|By Karlen Cole|
The optical protocol for the successful dispensing
of 30-day continuous-wear contacts
Continuous-wear contact lenses have taken the CL arena by storm since their introduction into the U.S. in late 2001. There are currently two brands on the market that have been approved by the U.S. Food and Drug Administration: CIBA Vision’s soft silicone hydrogel Focus Night & Day lens and the oxygen-permeable (GP) fluro-siloxanylstyrene Menicon Z lens, marketed by Con-Cise Contact Lens Company. Busy consumers are embracing this option, enjoying the convenience of continuous-wear contact lenses—which require less lens care and handling—and the uninterrupted visual acuity the lenses provide. Those patients with busy, unpredictable schedules and a desire for low maintenance are good candidates for theses CLs, providing their vision, corneal health evaluations and their hygienic habits fall under the required parameters.
“In today’s society, everything is fast paced and disposable,” says David Shipley, OD, owner of Guardian Eyecare Center in Deerfield Beach, Fla. “Patients want things to be as simple and easy as possible, to fit into their lifestyle.”
That said, it is up to ECPs to protect their patients’ eye health, especially with an up to 30-night wearing schedule. Continuous-wear lenses have different requirements for fitting, follow-up and ongoing patient care than traditional soft contact lenses.
“Patient selection is the key to success with this modality and in avoiding any visual or eye health problems,” says H. Dwight Cavanagh, MD, PhD, of the Department of Ophthalmology at the University of Texas Southwestern Medical School. “Don’t make choices for patients, offer them options.”
Patients must be monitored closely during the first month of continuous-wear. Follow-up visits are extremely important, as are written and signed documentation of all patient instructions and compliance agreements.
ECPs should contact the manufacturers and distributors of soft and oxygen-permeable (GP) continuous-wear lenses for information such as technical data, fitting guidelines and product brochures. Fresh clinical data from ongoing studies will be available throughout the next several years. Practioners should keep a close eye on study results for updated eye health, fitting and wearing information.
Cleaning and Care
Patients should be assessed for motivation and their willingness to comply with instructions regarding lens wear, care and hygiene. CIBA Vision advises that continuous-wear contact lens patients ask themselves this question daily: “Does my lens look good, feel good and do I see well?”
Wetting drops can be used, but should adhere to the manufacturer’s recommended types. Saliva, tap water, distilled water or homemade saline solutions should never be used in caring for continuous-wear contact lenses.
Contact lenses should not be worn while taking certain medications and may not be suitable for certain occupations. Lifestyle considerations—including how a patient will care for their lenses and their eyes—is of primary importance with continuous-wear. The lenses should also not be worn while swimming or during other water sports, or if the patient is sick with a cold, flu or respiratory infection.
After being worn continuously for up to 30 nights, CIBA’s Focus Night & Day CLs must be discarded and a new pair inserted. During those 30 days, the lenses may be removed, cleaned, rinsed and disinfected, then reinserted. Menicon recommends that during continuous-wear the Menicon Z lenses be removed and cleaned every week. It is also important each continuous-wear patient have on-hand a pair of up-to-date prescription eyewear.
Patients should be aware that they need to contact their ECP immediately if they are experiencing moderate-to-severe eye pain; unusual eye secretions; redness; sensitivity to light; burning, stinging, itching or watering eyes; reduced visual acuity; rainbows or halos around objects; or an uncomfortable or dry lens. ECPs should set up special protocol to handle calls, questions and problems from continuous-wear CL patients, including where to instruct patients to get medical advice and care 24 hours a day in the event of an emergency. And remember, tell patients, “When in doubt, take it out.”
|30-Day Continuous-Wear CLs: Just the Facts|
Currently, there are two contact lenses on the market today that have been approved by the U.S. Food and Drug Administration for up to 30 days of continuous wear, CIBA Vision’s soft silicone hydrogel Focus Night & Day lens and the oxygen-permeable (GP) fluro-siloxanylstyrene Menicon Z lens, marketed by Con-Cise Contact Lens Company. Another soft CL, Bausch & Lomb’s PureVision lens, was marketed in the U.S. for up to 30 days of continuous wear until a patent infringement lawsuit brought by CIBA halted U.S. manufacturing and sales of the B&L lens until 2005.
The CIBA Focus Night & Day lens is currently available in sphere powers of +6.00 to -10.00D, in 8.4 and 8.6mm base curves and a 13.8mm diameter. The lens has a Dk/t (transmissibility) of 175.
The Menicon Z lens is available in spherical, custom toric and multifocal options, in a power range of +20.00 to -25.00D, in base curves of 6.50 to 9.00mm and diameters of 8.0 to 11.0mm. The Menicon Z also has a DK/t of 175.
“Oxygen permeable contact lenses are experiencing a renaissance due to the availability of a GP lens for continuous wear,” says Joe Barr, OD, assistant dean of clinical affairs at the Ohio State University College of Optometry. “Wearers are experiencing more comfort wearing a GP lens overnight.”
Both the soft and GP lens materials are called “hyperpermeable” because they provide high oxygen permeability, which allows for better tear exchange and a healthier cornea.
“Today’s GP designs are more refined and precise, which makes them much easier to fit and duplicate,” says Carl Moore, president of Con-Cise Contact Lens. “The hyper Dk Menicon Z lens is also more forgiving. Many fitters may be hesitant to prescribe GP lenses, but the adaptation is very rapid. With a little handholding, patients are up to full time wear in just a couple of days.”
Continuous wear can also mean flexible wear. When 30 days of wear is not desired or possible, both soft and GP hyperpermeable CLs can be customized to fit the wearing schedule the eyecare professional wants for their patient.
“Practitioners are using Focus Night & Day lenses for up to 30 days of continuous wear,” notes Rick Weisbarth, OD, CIBA Vision’s executive director, professional services North America. “The patient’s wearing schedule does not have to be 30 days; it can be flexible within that timeframe. ECPs are customizing the lens’ wearing schedule for individual patient needs.”
Continuous-wear CLs are also being marketed and accepted in the marketplace as an alternative to vision-corrective surgery, such as LASIK. Both Moore and Dr. Weisbarth point out that used as prescribed, continuous-wear lenses provide convenient, safe vision correction with none of the invasiveness or irreversibility of refractive surgery.
“The bottom line for practitioners,” says Mark Cloer, instructor and director of the Contact Lens and Low Vision Service of University Ophthalmology Associates at the University of Mississippi Medical Center in Jackson, Miss., “is keeping their patients in-office, while maintaining safety and profitability.” —KC