CONTACT LENS BUSINESS
A New Era in Continuous Wear
Three doctors discuss the potential advantages and practice impact of the new 30-day contact lenses.
BY CHRISTOPHER KENT, SENIOR ASSOCIATE EDITOR

Until recently, 30-day continuous wear lenses were a great idea whose time hadn't come. That's changing, thanks to the development of a new fluro-silicone hydrogel material that supplies six times more oxygen to the eye than current disposable lenses and resists protein deposit buildup. CIBA Vision's Focus Night & Day lenses, made with the new material, recently received FDA approval for 30-day continuous wear. As this issue was going to press, Bausch & Lomb also received FDA approval for 30-day continous wear of its PureVision lens, also made of a silicone hydrogel material.

We asked three doctors to share their thoughts on the impact this new option will have on their patients and practices.

CUTTING THE RISK OF INFECTION

H. Dwight Cavanagh, M.D., professor and vice chairman of ophthalmology at the University of Texas Southwestern Medical Center at Dallas, has done extensive research demonstrating a correlation between oxygen transmissibility in contact lenses and the ability of bacteria to bind to surface corneal cells.

"This new generation of materials is important," he says, "not just because it provides increased oxygen permeability, but because it reduces or eliminates bacterial binding and potential infection.

"All current lens materials have a risk factor for infection. In fact, half of all infections occur in daily wear lenses. The new lenses may be as much as 10 times safer than the old lens materials, for both daily and extended wear.

"Thanks to this new development, the contact lens business will be interesting for the first time in years!"

GAUGING THE IMPACT

James E. Key II, M.D., clinical professor of ophthalmology at Baylor College of Medicine in Houston, lists multiple advantages of the new lenses: "Thirty-five percent of all contact lens wearers want the convenience of not having to remove their lenses every day; they're an alternative to LASIK; wearing lenses is generally safer than having surgery; and they have a cost advantage.

"However, we shouldn't assume that the new lenses will eliminate infection. The clinical trials of the first extended wear lens (the Permalens) showed no infections either. Only when people began wearing them in the real world, with sloppy care habits, did infections start to show up. Of course, the characteristics of the new lens material gives these lenses a distinct advantage.

"I think 30-day lenses will impact the 1- and 2-week disposable market, but not the daily disposable market. Daily wear lenses and extended wear lenses meet different needs. One group doesn't like to clean lenses or wear them at night; the other group doesn't want the daily care routine.

"However, the new lenses might be excellent as daily wear lenses for patients with a deposit problem or dry eye."

LASIK OR LENSES?

Peter C. Donshik, M.D., of Bloomfield, Conn., performs LASIK and has a thriving contact lens department. "Some of my patients inquiring about LASIK are intrigued by this new option," he reports. Asked whether he wouldn't profit more if patients opted for LASIK, Dr. Donshik said he wasn't convinced. "It costs a lot to bring in LASIK patients. In any case, the important thing is to do what's right for the patient.

"I expect a lot of patients will be interested in trying these lenses, but I don't know how many will go for them initially. We've educated patients about all the problems and potential pitfalls associated with extended wear in the past. Now we have to re-educate them that these lenses are safe and worth a try.

"Of course, safety is relative. These lenses should have a better safety profile than LASIK, but it's possible patients could have more nuisance or ocular surface problems with these lenses than they'd have with daily disposable or frequent replacement daily wear lenses.

"However, these lenses are a real innovation. They're the first truly new product in a long time, and initial studies indicate that they're safe, with good visual acuity and comfort."