2022 contact lens controversies

May 19, 2022
COVID-19, myopia management and presbyopia-correcting pharmaceuticals: debating the different perspectives of popular contact lens topics.
2022 contact lens controversies

The contact lens industry is constantly evolving and 2022 is no different. With new management options available to practitioners, it is worth discussing whether to adopt these changes or continue with what is known to be effective.

That’s what members of the AOA’s Contact Lens & Cornea Section will be discussing at Optometry’s Meeting® 2022, June 15-18, in Chicago. The course, titled “AOA CLCS Presents: 2022 Contact Lens Controversies” is designed to debate the different perspectives of popular contact lens topics in 2022.

Read on to learn more about these controversies and how you can participate in the discussion at Optometry’s Meeting.

Controversy No. 1

The first controversy focuses on current fitting practices in a COVID world, which are empirical versus diagnostic fitting. During the height of the COVID-19 pandemic, there were serious concerns about office protocols and a need to limit patient contact. While the literature supported the use of contact lenses, there was a legitimate concern about the safety of reusable, in-office, diagnostic lenses. Today, contact lens laboratories offer extensive resources so that we do not have to reuse lenses. Advanced fitting algorithms, especially when coupled with technology such as profilometers, can dramatically increase our success rate without having to try on a diagnostic lens.

Newer technologies provide opportunities to predict first lenses and potentially empirically design and customize lenses. These technologies certainly help streamline fitting. When lenses are empirically fit, there are no lenses to disinfect. The Guidelines for Handling of Multipatient Contact Lenses in the Clinical Setting standards require logging every lens and disinfecting in full strength 5% hydrogen peroxide for three hours prior to neutralization. Empirical fitting eliminates this time-consuming and cumbersome step. It also allows the first on-eye experience to be with a lens that was specifically designed to accommodate that patient’s individual eye shape and prescription, potentially providing very good vision and comfort. But wait! An argument can be made not to throw away your diagnostic fitting sets just yet. A wealth of information can be received by viewing the initial lens on the eye. Additionally, implementing the correct cleaning protocols can help increase your comfort level with using reusable lenses. Diagnostic fitting focuses on the practitioner’s expertise on evaluating the fit and then customizing the lens. Diagnostic fitting does provide a more accurate power recommendation.

Perhaps a combination of these two approaches could provide the best outcome for each individual patient and practice.

Controversy No. 2

The second controversy is overnight orthokeratology versus soft, multifocal contact lens wear for myopia management.

Decades of research has demonstrated that orthokeratology (OK) is safe, effective and very convenient for our patients. With any contact lens modality, the major safety concern is microbial keratitis (MK). A 2016 paper found no incidences of MK in their OK study population, and though they found a higher incidence of nonsignificant adverse events, the dropout rate was similar to the controls in single-vision spectacles. The overall incidence of MK has been estimated at 7.7 per 10,000 years of wear.

Many risky contact lens behaviors can be avoided in OK. Swimming, for example, should be avoided in soft lens wear but is not a concern with OK. Also, children in daily-wear soft lenses may find it inconvenient to wash their hands or use proper cleaning solutions if they need to handle their lenses away from home; children in OK are almost always near their solutions, soap and assistance from parents while handling lenses. Along with a good safety profile, current research suggests that axial length progression can be slowed by around 50% with OK. Over many decades of use, research and improvement, OK has secured its place as one of the most safe and effective options in myopia management.

A clinical pearl is that OK requires many contact lens solutions to keep lenses properly cleaned and disinfected. An important variable that influences the risk of corneal infiltrative events and MK is lens storage. The risk of moderate and severe MK in daily-wear lens users was increased 6.4 times by poor storage case hygiene and 5.4 times by infrequent storage case replacement, according to a study in Ophthalmology. This risk can be decreased by effective education on being compliant with cleaning and disinfecting both the lenses and storage case and discarding lenses and cases on the scheduled replacement period. Because soft MF lenses are available in a daily disposable modality for myopia control, prescribing this lens option also further decreases the risk of corneal complications.

Controversy No. 3

The third controversy is presbyopia-correcting pharmaceutical and contact lens wear. Pharmaceuticals are changing the way that we treat ocular disease. For the first time in history, we have a pharmaceutical miotic approved to treat presbyopia by increasing a presbyope’s depth of focus. There will be both opportunities and challenges with this pharmaceutical, and others to follow, with contact lens wearers. Pharmaceuticals seem to be a logical fit to use 10 minutes prior to insertion of single-vision distance contact lenses for patients with mild or moderate presbyopia. For more advanced presbyopes, the verdict is still out. We have had early success with VUITYTM drops for advanced presbyopes after being fit with a low monovision correction with a +1.00 over the nondominant eye. Setting proper expectations is critical when prescribing pharmaceuticals with contact lenses. As the category expands, our knowledge and patient selection will improve as well.

Although we are excited about a constantly evolving contact lens industry, it does require more on our part. If you think about what has happened in contact lenses over the past 5-10 years, you can quickly see that it’s not enough to rely on the training that you received in school. We must be proactive in keeping up with industry changes.

Fortunately, we have multiple resources to stay current. Conferences are always a great place to start. It is an opportunity for our industry partners to display their latest technology, while at the same time demonstrating how to implement new contact lens options in your practice. There also are various organizations dedicated to contact lens education and training, such as the AOA Contact Lens and Cornea Section, Gas Permeable Lens Institute and the Scleral Lens Education Society. When we utilize the tools that are readily available to us, we will be sure to stay current within a growing contact lens industry.

Know Before You Go

What: AOA CLCS Presents: 2022 Contact Lens Controversies
Where: Optometry’s Meeting in Chicago
When: 7-8 a.m., Thursday, June 16
Credit Hours: 1

Register to attend the meeting.

Written by Melissa Barnett, O.D., CLCS chair; Jason Compton, O.D., immediate past chair; Paul Velting, O.D., chair elect; Mile Brujic, O.D., vice chair; Renee Reeder, O.D., secretary; Melanie Frogozo, O.D., council member; Karen DeLoss, O.D., council member

Disclaimer: The information contained in this article represents the opinion of the author and not the AOA. These are not clinical practice guidelines, nor has the evidence been peer reviewed. There are additional aspects to this topic that may not be presented, or considered, based on the specifics of the case.

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