C L I N I C A L A N D E X P E R I M E N T A L

OPTOMETRY
EDITORIAL

Why are we still fitting reusable soft contact lenses?

Clin Exp Optom 2014; 97: 386–388 DOI:10.1111/cxo.12170

Nathan Efron PhD DSc in Hungary,3 which every day produces over alternate between various lens combina-
Institute of Health and Biomedical Innovation and 150 million silicone hydrogel daily dispos- tions. Daily disposable lenses are also espe-
School of Optometry and Vision Science, Queensland able lenses in spherical, toric and multifocal cially useful for part-time wear, such as for
University of Technology, Kelvin Grove, Australia
designs. sporting activities. Compliance is easier
E-mail: n.efron@qut.edu.au
Despite the capacity for virtually all because there are fewer instructions to
ametropic contact lens wearers to be fitted remember.
Whether the first daily disposable soft
with daily disposable lenses, an international Daily disposable lenses are convenient for
contact lens to enter the market in 1994 was
survey of contact lens prescribing in 31 travel, as there is no need to carry bulky
the Premier lens (Award Technology, Scot-
markets during 2013 revealed that these lens-care solutions. Packaging of daily dis-
land, UK; subsequently purchased by Bausch
lenses constitute only 31 per cent of fits4 posable lenses has become more compact in
& Lomb, Rochester New York, USA) or the
(38 per cent in Australia4). In some markets, recent times, with a significant advance
1-Day Acuvue lens (Johnson and Johnson
the vast majority of fits are with daily dispos- being the wafer-thin ‘flat pack’ (Miru,
Vision Care, Jacksonville, Florida, USA) has
able lenses; for example, in Denmark, 65 Menicon, Japan), which is 12.5 per cent of
long been a matter of bitter dispute1 but
per cent of all soft lens fits are with daily the thickness and 40 per cent of the volume
whatever the answer, this year marks the 20th
disposable lenses—a value that rises to 87 of a conventional disposable lens pack.5
anniversary of the launch of this modality of
per cent if only daily wear spherical lenses
lens wear.
are considered.4
The concept of daily disposability has
To my way of thinking, the benefits of daily ADVANTAGES FOR PRACTITIONERS
been fully embraced by the contact lens
disposable lenses compared to reusable
industry. All of the major global contact lens There are many advantages of daily dispos-
lenses are overwhelming. This leads to the
companies and many smaller regional com- able lenses over reusable lenses from the
obvious questions—why are we still fitting
panies now manufacture a variety of types of standpoint of the practitioner. Less ‘chair
reusable soft contact lenses? Or considering
daily disposable lenses. They are produced time’ is required for patient education, as
the antithesis—why are we not fitting all
in hydrogel and silicone hydrogel materials virtually no advice needs to be offered con-
contact lens wearers with daily disposable
and are available in spherical, toric and cerning lens care. Less chair time is incurred
lenses? Let me first consider the benefits of
multifocal designs. At the present time in due to unscheduled visits relating to prob-
daily disposable lenses and then I shall
Australia, 25 daily disposable lens products lems with lens care solutions (for example,
return to this question.
are available—19 spherical, four toric and solution-induced corneal staining) or to
two multifocal designs.2 Daily disposable patient non-compliance with the use of lens
lenses are manufactured in a wide range CONVENIENCE FOR LENS WEARERS care systems. Less ancillary staff time is
of parameters; for example, 1-Day Acuvue required because there is no need for discus-
Moist for Astigmatism (Johnson and The convenience that daily disposability sions and sales advice relating to lens care
Johnson Vision Care, Jacksonville, Florida, offers to lens wearers is perhaps the most products. Lens wearers can be supplied with
USA) is available in spherical powers from obvious benefit and does not really need to an initial starter set of five pairs of lenses.
+4.00 to -9.00 D, four cylindrical powers be spelled out to the informed readership of Practitioners can work with contact lens
from -0.75 to -2.25 DC and 10 cylinder axes.2 this journal, but I shall restate the key issues manufacturers to effect timely and efficient
As such, only a tiny minority of potential for completeness. Wearers of daily dispos- lens supply either via the practice or directly
contact lens wearers would have refractive able lenses do not need to concern them- to the lens wearer’s home.
errors that fall outside these currently avail- selves with tedious lens care, as is required
able daily disposable lens parameters. with reusable lenses, notwithstanding the
The fifth largest global contact fact that lens maintenance procedures ENHANCED VISION
lens company—Sauflon Pharmaceuticals have become somewhat simplified with mul-
(Twickenham, United Kingdom)—has tipurpose solutions. The requirements for The early literature showed that with the
recently repositioned its strategic direction possessing and caring for lens cases are obvi- prolonged wear of reusable soft lenses,
by almost exclusively manufacturing daily ated. Daily disposable lenses are easy to deposits such as protein and lipids gradually
disposable lenses.3 This has been achieved by discard (‘any time, any place, without a build on the lens surface despite daily
consolidating all of their daily disposable case’). They are excellent for monovision lens cleaning.6 The greater the extent of
lens manufacturing into a large-scale facility correction of presbyopia, as it is easy to these deposits, the greater is the amount

Clinical and Experimental Optometry 97.5 September 2014 © 2014 The Author
386 Clinical and Experimental Optometry © 2014 Optometrists Association Australia

Such persons explained by cost considerations. The primary outcome of course. ciples underlying hygienic and meticulous Is it true that daily disposable lenses are A study of the environmental impact lens handling and wear. has takes into account all direct costs. In silence. posable lenses in different nations and the tion to an audience: ‘Putting aside the issue posable lenses were introduced in 1994. then vision can be optimised bother fitting reusable soft lenses? reusable lenses.13 However. As well. is a major influence. Of of daily disposability. it is clear that for the majority of valid reason for avoiding fitting of these lenses. which may remain undetected academic eye care centres in the USA. this issue is not specific to 12. unregulated lens supply is of great leagues9 identified cases with symptomatic the model is that daily disposable lenses cost concern in view of the potential for lens corneal infiltrative events in a retrospective. A more recent 2012 lens wearer is compliant with the specified facturing. the wealthier people thing other than daily disposable lenses?’ perhaps were considered to derive what was are in a country. LENSES TO EVERYONE? lens wear—which today is essentially the So what about the increased cost to the longest time for lens wear prior to lens With the clear benefits of lens wearer con. I pose the following ques- products enter the market. DISPELLING OTHER CONCERNS thought to have been confounded by skewed and whether these lenses really are more practitioner prescribing approaches and dis.10 So. I would argue that this is a price worth which limits the extent to which such paying for the sheer convenience. in relation to the number of hold waste and insignificant when compared lens wear is the appearance of corneal times lenses are worn. including supply.of visual degradation. with daily ‘Cost’. They sive when worn fewer days per week. let us consider the vision and superior ocular health of this cost issue from two perspectives—the form of lens wear.5 September 2014 Clinical and Experimental Optometry © 2014 Optometrists Association Australia 387 . A strong I have been espousing the virtues of daily torted consumer demand behaviour that positive correlation has been demonstrated disposibility at practitioner conferences for can arise when new and exciting health between the rate of prescribing of daily dis. Some cite the threat of unregulated lens ‘risk-taking early adopters’ are obviated. those wearing this modality. the same as reusable lenses when lenses are wearers to develop asymptomatic ocular multi-centre case-controlled study at five worn five days per week. expensive than reusable lenses. When daily dis. each to environmental waste generated by major infiltrative events. on average. ease of lens fitting and supply. representing less Perhaps the most sensitive indicator of wearing any specified lens brand each time then 0.11 Given and lead to more serious ocular health prob- reported that reusable soft lenses carried a that 55 per cent of those using daily dispos. pathology. Compared to wearing time. and superior ocular health. they gross domestic product of those nations. cost able lenses is greater than that with reusable ceptible to be non-compliant with the prin. this analysis showed that 55 per cent has occasionally been raised is environmen- eager to try new untested products can be of daily disposable lens prescribing can be tal impact. such as via the internet. Simply put. week. which assumes that the activities/projects. improved OCULAR HEALTH lenses are fitted. the more daily disposable This question is generally met with stony perceived to be the added health benefits of contact lenses are fitted in that country. can you think have adopted a conservative approach and the average personal wealth of individuals of any reason why you might prescribe any- selected difficult or problem patients. lens care solutions and to avoid fitting daily disposable lenses. Well. the additional daily cost by more regular lens replacement. Nevertheless. Often. The model. as a reason demonstrated distinct health advantages the cost of the lenses. although one issue of concern that such a product.8 These factors could more expensive than reusable lenses? This of contact lens wear12 has confirmed that explain the initial counter-intuitive findings question has been tested with the aid of a slightly more waste is generated from usage that daily disposable lenses induced a higher ‘cost-per-wear’ model11 and the results of this of daily disposable lenses compared with rate of adverse reactions than reusable analysis are revealing. civil engineering programs (con- study.12 effects of ‘problem-patient prescribing’ and usage (if reusable lenses are being worn). disposable lenses are generally more cappuccino coffee served up at your local expensive than equivalent reusable lenses. Early controversial reports of adverse ocular broad perception of cost and its impact reactions to daily disposable lenses7 are now on prescribing daily disposable lenses.6 although it is true wear are actually less than for those wearing SO WHY NOT FIT DAILY DISPOSABLE that reduced vision over four weeks of reusable lenses. and are less expen. amount of waste material entering the envi- may have accompanying personality and although other factors are involved in the ronment as a result of wearing daily dispos- behavioural traits that make them more sus. which represent a pro. lens wearers who are fact. lems.10 of cost and assuming that a lens wearer falls were initially available in limited supply The gross domestic product of a nation is a within the available range of parameters of and priced at a premium. lenses. (which can be described as ‘full time’ wear)? reason that if vision decreases with increased radation. it stands to avoidance of lens deposition and visual deg. Thus. in which the potentially confounding schedule of lens replacement and solution structing roads and railways) et cetera. Chalmers and col. This refers to the notion that the considered to be ‘risk takers’. the ‘cost. the amounts we lenses. why I have a simple answer for this. many years. using lenses six or seven days per week with a letter chart. reusable lenses. Practitioners may financial construct that essentially indicates currently available products. minority of daily disposable lens wearers replacement—would be difficult to detect venience. decision to fit daily disposable lenses. café.5 times greater risk of developing such able lenses wear their lenses five or less days daily disposable lenses and therefore is not a events compared with daily disposable per week. professional fees. I hear you shout! incurred as a result of full-time daily dispos- disposability representing the optimum There is a common perception that daily able lens wear is equivalent to the price of a replacement frequency. © 2014 The Author Clinical and Experimental Optometry 97. who in that nation. the costs of lens lenses. such as large-scale manu- inflammatory reaction.5 per cent of average domestic house- an adverse ocular reaction to contact lenses are worn. however.7 per-wear’ model describes the cost of are dealing with are small.

Morgan PB. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. 29: 30–35. Morgan PB. When considered in terms of ‘cost per-wear’. Teufl IM. Environmental impact of three replacement modalities of soft contact lens wear. Dart JK. 96: 250. Woods CA. Clin Exp Optom 2013. 5. 93: 253–260. Carnt N. An international survey of daily disposable contact lens prescribing. 12. Contact Lenses Product Guide. 96: 58–64. Efron N. and in many instances is considerably less. than the cost of reusable lenses. Woods CA. I also believe that it is now time for contact lens practitioners to follow the lead set by our Danish colleagues and fully embrace the concept of daily disposability. Am J Optom Physiol Opt 1988. McNally J. Morgan PB. Optician 2010. 231 (6053): 12. Visual decre- ment with deposit accumulation on HEMA contact lenses. 6. 86: 58–59. 2. Morgan PB. Cont Lens Anterior Eye 2010. Stapleton F. Clinical and Experimental Optometry 97. Verma S. Interna- tional contact lens prescribing in 2013. Mivision 2013. Carnt N. 8. 34: 202–206. Discovering the revolutionary flat-pack contact lens. Ophthalmology 2008. Chalmers RL. Efron SE. I believe that it will not be long before the four major global contact lens companies follow the lead set by Sauflon Pharmaceuticals and gear up their production to exclusively produce daily disposable lenses. 2013. Gellatly KW. Meyler J. 26: 43–46.5 September 2014 © 2014 The Author 388 Clinical and Experimental Optometry © 2014 Optometrists Association Australia . 7. Optician 2006. Willcox M. Brogan R. Clin Exp Optom 2010. Efron N. 13. Keay L. Morgan SL. Stapleton F. Evans V. Contact Lens Spectrum 2014. Australia: Optometrists Association Australia. Radford CF. The world’s first daily dispos- ables. Minassian D. attitudes and level of compliance to lens care. Contact Lens Ant Eye 2003. Cont Lens Anterior Eye 2011. 4. Kell M. Higher risk taking propensity of contact lens wearers is associated with less compliance. Efron N. Optom Vis Sci 2012. Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates. Kern J. Brennan NA. Carlton.CONCLUSION Contact lens practitioners and lens wearers alike derive far more benefit from daily dis- posable lenses than reusable lenses. 11. The International Contact Lens Prescribing Survey Consortium. 89: 316–325. Efron N. 33: 183–188. REFERENCES 1. 10. Grupcheva CN et al. relegating reusable lenses to the annals of history. Contact lens user profile. Wu Y. Keay L. the overall cost of daily disposable lenses to the lens wearer is not that much more. Tranoudis IG. Ruston D. Morgan SL. 9. 65: 937–941. Stapleton F. Erratum: 2013. Efron N. October 1: 22–23. An eye for business. Helland M. A ‘cost-per-wear’ model based on contact lens replacement frequency. 115: 1647–1654. 3.