Contact lens innovation delivers opportunity

Excerpted from page 20 of the September/October edition of AOA Focus.

Like many doctors of optometry, Ben Casella, O.D., found himself facing a great deal of uncertainty when pandemic lockdowns and stay-home orders led to a suspension of routine eye care. One of the biggest uncertainties was how to care for his patients’ basic needs, especially contact lens refills, when it could be weeks before they’d be able to return to his Augusta, Georgia, practice.

His solution? Double down on that aspect that internet retailers can’t replicate: the quality care and service afforded only by a strong doctor-patient relationship. Dr. Casella hit the road hand-delivering patients’ contact lenses.

“It started with a simple offer to a friend who was in need of a trial pair to get him by until his boxes came in,” Dr. Casella explains. “Then I thought, well I’m only seeing emergency patients [at the time] so this was a good way to reach out and let my patients know I miss them and care about them.”

The overwhelmingly positive reactions from his patients even solicited an appropriate response for the times: “One guy came outside and tried to hug me,” Dr. Casella says. “He settled for a socially distanced, air high-five.”

Practitioners going the extra mile—in Dr. Casella’s case, quite literally—are what set them apart from online retailers, especially in the contact lens space. As recent advances in materials technology and specialty lenses open the modality onto whole new subsets of patients, so, too, the range of available options is making it easier than ever to serve existing patients and identify new candidates.

In fact, the AOA’s 2019 Optical Survey found overall contact lens fittings were not only up nearly 3% but also new contact lens fittings were up by nearly 26% from the previous year. As far as outlooks go, contact lenses’ future couldn’t be brighter.

But then came the COVID-19 pandemic.

An opportunity for daily disposables

Suddenly, convenience was no longer the hot-button issue in the contact lens market—it was safety. As patients procured face masks and relearned the importance of handwashing, they also yearned to know whether it was safe to wear their contact lenses. The short answer: Yes. But, there’s a caveat.

The Centers for Disease Control and Prevention (CDC) states there is no evidence to suggest contact lens wearers are at increased risk for COVID-19 as compared to eyeglasses wearers. However, safe contact lens wear and care habits remain the variables that help prevent viral transmission.

“It’s like what’s old is new again,” says Pamela Lowe, O.D., past chair of the AOA Contact Lens and Cornea Section. “Everything we’ve been training our contact lens wearers to do since we’ve been fitting contacts is still the same—follow those wear and care guidelines.

“People should’ve always been washing their hands. Now, in the ‘new normal,’ that’s just more front and center.”

Call it a silver lining. Time and again, doctors of optometry and the AOA have stressed the importance of doctor oversight and the doctor-patient relationship in advocacy surrounding healthy, safe contact lens wear. But the pandemic honed the point. Now, there’s an opportunity to emphasize advances in contact lenses that promote safety.

There’s nothing healthier than a fresh lens, Dr. Lowe says, so consequently, there’s never been a better time for doctors to extoll the benefits of single-use, daily disposable contact lenses. The onus is on practitioners to drop their assumptions and lean into that education.

“We always have positioned single-use, daily disposable lenses first, and the only time I bring up a reusable lens to a patient who is a good candidate for single use is if they have the want or need to sleep, like my first responders,” Dr. Lowe says. “Police officers, firefighters or paramedics need to have that flexibility of overnight wear, and I won’t even discuss a reusable lens unless it’s for that matter or a special cornea that needs a reusable lens.”

That brings up another point about essential, front-line workers caring for COVID-19 patients, Dr. Lowe says. Considering care providers in hospital ICUs often wear a double layer, N95 and surgical mask combo, safety goggles and a face shield to boot, contact lenses won’t fog up or take up face real estate like spectacles.

“At the height of the pandemic, if a police officer or health care worker called when we were open for urgent care only, those were the only ones we’d provide a refraction,” Dr. Lowe says. “If there’s a resurgence in the fall, it’s definitely a top priority to get those patients in.”

Comfort in contact lenses

This renewed attention on single-use dailies for the sake of health and comfort reinforces the kind of innovations that have occurred within contact lenses. But daily disposable lenses continue to be the fastest growing modality, says Rick Weisbarth, O.D., vice president of professional affairs for U.S. Vision Care, Alcon.

“As more options, parameters and new materials have become available, practitioners and patients continue to see the tremendous benefits that daily disposability offers,” Dr. Weisbarth says. “In light of the COVID-19 pandemic, they are a safe and easy way to wear contact lenses.”

Advances in lens materials are a big component of that—Dr. Weisbarth says practitioners can now fit even more patients and upgrade their current wearers to a better contact lens-wearing experience. He notes one practice that’s seen growing popularity is the ability for existing lens-wearing patients to trial run new lens products prior to their annual exams.

“This activity allows the patient to ‘test drive’ the new product, reduces the number of office visits and office traffic, as well as allowing for a more real-world assessment of fit, performance and patient satisfaction,” Dr. Weisbarth says.

Ryan Corte, O.D., a practitioner in Concord, North Carolina, is an overt contact lens-innovation aficionado, and when it comes to contact lens advances, he says look no further than silicone hydrogel (SiHy) technology.

It starts with comfort. Nearly half of all contact lens patients who drop out do so citing comfort as their top reason for discontinued wear, AOA research shows. That figure hasn’t changed much in recent years, which is why new materials hitting the market as soon as this year could make a drastic difference.

“In general, contact lenses alter the homeostasis of the ocular surface, and that can lead to dryness, discomfort and eventually the patient just dropping out of contacts altogether,” Dr. Corte says. “So, there’s always room for improvement in terms of comfort for patients, in my opinion, even with some of the premium daily silicone hydrogels that are out there.”

For example, Dr. Corte points to an emerging, daily disposable SiHy lens from Bausch + Lomb, called Infuse, as a lens that bears in mind that delicate balance on the ocular surface. It combines what Bausch & Lomb describes as a “next-gen material with pro-balance technology” that helps minimize discomfort on the ocular surface and helps maintain tear retention throughout the day.

The evolution of the daily SiHy should be something that doctors of optometry eagerly track, Dr. Corte says, outside of specialty products. So many patients wear spherical lenses that advances in SiHy technology promise to immediately benefit most patients. And as part of that, manufacturers are doubling down on the development of proprietary technology for those SiHy lenses—wetting agents or therapeutic agents released on the surface of the eye—to help with comfort, considering device use is such a large part of our lives now.

“If you look at optometry and eye care, in general, there’s a lot of focus on ocular surface,” Dr. Corte says. “You see companies creating therapeutic agents and different effective treatment options to help with the ocular surface, then you see contact lens companies focused on keeping patients comfortable because contact lenses naturally do disrupt the ocular surface.

“In my opinion, this generation of contacts—really in the past five to 10 years—is really good and they’re very comfortable. They just continue to push the envelope in providing patients with comfort, one of the biggest reasons we see dropouts.”

New technologies, specialty lenses growing

Each generation of contact lenses delivers an even better experience than patients have had in the past, says Charissa Lee, O.D., head of professional affairs, North America, at Johnson & Johnson Vision Care (JJVC). Innovation keeps the modality always delivering new capabilities for critical, unmet needs.

For instance, Dr. Lee cites the new technology contained within ACUVUE® OASYS with Transitions™, a lens that JJVC describes as seamlessly adapting to changing light, as well as continuing investigation into emerging products, such as drug-eluting lenses.

“Just as we are always pushing ourselves to think beyond what is currently offered, we are also striving to enhance the current contact lens-wearing experience for patients,” Dr. Lee says. “Offering better, more comfortable options often comes down to the conversations doctors have with their patients; firstly, doctors simply need to offer contact lenses as an option, and secondly, recommending an upgraded experience to current contact lens patients. We shouldn’t diminish the fact that optometrists can change lives by presenting contact lenses as an option to patients. It doesn’t have to be an either/or, it can be an ‘and.’”

Especially in a time such as the pandemic, Dr. Lee says it’s important to innovate and identify opportunities to improve patients’ quality of life. She suggests doctors consider how they can revolutionize their own patient experience and adapt to their changing needs and expectations.

“Simple ways to greatly enhance patients’ daily lives could be options like offering multifocal contact lenses or even daily disposable contact lenses,” she says.

Soft sphericals still represent most of the contact lenses that doctors of optometry prescribe and dispense, AOA research shows, but they’re far from the only lens type. While specialty contact lenses have been around for some time, it’s only recently that an ever-expanding availability of multifocals, torics, sclerals or gas permeables have become effective options for more categories of patients. Consequently, it’s an area of opportunity for doctors of optometry.

Consider advances in contact lenses for patients with both presbyopia and astigmatism. Before, Dr. Corte says, doctors might have considered fitting these patients with torics and readers over top; or monovision lenses with eyes corrected for separate distances; or even still, attempting to fit the patient in a multifocal and masking the amount of astigmatism they had to give patients the best vision possible.

Last year, Bausch + Lomb released ULTRA^® multifocal for astigmatism, which Dr. Corte considers almost a “second, new generation of toric multifocal” considering those prior to ULTRA multifocal had to be custom ordered or weren’t as effective. Now, CooperVision^® released its Biofinity^® toric multifocal, which takes the technology behind Biofinity toric and Biofinity multifocal and puts them together as one. This combination offers more than 200,000 prescription possibilities, helping keep patients wearing contact lenses with all their vision and confidence-driving benefits, says Michele Andrews, O.D., CooperVision’s senior director of professional and academic affairs in North America.

“Now, we have the one-two punch of two different brand options to provide our patients which, again, is pretty awesome,” Dr. Corte says.

Adds Dr. Andrews: “We have a generation of wearers who might have typically moved out of contact lenses and into reading glasses or progressive spectacles now rethinking those traditional choices—new options give them that ability.”

Still, soft multifocals and soft torics represent about 15% and 24%, respectively, of the overall types of contact lenses that doctors of optometry dispense, the AOA’s 2019 Optical Survey shows. But they’re gaining in popularity, Dr. Weisbarth says.

“Better designs, ease of fitting and daily disposable options have allowed eye care providers to offer contact lenses to more of their baby boomer patients,” he notes. “This growing population is increasingly active and benefits from the visual freedom of being spectacles-free for many of their activities.”

Particularly, this generation has much to gain from emerging lens technologies. It’s not only that new lenses feature water surface technology, surface treatments and other modifications to enhance success and boost popularity but also that accommodating lenses will allow even more presbyopes to experience natural vision at far, intermediate and near, Dr. Weisbarth says.

While at the other end of the age spectrum, contact lens innovation has opened new options for myopia control in children. A largely unaddressed need that’s galvanizing parents, public health officials, pediatricians, teachers and practitioners alike is myopia management, Dr. Andrews says.

CooperVision’s MiSight^® one-day soft contact lens became the first and only Food and Drug Administration-approved product to slow myopia progression in children between 8 and 12 years old. Intended as a single-use, disposable lens, MiSight corrects refractive error and slows myopia progression in children with healthy eyes.

“Our introduction of the Brilliant Futures Myopia Management Program featuring MiSight one-day contact lenses has created incredible enthusiasm among doctors of optometry and parents,” Dr. Andrews says.

“Optometry practices have a chance to establish themselves as experts in their communities, creating long-lasting relationships with families that will benefit everyone involved.”

And that’s precisely what contact lens advances have offered doctors today. “Advancing technology for the purpose of delivering meaningful innovation to doctors and patients is more important now than ever,” says Jill Saxon, O.D., executive director, professional strategy U.S. vision care, Bausch + Lomb. “To do this, truly understanding the [barriers that doctors face throughout the fitting process and] experiences patients are having is critical. When it comes to developing products, understanding why there is still unmet need is the key and allows manufacturers to look to the latest science to develop products truly designed for today and the future.”