As a comprehensive ophthalmologist, I'm certainly familiar with the latest vision correction technologies. But today, most people expect more than better vision. They also want to feel comfortable and look good. Over the past few years, I've seen a dramatic change in what my patients want, which makes me remember the old saying: "If you don't give people what they want, you probably won't see them again."

Easy access to more information has created a demand from consumers for a wider variety of vision correction choices. Most people are willing to explore almost any reasonable option that can enhance their everyday life.

For example, there's the baby boomer who wants to wear glasses sometimes, contact lenses and fashion sunwear at other times, and may be considering LASIK in the future. This type of patient is becoming the norm, not the exception. While our progress in surgical vision correction and spectacle lens technology has made headlines, what about contact lenses? How can I use the latest in contact lens technology to meet patient needs, while at the same time creating new opportunities for the practice?

This article is intended to provide you with an overview of the latest trends in contact lenses. Hopefully, it will spark your interest in obtaining more specific information about the wide variety of products that are now available.

Demand grows for daily disposables

Within the past 5 years, there's been a shift toward planned replacement lenses and away from conventional daily wear or extended-wear lenses.

While daily disposables currently make up only about 15% of the overall contact lens market in the United States, they now have an impressive 40% share of the market in Japan and the United Kingdom.

Today, more than half of the new contact lens wearers that we see in our practice are choosing daily disposables. Once we're able to educate them about the health benefits and convenience of these lenses -- and patients come to realize that a pair costs less than a can of soda or cup of coffee a day -- they have no reason to stay with conventional lenses.

There are many advantages to daily disposables:

�         For the physician, disposables are the safest type of soft lens available. They're less likely to cause giant papillary conjunctivitis (GPC) or corneal neovascularization, and they avoid the complications seen with solutions, cleaning, and storage.

�         For the optician, they're easy to fit and have a wide range of powers, from + 6.00 to -10.00.

�         For the patient, they provide crisp vision, ease of care, comfort, easy replacement if lost or torn, and good value.

In addition to being the best choice for most patients, they're excellent for younger contact lens wearers with busy schedules who alternate between glasses and contacts, and for middle-aged or older patients who only occasionally wear contact lenses for social occasions.

Planned replacement and daily disposable lenses have become the mainstay of my practice because they're less likely to cause problems. What's more, my patients have told me they like to wear them.

Toric lenses gain acceptance

In the past, when I had a patient with significant astigmatism who wanted to wear contact lenses, I immediately thought of a difficult fit, multiple visits, and the possibility of an unhappy patient plagued by fluctuating vision. But no more. There are about 10 different types of planned replacement toric soft lenses on the market today, and certain products can correct up to 9.75 diopters of cylinder. The category is expanding rapidly, with 35% growth in the past year. And the reproducibility and accuracy of these lenses continues to improve. We'll soon have daily disposable torics to offer our patients.

Meeting baby boomers' needs

It's a fact; aging baby boomers are becoming presbyopic and often have dry eyes. They're adapting nicely to the new progressive spectacle lens designs, but many want -- or even demand -- contact lenses that enable them to function successfully at work and at home.

For the early presbyope, aspheric contact lenses create an intermediate zone of vision for near tasks, have increased depth of focus, and improve contrast sensitivity. They fit the cornea in a more natural way to give added comfort. New lens materials, such as Hioxifilcon A, reduce drying and are highly resistant to deposits. Solutions that prevent protein buildup while the lenses are being worn are also available for the dry eye patient.

Don't overlook the advantages of offering disposable soft bifocal and multifocal contact lenses to your patients. Use of bifocal contacts is up 20% in the past year. There's no better time than now to expand your knowledge of these new products, develop your practice opportunities, and give patients what they want.

It's actually easier than you may think to understand the technology. Soft bifocal contact lenses create simultaneous vision in which the lens focuses distance and near vision at the same time. The patient adjusts to the sharpest image depending on what he's doing at the moment.

Of the brands available, some use a near-vision center with a large peripheral distance zone, while others have the distance correction in the center. What's interesting is that a patient who dislikes the vision with one type of lens often will do better with the other design. For this reason, we can satisfy more than 75% of patients. And because the product is disposable, the patient can adapt to this lens at home in natural surroundings -- and we can easily make refinements.���������

Satisfying first-time wearers

In a competitive market, it's more important to create new lens wearers than to try to satisfy the patient going from place to place looking for the best price. Approximately 95% of all first-time contact lens wearers are less than 20 years old. Satisfying the specific needs of younger patients can be a key to building a more successful practice. One strategy that's working well for me is to offer these patients multiple choices.

First, remind first-time contact lens wearers that they need glasses. It's important to give the cornea a rest, so recommend the use of glasses in the evening or at least 1 day a week. The glasses shouldn't just be an afterthought to the contacts, or they'll most likely be disregarded.

I find that younger patients love the polycarbonate photochromic lenses; I appreciate the UV protection and safety offered by this product. I also remind my younger patients to wear UV protective, polycarbonate plano sunglasses with their contact lenses.

Sleeping in conventional daily-wear lenses or overwearing extended-wear lenses is more likely in this group of patients. For that reason, I recommend planned replacement or daily disposables almost exclusively at this age. Younger patients will specifically ask for color lenses, and we now have planned replacement tinted lenses in a variety of brands. There's even an in-office system approved for tinting contact lenses.

Think differently when it comes to teenagers and young adults. In this age group, patients interested in enhancing their natural eye color, as well as athletes and theatrical performers, may want tinted specialty lenses. UV protective contact lenses have gained more and more acceptance with active young people. (Don't forget the "fun lenses" for Halloween and other occasions.)

This age group offers the potential for multiple sales of both spectacles and contact lenses. Don't assume that price is the most important consideration for the patient or parent. Educate the family about the benefits of several specific types of products. It may lead to surprisingly positive results.

Extended-wear lenses make a comeback

Currently, only a small percentage of patients in the United States use extended-wear lenses, mainly because of the complications seen throughout the 1980s. Worldwide, there's been a resurgence of extended-wear products, primarily because of the new silicone-hydrogel material now being used in these lenses. The lenses can be worn for 6 or 7 days at a time and they give the wearer exceptional movement and comfort. Studies show that these new lenses don't produce much more cornea swelling than non-contact eyes experience overnight. They also reduce the potential for bacterial binding. But more research will be needed to overcome old fears.

Benefits for patients; opportunities for you

Since the introduction of disposable lenses in the early 1990s, the contact lens market has grown dramatically. Today, more than 33 million people in the United States wear contact lenses, as compared to the almost 3 million individuals who've had LASIK. Despite the surge in refractive surgery, it's important to recognize the need to offer all forms of vision correction to your patients.

With the heightened interest in spectacle and contact lens technology, more ophthalmologists are dispensing than ever before. About 71% of all ophthalmologists dispense contact lenses, accounting for 12% of today's new contact lens fits.

As ophthalmologists, we're in a unique position to meet all the eyecare needs of our patients. Offering premium quality spherical, aspherical or soft toric lenses, encouraging baby boomers to try bifocal contacts, and giving the first-time lens wearer multiple options are just as important as prescribing quality spectacles or performing LASIK. Manufacturers are creating innovative new products and services at an explosive pace. We can ensure success by first educating ourselves about the new possibilities and then educating our patients.

Thomas J. Pusateri, M.D., has been in private practice at the Florida Eye Center in Tampa, Fla., for the past 12 years and is an assistant clinical professor in the Department of Ophthalmology at the University of South Florida. He has numerous publications to his credit, including research in the field of spectacle lens technology. He also lectures nationally on optical dispensing and managed care.