Three ODs divulge their by-far biggest challenges with keeping patients in contacts—and reveal their smartest strategies for addressing them

while new technologies are keeping patients in contacts longer, ECPs report there are still some problem areas. We spoke with three optometrists to find out about key fitting challenges—and, more important, how they overcome them.

PROBLEM: Gen X’s Discomfort

Jason Miller, O.D., MBA, FAAO, is a faculty member at Ohio State University and practices at EyeCare Professionals of Powell in Powell, OH.

Increasing challenges, he says, “are visual fatigue and contact lens-related discomfort among emerging presbyopes (ages 38-42). Many are long-time wearers suffering from intermittent blurred vision or heavy users of multiple monitors and devices, causing them to wear spectacles more and contact lenses less.”

SOLUTION: Daily Disposables + Low-Add Multifocals

The solution, he says, “starts with looking for underlying ocular surface disease. If the patient has any signs, treat that condition first, then focus on the best contact lens solution.

“For emerging presbyopes, that is often a one-day disposable and/or a one-day disposable low-add multifocal lens. Be proactive and discuss why their symptoms are occurring, and offer the newest contact lens technology like the Biotrue ONEday for Presbyopia, 1-Day Acuvue Moist Multifocal, and DAILIES Total 1 Multifocal.

“Many wearers started in contacts when the soft lens market was exploding in the ’80s. These patients are turning presbyopic now and don’t want to stop wearing contacts. This represents a big opportunity to keep them happy—and visually healthy—contact lens wearers way into presbyopia.

“Another plus? The newer one-day disposable multifocal contact lens options often have less chair time as well as improved fitting success. It’s a win-win,” he adds.

PROBLEM: Keeping Boomers in Contacts

Christopher Lievens, O.D., MS, FAAO, is a professor and chief of staff for The Eye Center at Southern College of Optometry in Memphis, TN. The biggest problem he sees—and one he has experienced himself—is keeping presbyopes in contacts.

“I still remember the very first fit set I received for soft multifocal contact lenses (circa Y2K),” says Dr. Lievens. “It did not fare well in our practice.”

SOLUTION: From Monovision to Binocularity

“Fortunately for me, as a multifocal patient and prescriber, optics and materials have improved for some designs so that, as long as we don’t include astigmatism, presbyopic patient successes far outweigh failures.

“Most, if not all, ECPs now promote binocularity, though this flies in the face of what we did by prescribing monovision for years. When given the choice, most prescribers prefer patients use both eyes for all distances. This is now possible, and I now fit mostly daily disposables for presbyopes—the DAILIES AquaComfort Plus Multifocal and, most recently, the DAILIES Total One Multifocal.

“The story wouldn’t be worth telling, however, if there wasn’t a demand,” he adds. “The year 2014 was dubbed the ‘Year of the Boomer’ as the youngest baby boomer turned 50 (and presbyopic). Baby boomers control 70% of all disposable income, and when you combine purchasing power with the desire to stay and feel young, the result is that we have a massive opportunity.”

PROBLEM: Managing Dry Eye

Chet Steinmetz, O.D., is owner of Visual Effects Optical, a high-end practice in the Lincoln Park section of Chicago. “The most common reason for contact lens dropout I see now is dry eye,” he says. “When patients learn that wearing contacts will make their eyes uncomfortable—or they can’t be worn as long as desired—the lenses are put away.

“We can fix most of those issues with better plastics, single-use product, and managed expectations. However, not all patients—especially ones with dryer eyes—are willing to fix these things.”

SOLUTION: Increasing Comfort + Comfort Levels

“Though my practice is retail oriented and doesn’t take insurance, I am getting set up for better dry eye therapy. It will be interesting to find out how much of a difference it will make in a patient’s desire to wear their contacts after a round of dry eye treatment,” Dr. Steinmetz says.

“The bottom line, however, is that it’s not one issue like dry eye or one particular product. It’s about creating realistic expectations. Some people just give up because contact lenses are a bother and are easy to remove from the routine of their busy day.”

—Stephanie K. De Long