As we saw in our previous blog post, the main reasons1 for contact lens dropout in the presbyopic population are:

Reasons for contact lens discontinuation (Rueff's study)

Also, studies2-4 have shown that the reasons for dropping out vary slightly depending on the amount of time that the patient has been wearing contact lenses. These findings suggest that eye care professionals should have a different protocol of action for each case. Addressing these difficulties is key to make contact lens wear a success!

Poor Vision

Vision is a set of factors that produces a result. Those factors are sphere, cylinder, axis, addition and geometry. And the result should be good vision. Each factor needs to be carefully evaluated and adjusted to produce the needed result.

Since good vision is especially important to new wearers of multifocals, eye care professionals need to manage their expectations from the beginning. The eye care professional should adapt vision correction to the patients’ occupation and lifestyle. When a particular task needs to be accomplished, it is crucial to consider it.

Papas et al’s study5 showed that:

  • Early assessment may not be the best moment to evaluate the performance of a multifocal contact lens. Therefore, it is important to allow a period of adaptation.
  • Subjective measurements may be a better indicator of a presbyope’s vision than acuity-based measures. To ensure the patient is happy, you can ask them to score their subjective vision at distance, intermediate and near.

Moreover, it is essential to inform them that changes may happen in their near vision over time. When that happens, the eye care professional can help by seeking for a new contact lens prescription.

Finally, don’t forget that contact lenses and spectacles together may meet the spectrum of patient needs. Provide them both!

Discomfort

Contact lens discomfort is a condition characterized by episodic or persistent adverse ocular sensations related to lens wear, either with or without visual disturbance, resulting from reduced compatibility between the contact lens and the ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear.

Nichols KK, Redfern RL, Jacob JT, Nelson JD, Fonn D, Forstot SL, Huang JF, Holden BA, Nichols JJ; members of the TFOS International Workshop on Contact Lens Discomfort. The TFOS International Workshop on Contact Lens Discomfort: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2013 Oct 18;54(11):TFOS14-9. doi: 10.1167/iovs.13-13074. PMID: 24058134.

Contact Lens Discomfort is also the result of a combination of multiple factors. The Tear Film & Ocular Surface (TFOS) International Workshop members summed up all of them in the following chart:

Contact Lens Discomfort Factors

Because of its multifactorial nature, addressing comfort in contact lenses is complicated. Eye care professionals must know and be comfortable using a wide range of lens types and products so patients can wear contact lenses successfully. The contact lens must meet the patient’s needs for optimal comfort.

The TFOS proposed a progression of discomfort:

Progression of Contact Lens Discomfort
Progression of Contact Lens Discomfort

It is crucial to question patients about:

  • Are you as comfortable as you were at the beginning with your contacts?
  • Are you feeling that the contact lens behaves equally during the whole period of wear?
  • Are you wearing your contact lenses for as long as you wish during the day?
  • Are you wearing your contact lenses for as long as you wish during the replacement cycle?
  • How many hours per day and days per week are you wearing your contact lenses comfortably?
  • Con you grade your contact lenses performance on a 0-10 scale?

With all this information, the ECP can identify a “struggler” or even how far the patient has gone down the road of dropout.

Also, different studies6-7 have found an association between vision and comfort. Apparently, the symptoms of ocular discomfort are more intense when subjective vision quality is below acceptable. Therefore, it is crucial to evaluate visual quality throughout the day, when doing specific tasks, etc. to identify patients at risk of dropping out.

Convenience

Contact lenses may easily fall into the description found at Cambridge Dictionary for convenience: “is also anything that is easy to use and makes life comfortable”.

When the patient is a new wearer, confidence in handling is key for success. You may need to ask your patients several times if they feel relaxed leaving with their contacts. After a few sessions, handling should not be a problem.

Also, it is important to adjust the replacement of the lens to address convenience, flexibility and cost. We tend to think that daily disposables are the universal remedy but talk to your patients and find out whether a less frequent replacement suits them better. This may also help retain patients wearing contact lenses.

Eye care professionals must remember the importance of convenience and choice to presbyopes.

Conclusions

  1. After a year of wear, only 74% of new wearers2 kept using contact lenses. During the first month, 25% of users dropped out. After two months, 47% discontinued. Eye care professionals should follow up and closely monitor patients during those first months of contact lens wear.
  2. Contact lens dropouts are not definitive. A study showed that 74% of the time8 contact lens wear can be resumed. If you find out that a patient has dropped out, find the reasons why and start over!
  3. Always remember that vision, comfort and convenience are key to retain presbyopes in contact lenses.

At mark’ennovy, we believe that every patient can wear contact lenses. That’s why we manufacture our individually crafted contact lenses with an extended range of powers, an unrivalled combination of diameters and base curves, but also with different types of materials. Besides, our contact lenses for presbyopia include several additions and three different geometries (EDOF, CD and CN). As a result, we can meet the needs of wearers, thus ensuring perfect visual performance and comfort.

Contact our dedicated technical support team for more information

0800 328 0610 (Monday to Friday, 8.30am – 5.30pm)

mkservices@markennovy.com

References

  1. Rueff EM, Varghese RJ, Brack TM, Downard DE, Bailey MD. A Survey of Presbyopic Contact Lens Wearers in a University Setting. Optom Vis Sci. 2016 Aug;93(8):848-54. doi: 10.1097/OPX.0000000000000881. PMID: 27232896.
  2. Sulley A, Young G, Hunt C. Factors in the success of new contact lens wearers. Cont Lens Anterior Eye. 2017 Feb;40(1):15-24. doi: 10.1016/j.clae.2016.10.002. Epub 2016 Nov 3. PMID: 27818113.
  3. Sulley A, Young G, Hunt C, McCready S, Targett MT, Craven R. Retention Rates in New Contact Lens Wearers. Eye Contact Lens. 2018 Sep;44 Suppl 1:S273-S282. doi: 10.1097/ICL.0000000000000402. PMID: 28617731.
  4. Dumbleton K, Woods CA, Jones LW et al. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens 2013; 39:93-9.
  5. Papas, Eric B. Ph.D.; Decenzo-Verbeten, Teresa O.D.; Fonn, Desmond M.Optom.; Holden, Brien A. Ph.D.; Kollbaum, Pete S. Ph.D.; Situ, Ping M.Sc.; Tan, Jackie Ph.D.; Woods, Craig Ph.D. Utility of Short-Term Evaluation of Presbyopic Contact Lens Performance, Eye & Contact Lens: Science & Clinical Practice: May 2009 – Volume 35 – Issue 3 – p 144-148 doi: 10.1097/ICL.0b013e3181a20361
  6. Subam Basuthkar Sundar Rao, Trefford L. Simpson; Impact of Blur on Suprathreshold Scaling of Ocular Discomfort. Invest. Ophthalmol. Vis. Sci. 2015;56(4):2304-2311. doi: https://doi.org/10.1167/iovs.14-14931.
  7. Maldonado-Codina C, Navascues Cornago M, Read ML, Plowright AJ, Vega J, Orsborn GN, Morgan PB. The association of comfort and vision in soft toric contact lens wear. Cont Lens Anterior Eye. 2021 Aug;44(4):101387. doi: 10.1016/j.clae.2020.11.007. Epub 2020 Dec 9. PMID: 33308907.
  8. Pucker AD, Tichenor AA. A Review of Contact Lens Dropout. Clin Optom (Auckl). 2020 Jun 25;12:85-94. doi: 10.2147/OPTO.S198637. PMID: 32612404; PMCID: PMC7323801.

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August 2022

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Mark’ennovy

mark'ennovy is a custom monthly soft contact lens manufacturer. We believe that you should be able to fit the right lens to every prescription, that’s why we start with the eye’s own unique measurements, and then individually craft a lens to match. Our unrivalled combination of contact lens parameters, geometries, materials, and expert technical advice, is backed by world class manufacturing technology and an exclusive focus on the Eye Care Professional.