Use of silicone hydrogel contact lenses by Australian optometrists

Background: Prior to the launch of silcone hydrogel (Si-H) materials in Australia in 1999, only 1.6 per cent of lenses were prescribed on a continuous wear basis.

Methods: One thousand surveys were distributed randomly to practitioners in Australia during January 2000, 2001 and 2002 (total surveys 3,000). Each anonymous survey requested data about the next 10 patients fitted with contact lenses, including date, age, gender, new fitting or refitting, lens material type, lens design, frequency of replacement, modality of wear, uses per week and care regimen.

Results: Twenty per cent (599) were returned, reporting data on 5,976 fittings. A total of 710 fittings used Si-H contact lenses (11.9 per cent), which represented 18.6 per cent of all soft lens fittings. During the three years, the proportion of practitioners prescribing Si-H lenses increased from 42.2 to 52.5 per cent. In 2000, 43.8 per cent were daily wear, which decreased to 32.2 per cent by 2002. The solution system of choice for daily wear lenses was multipurpose solutions (98.4 per cent); the only alternative was hydrogen peroxide systems. Continuous wear represented 11.7 per cent of all fittings, ofwhich 85.7 per cent were Si-H, 3.0 per cent RGP lenses and 11.3 per cent conventional hydrogels. For continuous wear, 79.0 per cent of fittings were to existing wearers, whereas for daily wear, 59.4 per cent were existing wearers. More males were prescribed Si-H continuous wear contact lenses, while females were more likely to be prescribed Si-H on a daily wear basis.

Discussion: Si-H contact lenses were introduced to the Australian market as a continuous wear contact lens, yet many practitioners use this product for daily wear with multipurpose solutions. By 2002, more practitioners were prescribing Si-H contact lenses for continuous wear than in 2000, suggesting a growing confidence in that product for that mode of wear. A comparison with an earlier survey shows there is an increase in continuous wear from 1.6 per cent to 11.7 per cent over a five-year period.

The parameter stability of a high dk rigid lens material

The use of rigid materials with high oxygen permeability (Dk) is on the increase, their major benefit being the reduction of hypoxia. However, there is a reluctance to use these materials possibly due to increased surface scratching, reduced wettability, increased deposition, reduced life expectancy and parameter instability. Considering parameter stability, various studies have demonstrated contradictory results or used high Dk materials based on the silicone acrylate polymer. This study was designed to investigate whether the parameters of a high Dk rigid fluorocarbon contact lens material changed during daily wear and extended wear schedules. Thirty five subjects, divided into group groups, Group I wore the lens on a daily wear basis, whereas those in Group II wore the lens on a monthly extended wear basis. The parameters and integrity of the lenses were monitored in both groups every 3 months. For lens integrity a statistically significant increase in surface scratching was demonstrated for the lenses worn by the subjects of both groups over the time of the study (Group I, F=7.990, P <0.0001 [ANCOVA]; Group II, F=6.241, P=0.003 [ANCOVA]). The only parameter to show a statistically significant variation over the study period was that of centre thickness for the lenses worn by the subjects in Group I (F=3.976, P=0.0063 [ANCOVA]), with a mean reduction in centre thickness of 0.022 mm at the 12 month visit.

No change was noted for either group or between groups for the other parameters measured. This study demonstrates that the parameters of rigid contact lenses manufactured from high Dk fluorocarbons are stable with only a non-clinically significant reduction in centre thickness for the contact lenses worn by the subjects in Group I.

Measurement of the refractive index of soft contact lenses during wear

Purpose: To determine whether the refractive index (RI) of a soft contact lens can be evaluated using refractometry while the lens remains on the eye and to compare this with more traditional ex vivo RI measurements.

Methods: A slitlamp apparatus was modified to incorporate a customized Atago hand refractometer. With a double-masked study design, nine adapted symptomatic soft contact lens wearers wore a contact lens in each eye (lotrafilcon B and etafilcon A) in a randomized order. In vivo RI was determined from the relative Brix scale measurements immediately after lens insertion and after 1 and 10 hr of lens wear. Ex vivo refractometry was performed after 10 hr of lens wear for comparison. Means ± standard errors of the means are reported.

Results: In vivo RI values at baseline were 1.422 ± 0.0004 (lotrafilcon B) and 1.405 ± 0.0021 (etafilcon A); after 1 hr of lens wear, values were 1.423 ± 0.0006 and 1.408 ± 0.0007, respectively; and after 10 hr of lens wear, values were 1.424 ± 0.0004 and 1.411 ± 0.0010, respectively. Ex vivo RI values at the end of the 10 hr wearing period were 1.424 ± 0.0003 (lotrafilcon B) and 1.412 ± 0.0017 (etafilcon A). The change in in vivo RI across the day was statistically significant for the etafilcon A lens (repeated-measures analysis of variance, P<0.01) but not for the lotrafilcon B lens (P>0.05).

Conclusions: This novel adaptation of refractometry was able to measure the RI of soft contact lenses during wear (without lens removal). End of day RI measurements using in vivo and ex vivo refractometry were comparable with each other. Future work is required to determine whether this in vivo method can improve our understanding of the relationships between soft contact lens RI, hydration, on-eye lens performance, and symptomology.

Correction of presbyopia with GP contact lenses

Presbyopia can be safely and effectively corrected with gas permeable (GP) multifocal (bifocal) contact lenses, but statistics indicate that they remain the most underutilized contact lenses on the market. We believe that practitioners have been “turned off of” GP multifocals due to their experiences with older generations of these lenses, which tended to be difficult to fit, with poor visual results.

Fortunately, GP multifocals have come a long way, and practitioners who avoid fitting them are missing out on an important niche market. With this booklet, we hope to show you just how far GP multifocals have come and demonstrate the ease with which they can now be fit and managed.