer private label solutions with private label lenses. The only unknown factor is the patient’s own inherent biocompatibility and compliance with the regimen. Because most private label solutions are just national brands repackaged under the private label, efficacy is seldom an issue for practitioners. Unfortunately, because practitioners have no control over the provider of the basic solution, the contract may be re-competed to obtain a lower cost and a competitor’s product substituted. This information is seldom shared with the contact lens community, so no one really knows when generic products may be changed.
Patients who have insensitive eyes may be fine and never notice a difference. Others may begin to have subtle and not-so-subtle symptoms, which are simple solution incompatibility. To avoid the potential of another unknown problem to solve, some practitioners have chosen to not allow the care products to become an unknown factor and thus have “prescribed” them. With patients who have chosen generic solutions, which are successful and suddenly mysteriously unsuccessful, the source of the problem may be the inconsistency of the generic brand.
My advice to patients inquiring about generic solutions is to warn them of potential problems if the generic brand is changed without their knowledge, possibly resulting in incompatibility. The cost of an unnecessary office visit to solve this mystery may offset any savings the patients had from “cheaper” care products.
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- Glenda B. Secor, OD, FAAO, is in private practice in Huntington Beach, Calif. She can be reached at 17742 Beach Blvd., Suite 305, Huntington Beach, CA 92647-6818; (714) 842-0651; fax: (714) 848-7826; e-mail: GBSOD@aol.com. Dr. Secor has no direct financial interest in the products she mentions, nor is she a paid consultant for any companies she mentions.
Don’t switch brands
Charles D. Allen, OD, FAAO: We have been very effective in instructing our contact lens patients that they should never switch the brand of solution that we have determined to be most compatible with their eyes and effective in maintaining their lenses.
Those patients who are new to contact lenses or are previous lens wearers new to the practice are educated regarding the importance of the solution in maintaining the comfort of the lenses and the health of their eyes.
On rare occasions, a patient is seen for his or her 6-month follow-up appointment, and the conjunctiva is more hyperemic than it had been when last seen. This can be traced to switching to a generic brand of solution. This is more of a problem with soft lens solutions than with rigid gas-permeable solutions.
During our fitting period, we will evaluate different solutions as well as lenses, and when the fitting period is completed, the patient will know that he or she can sometimes use an alternate name-brand solution if the primary solution is not available. Nearly half of our contact lens patients are previous contact lens failures, and once we have them comfortable and seeing well, they are reluctant to do anything that might alter that. We stress the importance of solutions in contributing to their comfort.
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- Charles D. Allen, OD, FAAO, is in private practice in Princeton, N.J. He can be reached at 601 Ewing St., Suite B-8, Princeton, NJ 08540; (609) 924-3567; fax: (609) 924-2852. Dr. Allen has no direct financial interest in the products he mentions, nor is he a paid consultant for any companies he mentions.
Generics less than optimal
Mike Christensen, OD, PhD: On the surface, the use of store brand, private label products seem like a good idea for the patient. Private label brands are relatively inexpensive and they do meet Food and Drug Administration guidelines. Let’s look a little deeper. The FDA clears all contact lens solutions, yet there are differences in performance from a convenience, efficacy and tolerability standpoint.
In addition to benefiting from your expertise when receiving a lens care solution, patients are also directed in the proper use of that solution. When a patient buys a private label solution, the major determining factor is price. Efficacy, tolerability and instructions for use rarely enter into the decision-making process. This is especially important with the introduction of the branded solutions’ “no-rub” directions for use. Currently, there are no private label solutions sold for no-rub use, and patients using these products in a no-rub regimen are doing so outside the approved label and how the product was designed and studied.
Unless patients consult with their eye care practitioners, they may not realize they are getting different products when switching to a store brand or switching from one store brand to another. Patients may react differently to the different preservatives in these formulations. Because private label products are manufactured on a contract basis, the actual formulation could change even though the packaging does not. These formulation changes may not be visible to the customer.
Advances in lens material and lens care products come about from investment by brand manufacturers. Portions of the revenues from the sale of brand-name products go back into research and development. Private label products are produced and sold at an extremely low, often break-even cost. If the market were converted to 100% private label solutions, it would effectively be the end of any research and development efforts.
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- Mike Christensen, OD, PhD, is assistant director, Consumer Products Clinical at Alcon. He can be reached at Alcon Labs (R6-15), 6201 South Fwy., Fort Worth, TX 76134; (817) 551-4375; fax: (817) 568-7054; e-mail: firstname.lastname@example.org.
No payoff for cost savings
Michael Pier, OD: Some contact lens patients perceive generic/private label solutions to be “just as good” as branded solutions and usually base their purchase decision on price.
While cost can be a valid reason to choose a care system for lenses, the risk of complications can be greater than the rewards of a slight cost savings. The following points represent risks to the patient’s lens-wearing experience:
- Generic/private label solution formulations vary by retailer (there is no equality of ingredients).
- Generic/private label solution formulations change within the same retailer (different formulations may have the same name depending on the supplier who “bid” best for the contract).
- The training and recommendations given at the doctor’s office are usually specific to the branded care regimen. Generic/private label solutions may have different soak cycles, cleaning instructions and patient or lens compatibility issues that may affect the contact lens system’s performance.
It is clear that patients who purchase a generic/private label solution are at risk of compromising their lens-wearing experience. While they may initially save money by purchasing generic/private label solutions, the odds of creating unnecessary follow-up office visits to resolve problems created by incompatible care systems are definitely increased. When this happens, the money saved is more than lost, not to mention the vision, comfort and convenience that the initial system was intended to achieve. Branded solutions provide convenience, trust and — when used in conjunction with the recommendations of a professional eye care specialist — superior outcomes.
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- Michael Pier, OD, is director, training and professional development for Bausch & Lomb. He can be reached there at 1400 N. Goodman St., Rochester, NY 14603; (585) 338-5489; fax: (585) 338-0184; e-mail: Michael_D_Pier@bausch.com.
Premium brands offer benefits
Nicholas Tarantino, OD, FAAO: Contact lens solutions must accomplish several tasks. In the case of multi-purpose solutions, they must first adequately disinfect the lens. Second, they act to condition the lens for optimal and sustained wettability of the lens surface before placement on the eye. This must all be done with ingredients that are compatible with all lens materials. You can imagine the challenge in formulating a product that cleans a lens and kills microorganisms, yet at the same time provides comfort and is gentle on the eye and lens material.
All multi-purpose contact lens solutions basically disinfect lenses when used as directed. However, there may be significant differences in the level of lubrication and lens comfort provided by the contact lens solution. Contact lens solutions differ in how they feel on the eye, how well the lenses seem to stay moist and how soothing the solution feels. In general, a premium brand tends to offer benefits beyond the basic level of lens disinfection.
Although the same companies that make premium contact lens solutions often make generic/private label contact lens solutions, they are not necessarily made with the same premium and latest state-of-the-art ingredients. Due to the pricing constraints of generic/private label products, fewer up-to-date formulation technologies may be used.
My personal experience has been that patient satisfaction, ocular health and even useable lens life is enhanced with premium brand contact lens solutions compared to generic/private label solutions. Patient comfort, and thus lens wearing time, is increased. This tends to increase patient satisfaction with the contact lenses and my satisfaction, as the practitioner, with their lens-wearing progress.
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- Nicholas Tarantino, OD, FAAO, is director of worldwide clinical research and development for Allergan Surgical/Contact Lens Care Products. He can be reached at 2525 Dupont Dr., Irvine, CA 92612; (714) 246-2346; fax: (714) 246-2205; e-mail: email@example.com.
Provide more information
Sally M. Dillehay, OD, MS, FAAO: When a patient inquires about generic contact lens solutions, most are asking this question based on cost, because they have no other basis on which to make their decision. So if a patient asks whether or not it is OK for them to use a generic solution, they are really asking the eye care professional to provide them with more information.
Studies have shown that patients’ comfort with their contact lenses and their wearing time are greatly affected by the lens care solution they use — regardless of the brand of contact lens they are wearing. I would ask these patients about current symptoms of dryness or discomfort and whether or not they are able to wear their contact lenses as long as they would like.
In a recent study we conducted, nearly 85% of the patients who were asked these questions admitted they were experiencing some level of dryness or discomfort. The patient’s question about the use of generic solutions is a great opportunity for the doctor to discuss the benefits of the different lens care systems available and to let the patient know why a certain brand is recommended for their specific needs.
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- Sally M. Dillehay, OD, MS, FAAO, is head of academic development for CIBA Vision Corp. She can be reached at 11460 Johns Creek Pkwy., Duluth GA 30097; (678) 415-3198; fax: (678) 415-3048; e-mail: firstname.lastname@example.org.
I recommend specific brands
Donald A. Hood, OD: In my practice, we recommend specific brands of contact lens products and impress to the patients the importance of the solutions we want them to use with the lenses we have prescribed for their eyes. If patients want to study the ingredients of generic solutions to see if they are the same as in the solutions we recommend, they can do that, but we are not responsible for any problems created by not following our recommendations. Most of our patients follow our directions, at least for the first year.
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- Donald A. Hood, OD, is a member of the Editorial Board of Primary Care Optometry News. He can be reached at 1550 South Potomac #155, Aurora, CO 80012; (303) 369-1020; fax: (303) 369-1022; e-mail: email@example.com. Dr. Hood has no direct financial interest in the products he mentions, nor is he a paid consultant for any companies he mentions.