In our January 2013 Edition of Contact Lens Spectrum, we praised the Food and Drug Administration's 2012 efforts to move forward in modifying the regulatory guidance related to contact lenses and care solutions (http://www.clspectrum.com/articleviewer.aspx?articleID=107845). However, a recent research report provides a little insight into the flip side of the coin on regulatory issues. In short, over 200 leaders in major companies were surveyed on "risks" associated with their industries (http://www.protiviti.com/en-US/Documents/Surveys/NC-State-Protiviti-Survey-Top-Risks-2013.pdf). Interestingly, the overall highest area of concern was "the potential for regulatory changes to heighten regulatory scrutiny that will affect how products and services will be produced and delivered." While regulatory changes associated with contact lenses and care solutions are intended to be beneficial, let's not also forget about their potential impact on bringing new and novel innovations to the market.

CooperVision, Inc. will now offer eye doctors the ability to communicate with patients automatically using custom web-based software offered by Websystem3. Websystem3 builds on CooperVision's popular CV+ Program. With digital media and mobile device use on the rise, WebSystem3 allows practices to automate key communications, taking advantage of technology to build digital marketing programs to drive practice revenues.

According to the company, Websystem3 is powerful, cloud-based software created by an optometrist, Michael Arnell OD, for eye care professionals. Among its capabilities are the automatic scheduling of available appointment times and the ability to directly link satisfied patients to the most popular online review sites. These are essentials for eye doctors looking to acquire, retain, and engage patients.

The software enables an eye care practice to send out practice branded email marketing campaigns and newsletters, deploy survey requests, push text messages to patients and integrate with Facebook. An integrated mobile application and automated voice messaging is also available.

To find out more about this exciting new program, eye care professionals can speak with their CooperVision representative for details.

Bausch + Lomb (B+L) and Walgreens announced SightSense, a new online and in-store patient education program - an initiative to heighten eye health awareness and encourage consumers to take proactive steps to protect and preserve their sight.

The SightSense program features a special eye health section on Walgreens.com that provides tools, information and resources to help consumers become informed and proactive in their eye health, including a PSA-like video that illustrates the connection between eye health and overall wellness, as well as an eye health assessment test to screen for common problems. The website also provides an eye care professional locator for consumers to find an eye doctor near them, as well as a list of upcoming in-store events.

SightSense in-store events will be held in approximately 10 cities across the country in 2013, including Chicago, Los Angeles, and Miami. The events will feature educational forums led by eye health professionals as well as eye screenings for common problems. Additionally, informative brochures on eye health will be available at all Walgreens stores nationwide beginning in July 2013. Through both the online and in-store components of the SightSense program, consumers will be encouraged to get regular eye exams from their local eye care professionals.

Advantica, an ancillary benefits company, announced the launch of AdvanticaContacts.com, a proprietary online mail order contact lens program.

According to the company, AdvanticaContacts.com offers competitive pricing on an extensive selection of contact lenses including all major brands. The program is available to members covered by vision plans administered by Advantica for employer groups and health plans, as well as the general public. The general public receives discounts on contact lenses. Members have the added value of reimbursement on qualified purchases based on their plan coverage allowances.

All contact lens orders are shipped in full compliance with current contact lens prescription regulations. Prescriptions are verified prior to shipping by obtaining a copy of the contact lens prescription or contacting the eye care provider to verify the prescription.

The American Optometric Association (AOA) Paraoptometric Section (PS) will offer Billing and Coding: Foundations for Beginners, a nine-part series of webinars that will assist paraoptometric staff in gaining knowledge of billing and coding. The next webinar will be on March 20, 2013 and will conclude with the final unit on April 17, 2013. The webinar series was developed through an unrestricted education grant from Vision West.

The webinars are offered free to AOA Paraoptometric Section members and to Vision West members. Non-members may register for $25 per webinar. One hour of approved Commission on Paraoptometric Certification (CPC) continuing education (CE) credit is available upon successfully passing a short quiz after each webinar. There is a CE processing fee of $10 for PS members, $15 for Vision West members and AOA OD member's staff, and $25 for non-members for each hour of CE.

AOA Paraoptometric members may view all nine units on the Webinar Rewind page at ttp://bit.ly/14WbdRH. To find out more information or to register for one or more webinars, contact the AOA Paraoptometric Section at PS@AOA.org, or call 800-365-2219, ext. 4108.

In our last issue, we requested reader comments on whether the trend toward a relatively minor percentage of spectacle prescriptions filled over the internet will continue or if we will see more and more patients moving in this direction. We received comments on this issue and also the issue of growing contact lens internet sales as addressed in a previous poll (http://www.cltoday.com/issues/CLToday_060312.htm). Here are some of those comments.

I do not see people filling their spectacle prescriptions over the internet due to the fact that they do not know how to read their prescription. In addition, patients are too afraid of an error and how much time it may take to redo glasses. Also, I do not see this trend growing because we, as doctors, stress the need for patients to have accurate measurements and precise fitting for spectacles.
Kelvin Garner, OD
Dallas, TX

As long as ECPs are fitting their patients with the major soft contact lens brands, the commercial outlets, along with the internet providers, will continue to prosper. When patients are fit with specialty lenses such as rigid gas permeable lenses, scleral lenses, and specialty soft lens designs, etc., these patients will return to their original ECP providers/prescribers.
Edward Boshnick, OD, FAAO
Miami, FL

I think the internet sales of contacts will continue to increase. The only problem I have with this trend is the fact that, unlike pharmaceuticals, our scripts are not credited when an internet sale is made. And the sale is important for us to continue to receive trials and support from the companies. If there was parity in this arena, I would give "everybody" their contact lens prescription and tell them to have it filled outside. If doctors actually did the ordering and account maintenance, they would see that filling contact orders is a losing proposition. There is simply too much work involved for the margin overage to justify it.

Look at what is involved for the practice: 1) Going to a website, 2) Inputting an address, 3) Inputting parameters, amounts and delivery options, 4) Generating an invoice, 5) Reconciling that invoice, 6) Paying the monthly bill, and 7) Answering patient questions regarding delivery, replacing defective lenses, boxes, etc.

When patients go online, they have to do all this, not you. Yet, to stay competitive, you are charging only slightly more than what they would pay when they are doing all the work.
Stewart Gooderman, OD, FAAO
San Francisco, CA
^ Back to top  

Lens Replacement Compliance Linked with Eye Exam Frequency

It has been shown that compliance with lens replacement is worse for the 2-week disposable modality^{1, 2} where 50% of patients can be noncompliant with replacement frequency.¹ A recent study² analyzed the question of non-compliance in a different manner. They assessed whether there was a relationship between replacement compliance and the interval between full eye examinations.

Eye care practitioners and patients in the U.S. independently completed linked questionnaires evaluating their contact lens wear and care. Wearers of 2-week replacement lenses were significantly less compliant with replacement than wearers of both daily disposables and 1-month replacement lenses (34% vs. 74% and 67%, both p < 0.001). The mean interval between eye examinations was 16 months and was longer for wearers who were noncompliant with the manufacturers recommended replacement frequency (17.4 months vs. 14.5 months). Other factors affecting the interval between eye examinations were household income, insurance, purchase source, and sex.

Not surprisingly, non-compliance with lenses expands into other behaviors that may increase risk in contact lens wearers. Practitioners should monitor all aspects of non-compliance in the office to ensure years of uninterrupted successful lens wear.

1. Dumbleton K, Richter D, Woods C, Jones L, Fonn D. Compliance with contact lens replacement in Canada and the United States. Optom Vis Sci. 2010 Feb;87(2):131-9.
2. Dumbleton K, Richter D, Bergenske P, Jones LW. Compliance with Lens Replacement and the Interval between Eye Examinations. Optom Vis Sci. 2013 Feb 28. [Epub ahead of print.]

^ Back to top  

MATERIALS & DESIGNS
Ronald K. Watanabe, OD, FAAO

Myopia Control with Soft Bifocal Lenses

There have been a variety of optical methods that have been used to attempt to halt the progression of myopia, mainly including orthokeratology and multifocal contact lenses. These are desirable options for many myopic children and their parents. Most recently, there have been a few studies which have shown that distance-center multifocals and dual focus contact lenses may reduce myopia progression in children.^1-3 However, a concern is that multifocal soft lenses often decrease visual quality, particularly in low light conditions.

A recent paper⁴ compared the visual performance of a multizone/dual focus soft lens, MiSight (CooperVision), to that of Proclear Multifocal and spectacles. MiSight is available in parts of Asia as a myopia control device. This paper showed that the MiSight lens performs similarly to Proclear Multifocal D-lens with +2.00 add, but both had inferior visual quality to that of spectacles. This is a potential barrier to lens wear by children who may not accept the reduced visual performance. Also, a dual focus lens for myopia control is not yet available in the U.S. Center-distance multifocals like Proclear and Biofinity Multifocal are not approved as myopia control devices, but they may have some beneficial effect. Another option is the iSight Multifocal (GP Specialists) that uses a slightly wider distance zone with a higher peripheral add power. This area has a lot of potential, and we will likely see more myopia control designs come forward in the future.

1. Walline J, Jones-Jordan LA, Greiner KL, McVey M. The effects of soft bifocal contact lenses on myopia progression in children. Optom Vis Sci. 2011; 88: E-Abstract: 110642.
2. Sankaridurg P, Holden B, Smith E, et al. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results. Invest Ophthalmol Vis Sci. 2011; 52(13): 9362-9367.
3. Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmol. 2011; 118(6): 1152-1161.
4. Kollbaum PS, Jansen ME, Tan J, et al. Vision performance with a contact lens designed to slow myopia progression. Optom Vis Sci. 2013 Mar;90(3):205-14.

^ Back to top  

Eye care practitioners (ECPs) acknowledge that their patients do not always follow recommendations for lens replacement, but many may not realize the possible implications for their offices. The study was conducted to investigate whether there is a relationship between contact lens compliance and the interval between full eye examinations (IEE).

The study was conducted in ECP offices in the United States. Eye care practitioners and patients independently completed linked questionnaires, evaluating their contact lens wear and care. Patients were required to be current wearers of daily disposable (DD) lenses or reusable silicone hydrogel lenses with a manufacturer-recommended replacement frequency (MRRF) of 2 weeks (2WR) or 1 month (1MR).

A total of 2147 questionnaires from 141 offices were eligible. Fifty-four percent of patients were wearing 2WR, 37% 1MR, and 9% DD lenses. Wearers of 2WR lenses were significantly less compliant with replacement than wearers of both DD and 1MR lenses (34% vs. 74% and 67%, both p < 0.001); patients purchasing an annual supply were more compliant (55% vs. 45%, p < 0.001). The mean IEE was 16 months and was longer for wearers who were noncompliant with the MRRF (17.4 months vs. 14.5 months, p < 0.001). Other factors affecting IEE were household income (p = 0.030), insurance (p < 0.001), purchase source (p < 0.001), and sex (p = 0.007).

The researchers concluded that patients who were not compliant with the MRRF had longer IEEs and were less likely to purchase an annual supply of lenses. Patients who purchased lenses from their ECP, had a higher household income, had eye examination insurance, and were female had shorter IEEs. Patients failing to replace their lenses when scheduled were also found to be less compliant with lens care procedures. Eye care practitioners should reinforce the importance of all aspects of lens wear and care with their patients, with the overall aim of reducing possible complications and retaining successful contact lens wearers in their offices.

Dumbleton K, Richter D, Bergenske P, Jones LW. Compliance with Lens Replacement and the Interval between Eye Examinations. Optom Vis Sci. 2013 Feb 28. [Epub ahead of print]

^ Back to top  

A Proud Supporter of

Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

CLToday Services:
Subscribe; Unsubscribe; Submit Clinical Image
Submit news to cltoday@pentavisionmedia.com.

Send your comments and fitting tips to cltoday@pentavisionmedia.com. Please include your full name, degree or title and city/state/country.

For more information on Contact Lenses Today including archives of previous issues, please visit our website at www.cltoday.com. For the latest articles on contact lenses, important clinical information and helpful tools related to the contact lens practice visit the Contact Lens Spectrum website at www.clspectrum.com.

© 2013 All Rights Reserved Contact Lenses Today and CLToday are registered trademarks of:
PentaVision LLC, 323 Norristown Road, Suite 200, Ambler, PA 19002 | 215-646-8700
© 2013 PentaVision LLC. All Rights Reserved.