Welcome to the next era in contact lenses. We�re entering this millennium equipped with options that will help us deliver better care than we ever could before � and that, of course, means new possibilities for our practices and better outcomes for our patients.

Throughout the past year, contact lens manufacturers have introduced some exciting new solutions for presbyopes and they�re making it easier for practitioners to fit astigmats. Many of your patients will also be happy to learn about the new daily disposables or 7-day extended wear lenses. In this article I�ll also tell you about the newest spherical and aspheric designs, as well as provide the latest information regarding tinted lenses for fashion or sport.

The latest contact lens technology can help you to reach new heights. The key to success is staying up to date so that you can present these cutting-edge products to your patients. Read on to gather the information you�ll need to take your practice to the next level.

Options for presbyopes

As you would expect, some of the most notable developments in eye care during the first decade of this millennium will be an attempt to meet the needs of the aging baby boomer population. And that means more opportunity for us, especially as current contact lens wearers look to you for solutions to meet their changing needs.

Vistakon officials say, "According to a recent survey, before the launch of the Acuvue Bifocal contact lens, almost 66 percent of doctors interviewed had an unfavorable opinion of soft bifocal contact lenses for the correction of presbyopia. Currently, however, 95% of doctors have a favorable opinion of soft bifocal contact lenses."

Tom Steiner, Vice President of Marketing at Wesley Jessen, seems to agree. In his opinion, "The soft bifocal will be the most significant, largest growth category in contact lenses over the next 5 years."

It�s no wonder the major players are trying to capture this vibrant new sector of the market. Here�s what�s new:

• Vistakon. Special handling features and a strong advertising campaign have made Vistakon�s Acuvue Bifocal very popular with the over-40 crowd. The company says the number of new fits of soft bifocal contact lenses has increased by 285% during the product�s first 12 months in the market. Furthermore, reports suggest that 75% of people who have tried this lens are pleased with it.
  The Acuvue Bifocal is a concentric ring, distance-center, simultaneous vision lens. It uses a patented "Pupil Intelligent" design made up of five invisible viewing rings or "zones" alternating near and far correction. This helps presbyopes see near and far under varying light conditions. The lens also allows for zone-to-zone transitions designed to minimize halos and blur.
• CIBA Vision. Focus Progressives have also been launched recently. CIBA says these soft lenses deliver excellent near vision without compromising intermediate and distance acuity.
  Focus Progressives concentrate a high amount of near power in a small central area, allowing space for an expanded peripheral distance zone. Also, the single progressive add design reduces fitting variables. Only the distance power needs to be specified.
• Wesley Jessen. The FreshLook Progressive Bifocal is expected to roll out in the first quarter of 2000. It�s a disposable, 2-week replacement lens that will be sold in six-packs. This lens has a center near, simultaneous vision design with a distinct intermediate zone.
  Initially, FreshLook Progressive Bifocals will be available in three adds in +2D to -4D, but the company plans to expand the parameters quickly.
• Cooper Vision. CooperVision is working toward launching a bifocal lens near the end of 2000. Details aren�t yet available on the design.

Obviously, the need for these specialty lenses does, and will continue to, exist. Now it�s up to us to become more comfortable fitting them. Fortunately, each of these manufacturers has a support program to assist fitters.

Fitting more astigmats

Of course, the need for toric contacts always exists, which is why manufacturers are designing more lenses with wider parameters and more of the options previously available only to non-astigmats.

Here are some of the latest developments:

• Bausch & Lomb�s SofLens 66 Toric is now available in three cylinder powers (�0.75, �1.25, �1.75) around the clock in 10� increments.
• CIBA Vision�s Focus Toric is a disposable lens that�s now available all the way up to �2.50 cylinder, with full circle axis in 10� increments.
• CooperVision introduced the Preference Toric XR, an extension of its Preference Toric quarterly planned replacement lens. Parameters are now: daily wear; 14.4 diameter; base curve 8.7 and 8.4; sphere power +6.00D to �9.50D (�0.50D steps after �6.50D); cylinder power �0.75 to �2.25 in 0.50D steps and �2.75 to �9.75 in  �0.25D steps.
• CooperVision has also extended its Frequency 55 Toric lenses for monthly planned replacement wear. The parameter range now includes sphere powers ranging from +6.00 to �8.00.
• Sunsoft�s Multiples quarterly planned replacement lenses now go up to 6D of astigmatism and are available in a range of +6 to �8 sphere.
• Sunsoft�s Toric 15.0 is available in sphere powers from +10 to �20 and astigmatism of up to 7D in any axis.
• Vistakon�s highly anticipated Acuvue Toric Disposable contact lens is expected to be released soon.
• Wesley Jessen has entered the quarterly planned replacement toric segment with both color and clear toric contact lenses to correct astigmatism. OptiFit ColorBlends combines the 3-in-1 color technology of Wesley Jessen�s FreshLook ColorBlends spherical disposables with the lens design of its OptiFit Torics. OptiFit UV is a clear lens that contains an ultraviolet (UV) ray absorber. Both lenses are approved for flexible wear. A full range of parameters is available, including cylinder powers to �5.75D, spherical powers from +4.00D to �8.00D with around-the-clock axes. Colors include gray, blue, green and brown.

Replacement schedules

Isn�t it great that we now have the freedom to prescribe contact lenses that fit the busy patient�s lifestyle? When you offer them to patients, they feel that you�re offering them a solution � and that will bring you many referrals.

Of course, I�m talking about the surge of daily disposables and the introduction of 7-day extended wear lenses.

Three lenses in the new and increasingly successful category of daily disposables are Vistakon�s 1-Day Acuvue, CIBA Vision�s Focus Dailies, and Bausch & Lomb�s SofLens One Day. Wesley Jessen and Ocular Sciences may also be introducing a 1-day lens later this year.

I�ve found that many patients are willing to pay $1 per day for the convenience of always having a fresh lens without the trouble of cleaning. And the available parameters of these lenses continue to expand.

On the extended wear front, the high oxygen transmission of the new High-Dk hydrogel lenses should reduce complications associated with extended wear, making 7-day � or possibly even 30-day wear � a healthy and convenient option for your patients.

In March 1999, Bausch & Lomb�s PureVision became available in the United States for 7 days of extended wear. The company has approval to market the lens for 30 days of continuous wear in Europe and is hopeful about obtaining it in the United States.

PureVision is made of a silicone hydrogel lens material (balafilcon A) with AerGel technology. The consistently wettable lens has a water content of 36% and a Dk/t of 110. Currently, it�s available in one base curve with powers ranging from �0.50D to �9.00D.

CIBA Vision is also expected to offer extended wear. The company�s lens, Focus Night and Day, uses a fluorosiloxane hydrogel material (lotrafilcon A) that has a water content of 24% and a Dk/t of 175. Although Focus Night & Day lenses are currently approved for up to 7 days of wear, CIBA Vision has decided to delay its United States launch until receiving the 30-day approval that it now has in Europe.

New soft spherical

When Vistakon�s new soft spherical contact lens, Acuvue 2, debuted this summer, it created quite a splash. The lens has a contour intelligent design that incorporates a reduced edge height with an enhanced mid-peripheral zone for added comfort and handling. The new design makes the lens virtually invisible on the eye and reduces the adjustment period for new lens wearers.

Acuvue 2 is available in 1-week disposable extended wear and daily wear 2-week replacement modalities. Additional product features include UV blocking, a visibility tint and a "1-2-3" inside-out mark that will make lens insertion easier for your patients.

Vistakon officials say the new Acuvue 2 is not intended to be a replacement for the original Acuvue and Surevue lenses, and they don�t have any plans to phase them out.

Aspheric design

CooperVision recently launched the Frequency 55 Aspheric lens. This lens is intended to help wearers who perform activities that require precise vision � such as night driving and number crunching. The Frequency 55 Aspheric is also a good lens for emerging presbyopes and patients who have low levels of astigmatism. It improves contrast sensitivity and depth perception for better anticipation and response � even in low light conditions.

The Frequency 55 Aspheric lens features aberration-blocking (AB) technology to ensure comfort and crisp visual acuity. The basis for AB technology is a series of curves that reflects light to a centralized point.

Tinted lenses

In 1999, Wesley Jessen added substantially to the tinted lens market, and we can expect more of the same in 2000. It debuted two new ColorBlends shades (honey and turquoise) just this month.

The company has already released OptiFit ColorBlends, a quarterly replacement toric lens to correct astigmatism and expects to extend the ColorBlends technology to other specialty lenses over the next 12 months.

Plans for this year include bifocal, disposable toric and the DuraSoft Colors conventional color lens lines (for consumers who can�t be fitted with FreshLook disposables) becoming available in ColorBlends.

Wesley Jessen is also gearing up to launch a new category of conventional, tinted soft lenses for sports vision called ProSoft. The company is currently awaiting FDA approval, but it estimates a first quarter launch for it�s debut of a lens specially designed to maximize vision for tennis players.

The company has licensed Bolle�s Competivision tint, which neutralizes all colors in the spectrum other than optic yellow, which is the color of tennis balls. The new lens should make seeing the tennis ball easier. Wesley Jessen expects to roll out a lens for golfers next, with others planned not much further down the road.

Additionally, the continued popularity of WildEyes novelty lenses has led to more designs and expanded parameters.

It pays to share what you know

Now that you know what�s available, you can kick-start the new year by presenting these options to your patients. They�ll be thrilled that you care enough to offer them the best, and they�ll be impressed with your vast knowledge of contact lens fitting options. And those satisfied patients will generate new referrals for your practice.

Consider this: Next year, your happy contact lens patient may become your laser vision correction patient.

RGPs

Computer numeric control (CNC) lathes have led to some outstanding developments in rigid gas permeable lenses (RGPs) lately. CNC lathes help minimize error and allow greater flexibility of design. They cut smoother, and create lenses that have more consistent curves and edges and that require less polishing. They can even create uniform thickness lenses.

Your lab consultant can tell you all about the latest RGPs, as well as give you advice on which material and design is best for a particular patient.

Dr. Cykiert is a clinical assistant professor of ophthalmology at New York University Medical Center and an attending surgeon at the New York Eye and Ear Infirmary. He specializes in cornea, contact lenses and refractive surgery. He is also founder of the Doctornet service at www.doctornet.com.