strategic skill builders
A FREE CONTINUING EDUCATION SERIES
While daily disposables may no
longer conjure up excitement amongst practitioners, they are still considered a
desirable advancement by our patients.
JOSEPH SCHWALLIE, O.D., M.S.
advent of silicone hydrogel contact lens materials and a renewed interest in
extended wear, the excitement surrounding daily disposable contact lenses has
waned in the last few years. Despite this subdued interest, daily disposable
contact lenses are capable of providing many benefits while exceeding patient
expectations. Convenience, comfort, clinical performance, and safety are just a
few of the reasons daily disposable contact lenses should be considered a viable
alternative for our patients. Of course, patient needs will often dictate the
approach we take in prescribing a given contact lens. Knowing the advantages of
daily disposable lenses will allow you to determine if this modality will meet
It's hard to believe, but daily disposable
contact lenses became a reality in the marketplace more than ten years ago.
While most international markets experienced growth in the utilization of daily
disposable lenses, some countries embraced the concept faster than others. An
evaluation of international contact lens prescribing in 2004 showed daily
disposables only comprised 6% of new daily wear fits in the United States,
compared with over 30% in markets like Japan, Norway and the United Kingdom.1
The discrepancy between international markets is likely related to the
preferences and perceptions of not only patients, but also practitioners.
Despite this discrepancy, the daily disposable lens category will continue to
grow in the United States as product lines expand and consumer demand increases.
There are currently three spherical daily disposable lenses available in the
U.S. market, along with a daily disposable bifocal and a daily disposable toric
(see table, page 102).
The primary factor driving the increased use of
daily disposable lenses is convenience. Eliminating the time and effort involved
in cleaning and disinfecting, as well as the need to purchase the products,
simplifies the daily routine for patients. The current availability of daily
disposable lenses makes this modality available to nearly every contact lens
wearer. While every patient will appreciate a simplified lifestyle, the
convenience aspect of daily disposable lenses may be especially appealing to
certain categories of patients.
Children and teens represent a significant
population of patients who are particularly attracted to the convenience of
daily disposables. In addition, these patients represent the largest portion of
new patients in the vision-correction market at 36%.2 Parents are
also attracted to the convenience and safety of daily disposable lenses. Prior
to the introduction of disposable lenses, the fear of losing or tearing a lens
added to the apprehension of parents considering contact lens wear for younger
children. With daily disposables, the level of concern regarding loss or damage
is much lower when the cost of lens replacement is $0.50 per lens, versus $50
per lens. Easy access to lens replacements helps address the issue of lost and
torn lenses as well. Eliminating lens care also appeals to parents. They
appreciate knowing they won't have to rush out to the store to purchase more
contact lens solution when their child tells them at 11:00 p.m. that they ran
In today's practice, it's not uncommon for
children as young as eight years old to present to your office for a contact
lens exam. For these patients, convenience and ease of use are paramount to
success. A study at the Ohio State University's College of Optometry examined
daily disposable lenses in children.3
Results showed eight- to 11-year-old subjects are able to independently care for
daily disposable contact lenses and wear them successfully. The researchers
reported a 90% success rate with subjects who "usually did not have a problem"
or "never had a problem" handling their contact lenses.
Contact lens wearers with certain occupational
and recreational needs are also excellent candidates for daily disposables.
Frequent travelers comment about the ease of traveling with daily disposable
contact lenses because they don't have to pack solutions and spare lenses are
readily available. Contact lens patients who work in environments where there is
a risk of lens contamination are also excellent candidates. For example,
individuals who work at dusty construction sites, fume ridden chemical plants,
smoky restaurants, or even hospitals will appreciate the added aspects of a
cleaner, safer contact lens. It's also great for keratoconus patients who use a
piggyback system to improve comfort and corneal physiology.
A HEALTHY KEY TO COMFORT
The health benefits are a significant element to
the excellent comfort obtained with daily disposable lenses. Lenses that are
replaced every day are cleaner and allow less time for deposits to build-up on
the surface compared with lenses that are replaced less frequently.4
Using a clean lens every day can help patients avoid problems associated with
contact lens deposits, such as contact lens-induced papillary conjunctivitis and
bacterial binding. Daily disposable contact lenses may also offer an improvement
over two-week disposable lenses.
One study showed 82% of patients preferred the
overall comfort of a daily disposable lens when compared with a two-week
The obvious difference between these replacement regimens suggests that comfort
is better when contact lenses are replaced more frequently. Over time, contact
lenses will accumulate a variety of components commonly found in the tear film.
These deposits contribute to lens discomfort, as well as potentially adding to
the risk of inflammatory reactions and infections.
Of course, any lens that is used
more than once requires cleaning and disinfection at the end of each day. The
potential adverse impact of disinfecting solutions on the comfort of contact
lenses cannot be ignored. Several contact lens disinfecting systems have been
associated with corneal staining, palpebral hyperemia, itching and dryness. And,
dryness and discomfort are the most often cited reasons for discontinuation of
contact lens wear. If you suspect a patient is experiencing discomfort or
dryness related to solution sensitivity, the simplest resolution may be
eliminating the solutions altogether.
Another common cause of discomfort associated
with contact lens wear is allergies. Research shows that 20% to 30% of the U.S.
population suffers from some form of allergic eye disease. One study evaluated
patients with seasonal allergic conjunctivitis wearing either daily disposable
contact lenses or a new supply of their habitual contact lenses.7
Patients who wore the daily disposable lenses had fewer total symptoms of
seasonal allergic conjunctivitis compared with patients who wore their habitual
lenses. Another study showed certain allergy eyedrops used concomitantly with
daily disposable contact lenses may be beneficial and prevent chronic absorption
of the medication or its preservative.8
The authors concluded that use of Livostin with daily disposable contact lenses
is safe and associated with minimal symptoms. While eliminating the allergen is
the only true way to avoid allergic conjunctivitis, recommending a contact lens
option to increase patient satisfaction will benefit not only the patient, but
also your practice.
rates among a variety of lens replacement schedules.
Studies suggest that even though 75% of soft
contact lenses are prescribed for a replacement schedule of less than two weeks,
only 25% of patients adhere to that schedule.9 One-fourth of patients
stretch the replacement schedule to one month and 23% to as long as six months.
Another study showed 53% of patients replace their lenses less frequently that
Many practitioners find that, among all types of lens wear, daily disposable
wearers had the highest level of patient compliance. Some studies report this to
be as high as 93%.11 The chart above shows compliance rates with
replacement schedules for daily disposable, continuous wear and two-week
It also shows compliance rates with cleaning and disinfection systems, as well
as patient compliance with changing their contact lens case at least once a
year. While cleaning, disinfection and case replacement may not be an issue with
single use lenses, it may compound the issue of non-compliance with two-week
disposables and other multi-use lenses.
Part of the high level of compliance with daily
disposable lenses may stem from this fact: Patients select daily disposable
lenses for the convenience of not having to clean them. Purchasing the lenses
for their added convenience, and then avoiding compliance by cleaning and
re-using the lenses doesn't make sense. Of course, some wearers will undoubtedly
try to wear their lenses beyond one day. In this instance, it's quite possible
that lens performance may suffer. According to CIBA Vision, patients tempted to
re-use their Focus Dailies lens will experience about a 25% reduction in comfort
with each successive day of use.
Inflammatory conditions such as contact lens
induced papillary conjunctivitis, limbal hyperemia, and moderate-to-severe
corneal staining are just a few of the potential complications associated with
non-compliance to the recommended replacement schedule. Lenses worn past their
recommended replacement schedule risk accumulating a greater amount of tear
components such as albumin, lysozyme and lactoferrin, which increase bacterial
adhesion of certain strains of Staphylococcus and
Pseudomonas to the surface of a contact lens, potentially increasing the
risk of microbial keratitis.13-16
cost of daily disposable lenses compared with other
Discussion about daily disposable contact lenses
wouldn't be complete without touching on the sensitive issue of cost. Despite
the benefits of daily disposable lenses, many patients, as well as
practitioners, eliminate them as a potential option because the preconceived
notion is that they are too expensive. Undoubtedly, there will be some patients
who will be taken aback by the annual cost associated with daily disposable
contact lenses. However, these patients may be equally surprised to learn how
much they are already spending on their contact lenses and solutions. The simple
answer to the question, "Do daily disposables cost more than my current two-week
disposable lenses?" is yes. But a more appropriate answer that provides
direction is, "Yes, but would you like to know the difference in cost and give
the lenses a test drive before you decide?" If the patient answers "No," you can
move along and complete your exam. If the answer is "Yes," then you can proceed
with further explanation. Show-ing concrete examples of annual price comparisons
is often helpful, including the cost of solutions as well as lenses. The chart
on the right shows a relative comparison of the annual cost of various contact
lens modalities and their accompanying solutions.17 Some
practitioners also find value in offering cost comparisons relative to a cup of
coffee, owning a cell phone, or adding premium options to their eyeglasses.
As practitioners, we must put
aside our tendencies to pre-judge the affordability of daily disposable lenses
for a given patient. As noted above, some patients will have absolutely no
interest in paying one cent more for their contact lenses, especially if they
are non-compliant with their current replacement schedule. All too often it's
not until I show patients how much they are paying for their current two-week
disposable lenses that they blurt out, "Oh, I don't spend that much on contact
lenses because I only replace them every other month." Of course, this opens up
a whole new can of worms, but it's the kind of truthful information that allows
us to make recommendations based on the best medical interest of the patient.
Much like any aspect of a practice, success is
highly dependent upon your commitment, enthusiasm and willingness to inform and
educate patients about daily disposable lenses. Most experts agree that the best
way to do this is to offer them a small supply of diagnostic lenses.
Offering the option of daily disposable contact
lenses to every patient who qualifies helps us address their needs. As a primary
care practitioner, if you feel a daily disposable contact lens is the best
option for your patient, it is your duty to recommend it.
1. Morgan PB, et al. International Contact Lens
Prescribing in 2004. CL Spectrum. 2005 Jan; 20(1):34-37.
2. Barr JT. 2004 Annual Report. CL Spectrum. 2005
3. Walline J, Long S, Zadnik K. Daily Disposable
Contact Lens Wear in Myopic Children. Optom and Vis Sc. 2004 Apr; 81(4):255-259.
4. Curtis W. Continuous Wear or Daily
Disposables: What's Best For Your Pa-tients. CL Spectrum. 2002 Aug; 17(8):
5. Sindt C. Daily Disposable Versus Two-Week
Disposable Lenses. CL Spectrum; 2000 May; 15(5),33-36.
6. Dillehay SM, et al. A Comparison of
Multi-purpose Care Systems. CL Spectrum. 2002 Apr; 17(4):30-35.
7. Stiegmeier MJ, Thomas S. Seasonal Allergy
Relief with Daily Disposable Lenses. CL Spectrum. 2001 Apr; 16(4):24-28.
8. Kirstein MD, et al. Topical Antihis-tamine
Proven Safe in Single-use Lens Wear. CL Spectrum. 2001 Jun; 16(6):40-42.
9. Collins MJ, Carney L.G. Compliance with Care
and Maintenance Procedures Amongst Contact Lens Wear-ers. J Optom Asso of
Australia. 1986; 69:166-199.
10. Claydon BE, Efron N. Non-compliance in
contact lens wear. Ophthalmic Physiol Opt 1994 April; 14(4):356-64.
11. Ky W, Scherick K., Stenson S. Clinical Survey
of Lens Care in Contact Lens Patients. CLAO. 1998 October; 24(4):216-219.
12. Dillehay S, et al. Patient Experience and
Management in HDK Silicone Hydro-gel Soft Contact Lenses.
www.siliconehydrogels.org. Posters. April 2004.
13. Nichols KK, et al. Corneal Staining in
Hydrogel Lens Wearers. Optom Vis Sci. 2002 Jan; 79(1):20-30.
14. Langis M, Giasson CJ. Overwear of Contact
Lenses: Increased Severity of Clinical Signs as a Function of Protein
Ab-sorption. Optom Vis Sci. 2002 March; 79(3):184-192.
15. Choo J, et al. Bacterial Populations on
Silicone Hydrogel and Hydrogel Con-tact Lenses after Swimming in a Chlori-nated
Pool. Optom Vis Sci. 2005 Feb; 82(2):134-137.
16. Miller MJ, et al. Effects of Protein, Mucin
and Human Tears on Adherence of Pseudomonas aeruginosa to Hydrophilic Contact
Lenses. J Clinical Microbiol. 1998 Jan; 26(3):513-517.
17. Mai-Le K, Caroline P. The Cost of Lens Care
Vs. Daily Disposable Contact Lenses. CL Spectrum. 2001 Jul; 16(7):25-27.
CURRENTLY MARKETED DAILY DISPOSABLE CONTACT LENSES
CIBA Focus Dailies
PVA/69% Water Content (nelfilcon A)
Base curve: 8.6mm
Sphere Power: -0.50D to
-10.00D and +0.50D to +6.00D
CIBA Focus Dailies Toric
PVA/69% Water Content (nelfilcon A)
Base curve: 8.6mm
Sphere Power: +4.00D to
-8.00D, including plano
Cylinder Power: -0.75D
Axes: 90 and 180
CIBA Focus Dailies Progressive
PVA/69% Water Content (hilafilcon A)
Base curve: 8.6mm
Power: -6.00D to +5.00D
Add: Aspheric center near
progressive add up to 3.00
Bausch & Lomb SofLens One Day
HEMA/70% Water Content (hilafilcon A)
Base curve: 8.6mm
Sphere Power: -9.00D to
-0.25D and +0.25D to +6.50D
Vistakon 1-Day Acuvue
HEMA/MA/58% Water Content (etafilcon A)
Base curve: 8.5mm, 9.0mm
Sphere Power: -0.50D to
-12.00D and +0.50D to +6.00D
Optometric Management, Issue: September 2005