Contact Lens Options for the Non-Traditional Patient

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Contact Lens Options for the Non-Traditional
Patient

• Shane R. Kannarr, O.D.

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Non-Traditional Patients forContacts
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• Dry Eye Sufferer
• Astigmatic
• Presbyope
• Young Myope
• Non-Compliant Patients

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Benefitsof Fitting the Patients
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• Patient Satisfaction
• Loyalty
• Practice Builders
• 34 Million current wearers
• 12 million new fits
• 11 million drop outs
• PROFITABILITY

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Contact Lens Fits by Type

• Segment Trend
• Total Lenses 7
• SVS 4
• Toric 11
• Multifocal 25
• Colors 6
• Specialty lenses are driving the category growth
• Higher margin --gt higher profits

Source HPR 1H 2003
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Comfort and Vision are Top Benefits for both
Current Contact Lens Wearers and Considerers
( Absolutely Critical Top Box)
Source Vistakon Attitude and Usage Study of
Vision Corrected Consumers 2002
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Dry Eye
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Todays Choices
ACUVUE ADVANCE with HYDRACLEAR Revolutionary
Technology Exceptional Long Lasting Comfort
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ACUVUE ADVANCE with HYDRACLEAR

• ACUVUE ADVANCE with HYDRACLEAR
• A new generation in DAILY WEAR
• The outstanding initial comfort of a hydrogel
  lens
• Exceptional end of day comfort that outlasts the
  competition
• Uncompromized visual acuity of theACUVUE Brand
• Oxygen delivery and lens properties that help
  keep eyes as white as with no lenses

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Acuvue Advance

• Silicon Lens
• Hydrogel Comfort
• High Dk/t83
• Daily Wear
• 2 Week Replacement
• Same Design as Acuvue 2

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• 30 Day Lenses Not Just for Extended Wear
• Consider Low Water Contact Lenses
• Look at Systemic Medications
• (BCP and Antihistamine)
• Limit Wear Time
• Use Artificial Tears
• Consider Plugs

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AstigmaticsNot JustforRGPsAnymore
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Expectations
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Residual Astigmatism (RA)

• RARefractive Cylinder-Corneal Cylinder
• Example on Next Slide
• gt1D consider RGP

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Example

• Refraction -3.00 - 2.00 x 180
• K Readings 43.00 x 180 / 44.25 x 090
• For Our Purposes
• 2 1.25 .75
• (RGP probably not needed.)

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LARS RULE

• Left Rotation Add
• Right Rotation Subtract
• From your vantage point
• Each clock hour 30 degrees

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Example

• Trial Lens
• -3.00-1.25x090----OD rotates 20 degrees left
• -3.00-1.25x090----OS rotates 20 degrees right
• NEW TRIALS
• OD -3.00-1.25x110
• OS -3.00-1.25x070

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Fuzzy Math..
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Soft ContactLensOptions
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• A. Less than -3.00 D of Cylinder
• Acuvue Advance and Purevision
• are nice compliments.

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• Both are -0.75 to -2.25 Cyl in -0.50 Increments.
• Both are Axis 0 to 180 in 10 Degrees Increments.
• Good Stability.
• 2 Week to 1 Month Replacement.
• Avg. Sale Price/Box 42-45

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• Profit / Patient / Year 93.00/186
• Let Patients See the Improved Vision for
  Themselves.
• Up to -3.25 D of Cyl use Spherical Equivalent for
  Remainder.
• (example on next slide)
• Other Options
• Frequency 55 Toric/Vertex Toric

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• Example
• Refraction -2.00 -3.25 x 090
• Closest Lens -2.00 -2.25 x 090
• Uncorrected Astigmatism (UA)
• -3.25 2.25 1.00D
• Spherical Equivalent of UA
• -1.00 / 2 -0.50
• Add to Sphere of Refraction
• -2.00 0.50 -2.50
• New Contact Script -2.50-2.25x090

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• Greater than
• -3.50D of Cylinder

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• UCL, Sunsoft Toric, and Preference Work Well
  Together
• Parameters Sphere20.00/20.00
• Cylinder7D
• Axis is in 5 Degrees Steps
• Educate Patient about Possible Fluctuations in
  Vision
• Order with warranty

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• IMPORTANT
• Charge for your TIME
• Can not use standard multiplier
• Patient SatisfactionPractice Builder

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C. Rigid Lens Options
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• Front Surface Toric
• Correction on the front of the lens
• Low Residual Astigmatism
• Back Surface Toric
• Back of lens shaped to match cornea
• High Residual Astigmatism
• Excellent Vision
• Comfort is the Issue

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Presbyope
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No One likes Growing OLD
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A. Monovision
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• Start the Patient Early in Presbyopia
• Educate the Adaptation Time
• Start with the Non-Dominate Eye as Near (may
  switch)
• Return the Patient in 7-14 Days
• Manage Expectations

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• NO Contact Lens Salute
• Cost Effective for the Patient
• (any single vision lens will work)
• No Intermediate as Presbyopia Progresses
• Trouble in Low Light Conditions
• Trouble over 2.00 D of add

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KEY POINTS

• Will require chair time
• Inexpensive to patient
• Easier to start early in presbyopia
• Patients are happy that lens cost doesnt
  increase
• Works for the majority of the patient
• Decrease Depth perception
• (consider 3rd lens)

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B. Soft Contact Bifocals
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• Usually Provides All Ranges of Vision
• Comfort Over Rigid Lens
• Maintain Stereo Vision
• Works at All Add Powers
• Can be Costly
• Some Report Constant Blur

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• Halos at Night
• Let Lens Settle Before Rechecking
• 10-15 minutes is good
• Manage Expectations
• Return to Check After Wearing
• Use Trial Lenses

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Great Options
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Multifocal Market by Brand
Multifocal Shares Brand Share Share vs
YAgo Acuvue Bifocal 40.7 (21.1) SofLens
Multi-Focal 34.3 34.3 Focus Progressives 12.1 (1
3.8) Frequency 55 Multifocal 5.9 4.2 Dailies
Progressives 1.9 (0.2)

• In only 9 months, SofLens Multi-Focal is the
  fastest growing product in the category.

Source HPR Q22003
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Soflens 66 Multifocal

• Base Curve 8.8 / 8/5
• Powers
• Add Low (lt 1.75)
• High (gt 1.75)
• Design
• Watch Pupil Size in High Adds

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• Consider Modified Monovision
• Cost / Box31.25
• Avg. Price / Box 60.00
• Profit / Patient / Year119.00

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Exceptional Visual Acuity

• Natra-SightTM Optics
• Broad near to distance power transition to
  provide crisp, clear, natural vision
• Aspheric center-near with broad add profile
  across optic zone
• Equalized Mass Distribution
• Facilitates lens centration essential for
  effective functioning of the aspheric optics

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Natra-SightTM OpticsNot all aspherics are the
same
Power Profiles
SLMF Low ADD
SLMF High ADD
Ciba Progressives Single Steep Add
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Basic Fitting Tips

• Know the Distance/Near Demands
• Control Expectations
• Add power lt 1.75/Start with low add
• Add power gt 1.75/Start with high add
• Always use 8.5 BC with high add
• Aspheric Design offsets low amounts of
  Astigmatism

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Rule of Thumbs for Add Powers

• lt 47 Low Add in Both eye
• gt 47 Low Add in Dominate eye
• High Add in non Dominate eye
• Be a little Creative
• Tailor your fit to your patients needs

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Fits for Normal Demands/Distance Demands

• Find Prescription
• Fit on Rx OU/Low Add OU
• Let Settle 10-15 Minutes Before Checking
• Aim for 20/25 at Distance/20/40 at Near
• RTC 1 week (Patient to bring list of were lenses
  do and do not meet expectations)

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Difficulties

• Difficulties with Near
• Dominate Eye Remains the Same
• Non Dominate Eye
• Distance is Rx ½ of Add
• Low Add
• Difficulties with Distance
• Check Over Refraction with Trial Lenses
• Look at Base Curve

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Example

• Refraction -3.00DOU 2.00 AddOU
• OD is Dominate
• Initial Fit------- -3.00/Low Add OU
• 1st F/U--------- -3.00/Low OD
• -2.00/Low OS

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Excessive Near Demands

• Refraction
• Week 1 Fit on Refraction OU/Advise Readers
• Week 2 Dominate On Rx / Low Add
  Non-Dominate On Rx / High Add
• Week 3 Add to Non-Dominate with Trial
• Lenses until Near is Adequate

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Example

• Refraction -3.00 OU 2.00 Add
• OD Dominate
• Week 1 -3.00/Low OU/Readers
• Week 2 OD -3.00/Low OS -3.00/High
• Week 3 OR OS 0.50
• OD -3.00/Low
• OS -2.50/High
• Think before you use High Adds OU

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FREQUENCY 55 MULTIFOCAL LENS DESIGN
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FREQUENCY 55 MULTIFOCALPARAMETERS

• BC/Diam. 8.7/14.4 mm
• Sphere power 4.00 to -6.00D
• Add1.00 (NEW) 1.50, 2.00, 2.50 D
• Optical Design
• D lens for dominant eye
• N lens for non dominant eye
• Handling tint light blue edge-to-edge
• Packaging blisters in 6-packs, single blister
  trials
• Modality recommended for monthly replacement

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FITTING PHILOSOPHY

• Determine Spectacle Rx and Best Vision Sphere.
• ?
• Determine Contact lens power adjusting for vertex
  distance, if required.
• ?
• Determine the dominant eye. Consider fogging with
  a 2.00 lens test to determine dominancy.
• ?
• Place the D lens on the dominant eye and the N
  lens on the non-dominant eye. Wait 10 minutes
  for the lenses to equilibrate.
• ?
• Under normal illumination conditions, evaluate
  visual acuities for distance and near, first
  monocularly then binocularly

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FITTING PHILOSOPHY

• Acuity expectations
• D lens Distance 20/20
• Near 20/40 or better
• N lens Near 20/20
• Distance 20/40 or better
• Binocularly Distance 20/20
• Near 20/20

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Other Options

• Acuvue Bifocal
• Ciba Progressive

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C. Rigid Bifocals
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• Simultaneous Vision
• Concentric Design
• Translating Designs
• Is Great Vision Trade-Off for Initial Discomfort?
• Educate the Patient about Adaptation (It will get
  better!)
• Lots of Hand-Holding in the Initial Phases

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In All Options, Charge Adequately for Your
Time.
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Non-CompliantPatients
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• Significant Neo or Corneal Edema
• Again Look at 30 Day Lenses
• DK / L Comparison
• Poor Mans LASIK
• LASIK

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RapidlyProgressing Myope
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• Young Child -4.00 or Above
• Changing More Than -0.50 D / Year
• Fit a Half of a Diopter Flat
• Return to Check at 6 Months /
• Watch Cornea and Comfort
• Inform Patient of Proper Expectations
• Patience, Patience, Patience!