UPGRADING
TO SILICONE HYDROGELS
Upgrading Patients To Silicone Hydrogels
Concerns for ocular health and comfort are
leading these contact lens professionals to reevaluate their hydrogel wearers. See
why you should, too.
Dr.
Quinn: I'm interested to hear about your experiences with silicone hydrogel materials.
Do you keep your current hydrogel wearers in these lenses, or do you transition
them into the newer materials?
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Dr. Hom
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Dr. Hom: I feel very strongly that silicone hydrogels
are the wave of the future and a great first choice for contact lenses. I'm refitting
about half of my hydrogel-wearing patients with silicone hydrogels.
Dr. Miller: I'm transitioning as many hydrogel patients as possible to silicone hydrogels because of the health benefits.
While my patients are cost-sensitive, they also appreciate value. When I explain
the health and comfort advantages of newer silicone hydrogel materials, much of
their opposition to the higher cost goes away.
Dr. Lapple: I'm not refitting patients
as frequently as I was when silicone hydrogels were first introduced — partly
because of the cost but also because some of my patients didn't like the lenses
very much. Today, with the second-generation materials, I'm switching about 30%
of my asymptomatic hydrogel patients to silicone hydrogels because I feel it's the
right thing to do. I'm finding that patients like these newer materials better,
as well.
Laurie L. Sorrenson, OD: I mention
silicone hydrogels to every one of my contact lens patients. About 90% of my hydrogel
wearers receive a trial pair of silicone hydrogels when they come in for an examination,
and 70% to 90% continue with them.
Patients
have seen these lenses advertised on TV, and if I don't offer them the latest and
greatest, they'll think I'm not up-to-date on new treatments and technologies.
Dr. Kaminski: We need to tell
patients about the newest and best contact lenses available, so I'm very proactive.
In my practice, we've probably switched 75% to 85% of current hydrogel wearers to
silicone hydrogels.
When I have frank discussions with
my patients, I often find out they're not compliant, and many aren't very happy
in their current contact lenses. Silicone hydrogels have been a great problem-solving
tool for these patients. Also, we want our aging patient population in a better
contact lens for wetting and oxygen delivery.
ARE THERE 'MUST-SWITCH' PATIENTS?
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Dr.
Kaminski |
Dr. Quinn: Our decision
to switch a patient to silicone hydrogel contact lenses always will be based on
individual assessments, but sometimes the decision is quite simple. Dr. Lapple,
what's your experience?
Dr. Lapple: If a patient has
a symptom or a sign of hypoxia, the decision is easy. I switch him to silicone hydrogels.
I also switch my continuous-wear patients.
Lens power may be a determining factor
as well. For example, I'll always switch a hyperopic patient because he needs the
extra oxygen through that thick lens.
Comfort is another more subjective
reason to switch to silicone hydrogels. We may be able to alleviate some ocular
fatigue or redness with these lenses.
Dr. Miller: I would add teenagers to
that list. I switch them to silicone hydrogels because, in my experience, they're
more likely to be noncompliant. Even their parents don't know whether they're sleeping
in their contact lenses or wearing them too long, so I like that extra safety net.
And teenagers have many years of contact lens wear ahead of them, so the health
benefits and compliance
issues are important.
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Laurie L. Sorrenson, OD
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Dr. Sorrenson: All my hyperopes automatically
get silicone hydrogels. In fact, hyperopes are some of my most enthusiastic silicone
hydrogel wearers — the higher the plus power, the more they love them.
Cosmetically, limbal hyperemia is a
big issue, particularly for women. If a patient is complaining that her eyes look
red and unattractive, which is a significant percentage of patients in my practice,
we try silicone hydrogels.
Dr. Szczotka-Flynn: Patients whose
lifestyles often put them in "extreme" situations that stress their eyes and their
contact lenses — such as frequent fliers — are good candidates for silicone hydrogels. These lenses are an obvious choice for patients who want extended-wear
or continuous-wear contact lenses. I also consider silicone hydrogels for anyone
who has a corneal condition, such as Fuchs' dystrophy or a corneal transplant.
Dr. Kaminski: Let's not forget that
some of the fastest growing age groups of contact lens wearers are people who are
between 45 and 65 years old. We need to be on the lookout for signs of aging, such
as striae, indicating a need for more oxygen flow to the cornea. Typically, I switch
these patients to silicone hydrogels, which provide a better comfort level for both
of us.
Dr. Sorrenson: If possible, every
contact lens patient in my practice gets silicone hydrogels. Most have at least
some limbal hyperemia, so I always try them. They're not a magic cure, but silicone
hydrogels definitely help these patients.
NOT FOR EVERYONE
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Dr. Szczotka-Flynn |
Dr. Quinn: Let's take the
opposite point of view. Even Dr. Sorrenson, who's trying silicone hydrogels on 90%
of her patients, doesn't try them on everyone. Economic issues aside, which
patients do you keep in hydrogel materials?
Dr. Kaminski: In my practice,
only the patients whose parameters are not available in silicone hydrogels continue
with their hydrogel lenses.
Dr. Lapple: I have patients doing very
well in daily disposables. I'm not inclined to switch them.
Dr. Sorrenson: I agree.
They're usually in daily disposables for a really good reason. Maybe they are heavy
depositors or they had giant papillary conjunctivitis or allergy issues. One-day
disposables are problem-solvers for me, so it would be a rare occasion when I would
prescribe something else for these patients.
Dr. Lapple: If I have a potential
dry eye patient who is asymptomatic in hydrogels — for example, someone who
is 40 to 50 years old who wears hydrogels 15 hours a day and loves them — I
don't try to switch them. Of course, these patients are rare.
Dr.
Kaminski: We also need to think about patients — particularly women —
who try silicone hydrogels for comfort, and then experience lipid deposits. Sometimes,
they return to the hydrogel lens material.
By the way, my partner and I
seem to be seeing more lipid deposits in female patients. I don't know whether it's
cosmetics or cosmetic interaction, but we've seen an anecdotal trend in our practice.
Has anyone else observed this?
Dr. Szczotka-Flynn: What you're seeing
may not be so much the female tear film as it is external factors like makeup and
moisturizer. Silicone hydrogels deposit more lipids and less protein, and it's easy
to see how something like moisturizer could contribute to a lipid-based problem.
Dr. Hom: I think of deposits as two
different types: symptomatic and asymptomatic. You can almost predict which silicone hydrogel patients are going to have deposits. They're the ones with asymptomatic
deposits with hydrogel contact lenses. In my experience, these same patients often
show a lot of debris upon specular reflection of the prelens tear layer. It may
not create symptomatic deposits on hydrogel contact lenses, but it can coat a silicone
hydrogel.
ASYMPTOMATIC RESPONSE FACTOR
Dr. Quinn: Aside from a
patient's symptoms or diagnosis, we need to look at issues related to physiological
response that may not manifest symptomatically. How do you factor in the health
benefits of silicone hydrogels for patients who have no symptoms from their hydrogel
contact lenses?
Dr. Hom: We all have patients
who are comfortable in hydrogels, and I believe comfort is very important. But comfort
can keep us from seeing some problems. Some very comfortable patients can have ocular
surface damage, corneal staining or conjunctival staining. So just
because a
contact lens is comfortable, that doesn't necessarily mean it's the best contact
lens for the patient.
Dr. Szczotka-Flynn: We need to consider
why we should be monitoring patients for corneal staining. My colleagues and I presented
a poster at the 2006 meeting of the Association for Research in Vision and Ophthalmology
(ARVO) describing a study of 30-day continuous wear of silicone hydrogels.1
We found that patients with corneal staining had a significantly greater risk of
developing a corneal infiltrate. Another group out of Sydney found an almost identical
finding among daily contact lens wearers with solution toxicity staining.2
It doesn't really matter what's causing the staining, but two independent groups
found that staining can be associated with future adverse events.
Dr. Miller: Given the possibility for
noncompliance — a large percentage of patients will wear their lenses while
sleeping, no matter what we tell them — I feel good knowing I'm giving them
the best oxygen transmissibility available.
REFERENCES
1. Szczotka-Flynn LB, Debanne S, Cheruvu V, et
al. Predictive Factors for Corneal Infiltrates With Lotrafilcon A Silicone Hydrogel
Lenses Worn for up to 30 Nights Continuous Wear. Poster presented at ARVO 2006.
Ft. Lauderdale, FL.
2. Jalbert I, Carnt N, Naduvilath T,
Papas E. The Relationship Between Solution Toxicity, Corneal Inflammation and Ocular
Comfort in Soft Contact Lens Daily Wear. Poster presented at ARVO 2006. Ft. Lauderdale,
FL.
Contact Lens Spectrum, Issue: September 2006