optometry today contact lens guide 2009

Contact lens guide

27/03/09

Produced in association with

The latest developments

in the contact lens sector

Life through the lens

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Life throughthe lens

inside your Contact lens supplement...

... be part of something specialTo be a part of the next OT supplement,

telephone Sunil Singh on 020 7878 2327

or email [email protected]

6-7 Academic excellenceCIBA Vision’s training and education

10 Meeting the needs of wearersCooperVision’s latest developments

12-13 Investing in the futureCantor + Nissel benefits from technology

16-17 Fitting astigmatic patientsBausch & Lomb reviews its new lenses

20 New options for astigmatsJohnson & Johnson Vision Care

22 A proven solutionAlcon’s top selling products

In this current economic climate ithas never been more important forpractitioners to provide top quality

service to their patients.Research conducted by TNS Vision

Track in 2007 revealed that there isroom for growth in the British contactlens sector.

Contact lens penetration in GreatBritain is 6.2%, which is far behindSweden (18%) and the US (15%).

In another survey, CIBA Visiondiscovered that the drop-out rate forwearers is 12% per year, with 48%stopping use because of discomfort.

In this first-ever OT Contact LensGuide a number of the sector’s mostrespected clinicians and commentatorshave revealed how practitioners cancapitalise on these areas of weakness tosecure and retain future contact lenswearers.

Some of the world’s leading contactlens companies have contributed to theguide by letting readers get a firstglimpse of some of the latestdevelopments in contact lens

technology, trainingand expertise ahead ofthis summer’s BCLAconference.

Dr Philip Morgangives his predictionsfor the future ofcontact lenses,focusing on theimportance of comfort and ocularphysiology.

Cheltenham-based optometrist, KeithHolland examines another growth area,taking the reader through his tengolden rules for fitting children withcontact lenses.

OT has also spoken to four up andcoming young practitioners to find outhow they have differentiated theirpractices by making contact lenses afocal point of their businesses.

I hope readers will find this OTContact Lens Guide both an interestingread, and helpful in boosting thebusiness potential of a growing sector.Ryan BradshawAssistant and Production Editor OT

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LIFE THROUGH THE LENS: THE OT GUIDE TO CONTACT LENSES

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Some years ago, I overheard aconversation along the lines of,‘There’s nothing new to learn about

contact lenses’. But the contact lens story over the last 30 years is one of continuous evolution.

The BCLA has run a series of Pioneerslectures and produced a DVD of some of the famous trail blazers in the field. In those early days, it was like school boy chemistry with design of, andmodifications to, PMMA lenses beingdone in the kitchen. The advent of GPlenses occurred in the late 1970sfollowed quickly by the explosion of38% hydrogel lenses. Hands up thosewho remember fitting U3, U4 and O3, O4Bausch & Lomb lenses, or Zero 6 fromHydron. Now, of course, manufacturing isclosely regulated and there is little scopefor pioneering development outside themajor research facilities which havegrown so much in the last 25 years.These facilities owe a great deal to theinvestment in research and developmentof the major manufacturers.

The development of GP lensescontinues and, despite forecasts of theirdemise, they still play a small butimportant role in everyday practice aswell as being significant within ahospital setting. They are certainly firstchoice for irregular corneas – for

example, the Rose K lens from DavidThomas works really well forkeratoconus cases. There are a plethora ofGP materials available and practitionerswill know that the characteristics andproperties vary – not all materials suit allpatients. A well motivated GP lenspatient will wear lenses for years andoften will be very loyal to thepractitioner.

One of the difficulties these days iskeeping up with contact lensdevelopments and barely a week goes bywithout an increase in parameters or anew design/material in soft lenses. Onemanufacturer (CooperVision) now boastsover 500,000 parameter combinations.Now astigmats of ±20 with 5D cyls canbe fitted with a monthly replacementlens, along with presbyopes (see MarkEnnovy).

Silicone hydrogel lens materials andpowers are increasing all the time withmoderate astigmats and presbyopes nowcovered (Air Optix from CIBA Vision andPurevision from Bausch & Lomb).Another new material (Clariti fromSauflon) has come onto the market sincethe autumn. New lenses generally comein a limited parameter range and it isworth just checking availability beforerecommending a particular lens or brandto a patient.

For many patients, the ultimate inconvenience is the single use lens, ordaily disposable. Here again theparameters continue to widen so thatpresbyopes and astigmats can be fittedwith this modality. The first silicone oneday lens came to market in autumn 2008and I’m sure it is not the last.

There seems no reason that the rate of progress and development will slow.Each new development, be it in design,material or solution systems, is intendedto give a manufacturer an edge. All thisprogress is ultimately in the patient’sinterest. As practitioners, we arebeholden to stay up to date with all thesedevelopments. It is not in the patient’sinterest to continue to supply ‘the same

as always’ and each contact lens aftercareshould include a review of potential lensor solution upgrades. Practitioners canonly do this effectively if they are fullyaware of all the options. Part of contactlens practice is meticulous recordkeeping; in another two years, will youremember why you recommended alens/solution change?

A challenge for manufacturers is tomake their information available in a‘user friendly’ format which stayscurrent. (A personal plea would be for allinformation/data sheets to be dated thenat least I could throw the old ones away).The BCLA offers meetings which help tokeep practitioners right up-to-date andsome of the contact lens manufacturersarrange regional events.

Fitting a patient with some of the newcomplex designs such as a multifocaltoric soft lens can involve prolongedchair time and repeat visits to thepractitioner. Fee structures should reflectthe expertise and time involved but thereward should also be a satisfied contactlens wearer. These patients make greatpractice builders over time.

I hope everyone will find somethinguseful and informative in this special OT supplement.

Michael Charlton, AOP Chairman

Keeping up with contacts

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CONTACT LENS practice around the world was on the agendaas the British Contact Lens Association recently held its firstEuropean Day. Dr Philip Morgan hosted the event andpresented his predictions for the future of contact lenses.

“Although predicting the future for contact lenses requires adegree of guess work, I think we can be confident that newlenses need to excel in five key areas. First, three clinicalaspects in which the lens must succeed: vision, comfort andocular physiology. New products must also be user-friendly andthey must be readily available in the marketplace which meansthat they are prescribed by a large number of eye carepractitioners.

On this last point, contact lenses are now more accessible toconsumers than ever, via internet and supermarket sales, as wellas through established supply routes and free trials. While someof these routes have given rise to clinical concerns, thiswidespread availability of contact lenses is unlikely to changedramatically in the near future.

Vision is excellent with all modern contact lenses. Toriclenses are now much more predictable and reproducible, withbetter visual outcomes. New multifocal designs which will becoming to the market will get us talking more to presbyopesabout contact lenses. Another area which has been in thespotlight in recent times is aberration-control with contactlenses. There are some reports of measurable improvements invision in some situations with current lenses, which tend tooffer correction for an average amount of spherical aberration.Future products might see a more customised approach withmore bespoke lenses becoming available.

I believe that comfort remains the major issue for all contactlenses. We know that rigid lenses tend to be uncomfortableinitially and that soft lenses become less comfortable as the dayprogresses. A majority of drop-outs from lens wear are due todiscomfort and major efforts are underway to tackle thisproblem in an appropriate manner.

An important initial step is to characterise lens-relateddiscomfort and to understand what the eye actually feels. Weneed better ways for patients to report their comfort throughoutthe day in real-world situations and we hope that the automatedtext message system we operate in our clinical trials at EurolensResearch will go some way to achieve this. We also need betterunderstanding and measurement of in-eye wettability; perhapsthe nature of the tear film on the surface of a contact lens is thecritical issue, or maybe surface friction is the main determinantof lens comfort. The influence of these and other materialproperties on comfort will be a focus for future research.

The usability of contact lenses is an important feature toconsumers but is often neglected, and we may see majordevelopments in this area in the coming years. The applicationof flat-pack technology has led to prototype contact lenspackaging eight times thinner than conventional blisters makinglenses as easy to carry as a credit card.

Although some aspects of ocular physiology are improved

with the various silicone hydrogel materials available (eg limbalredness), practitioners are still hesitant about their use forextended wear. Indeed, we have not seen as much improvementin terms of infiltrates and keratitis as we might have thought.For patients sleeping in lenses, the severity of contact lens-associated keratitis may be less with silicone hydrogels thanwith conventional hydrogels but infections still occur.

Perhaps lens modulus has some role to play in the infectionsseen with extended wear? The move to silicone hydrogel lensesdoes mean stiffer lenses for the benefit of increasedoxygenation. We have reported a tendency for corneal infiltratesto occur in the superior cornea with silicone hydrogel extendedwear, supporting the notion that mechanical pressure isimplicated. In a way this is good news; this research was carriedout with the first generation of silicone hydrogels, whereasnewer lenses have a lower modulus. We can speculate that newstudies of contact lens infections might find lower infectionrates due to the general lowering of silicone hydrogel modulussince the first studies were conducted.

One development which may help improve ocular physiologyis the move to antimicrobial lenses. These are lenses coatedwith biological agents conferring resistance to infection andwhich may also reduce inflammatory events such as contactlens peripheral ulcers and contact lens-associated red eye. Thefirst human trials of these lenses are already underway.

That is the state of play in 2009. By 2020 or earlier we canexpect to see exciting developments in some of these areas.Certainly, manufacturers are already able to modify the surfaceof soft lenses to improve comfort, and continued efforts withantibacterial technology may lead to a silicone hydrogel lensthat is safer for extended wear. These will be just some of thetopics to be presented at future BCLA events.”� Dr Philip Morgan is director of Eurolens Research at theUniversity of Manchester. His primary interests are the clinicalperformance of contact lenses and the nature of the UK andinternational contact lens markets.

2020: Vision for the Future

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The Academy for Eyecare Excellencehas helped eye care professionalsto remain up-to-date with their

clinical knowledge of contact lenses,communicate effectively with theirpatients so that they can fulfil theirpatients’ lifestyle, vision and eye healthneeds, and also helps build strong,sustainable businesses.

Since its launch, the Academy hasbeen constantly updated with innovativeeducational programmes and resourcesmaking the content richer and morediverse. Structured under four pillars,each pillar of the academy offerseducation specific to the needs of everypractice individual. Details of theprogramme can be found atwww.cibavisionacademy.co.uk.

The Professional AcademyThe educational programmes deliveredunder the professional academy pillarhave successfully delivered the latestclinical education to eye careprofessionals to an excellent standard,comprehensively helping to combinehigh quality clinical skill with effectivepatient communication as well as

CIBA Vision aims foracademic excellence

Who are we:

CIBA VISION

When were we formed:

CIBA Vision was established in 1980.In 1996, CIBA Vision became the eyecare unit of Novartis.

Top selling products:

Air Optix Aqua, Air Optix Night &Day, Air Optix for Astigmatism, AirOptix Individual, Air Optix AquaMultifocal.Dailies AquaComfort Plus, FocusDailies All Day Comfort, FocusDailies All Day Comfort Toric, FocusDailies All Day Comfort Progressives.

What are our resources

for eye care professionals:

The Academy For Eyecare Excellence

What are our major

developments:

The New Air Optix Aqua Multifocalis a major development to realise theunmet need in the presbyopicmarket. The sustained moisturerelease technology used in our lensesoffers a great leap in lubricating andmaintaining comfort.

What are our future

projects:

CIBA Vision endeavours to developthe Academy for Eyecare Excellenceto continue to offer the besteducational resources for eyecarepractitioners. We see siliconehydrogel materials as the future of our industry and the rich R&Dinnovation pipeline at CIBA Visionwill offer some exciting new productdevelopments in the foreseeablefuture.

Consumer website:

www.cibavision.co.uk

Professional website:

www.cibavisionacademy.co.uk

DIRECTORY INFORMATION

Innovation is at the core of CIBA Vision’svalues and professional education is noexception. The Academy for EyecareExcellence, since its launch at the BCLAin May 2008, has provided training andeducation to support every individual inthe practice: eye care professionals,support staff, students and practicebusiness managers.

integrating insight into the contact lensmarket.

Through a recent series of six one-dayconferences, the ‘Maintaining the EDGEBuilding Patient Loyalty Roadshows’have educated eye care practitioners indelivering the quality of service that canhelp maximise patient loyalty.Particularly relevant now that we arefacing challenges in these currenteconomic conditions, it is recognised thatit can be highly effective for practices toretain their existing patients andoptimise value from them.

The Business AcademyThe Business Academy pillar continuesto actively offer business education.Through its acclaimed ManagementBusiness Academy (MBA) CIBA Visionhas delivered quality business education,offering an opportunity for practices totake part in an in-depth benchmarkingexercise to enable individual practices tocompare key variables with other leadingpractices and identify areas of strengthand weakness.

The second module of the MBA wassuccessfully launched this month to help practitioners build on the businessacumen developed through the firstmodule. A significant part of the coursefocuses on practice marketing. Thiscomplex subject is broken down intosections, so the concepts can be adapted

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LIFE THROUGH THE LENS: THE OT GUIDE TO CONTACT LENSES COMMERCIAL FEATURE

Delegates at the ‘Maintaining the EDGERoadshow’, found the conference to bean excellent way of building confidencein fitting multifocal contact lenses,making the most of every appointmentpractitioners have with their patientsand effectively communicating andoffering recommendations which gobeyond meeting the expectations oftheir patients. Later in the year, CIBAVision’s Academy for EyecareExcellence will be running more ‘EDGERoadshows’ which will focus onattracting new patients to the practice.

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to individual practice requirements. Priorto attending, delegates have theopportunity to complete a confidentialquestionnaire to better understand theirmanagement style.

The Business Academy also provides aguide to help practitioners wishing tochange to a professional fee-basedpricing structure. The professional feejourney plan takes practitioners througha series of small, achievable steps to easethe changeover, providing resources suchas the professional fees template whichhelps calculate the true cost of patientchair time, and downloadable patientletter templates and brochures that canbe adapted to include individual practice logos.

Also part of the Business Academy, the ‘Making Contacts Easy Guide’specifically looks at simple ways tomaximise the contact lens part of thebusiness. It shows how through offeringhome delivery, setting up direct debitprogrammes, improving in-storevisibility, managing inventory, andeducating all members of staff, contactlens sales can be boosted.

The Business Academy publishes aquarterly newsletter, Contacts in

Student AcademyThe final pillar of the Academy forEyecare Excellence is the StudentAcademy. Students have actively usedthe ‘Ask the Expert’ facility to posequestions to the Faculty and receiveadvice on aspects of their course. To helpgive direction to their future careers,students can read about the career pathstaken by members of the Faculty.

The Student Academy has also seengreat demand for the highly-rated CIBAVision student packs which include adifferential diagnosis poster, a clinicalguide to complications, an occluder anda memory stick containing a CIBA Visionproduct fact file.

The Academy for Eyecare Excellencewill continue to develop and deliver highquality, cutting-edge education through a variety of formats and cater for everyaspect and need of the optometricpractice. This will maximise CIBAVision’s support of eyecare professionalsto help them achieve every success intheir clinical and business objectives.

Visit www.cibavisionacademy.co.uk

In 2009, CIBA Vision has expanded theprogramme with a second module, MBA2. For those delegates who attended the first module, a follow-up programme has been designed to build on thefundamentals of MBA module 1.

Coming soon to the Support StaffAcademy is a contact lens insertion andremoval training video to help opticalassistants show patients how to insertand remove their lenses. It also givesappropriate advice on hygiene andaftercare. The video can be given topatients to take home.

Practices, offering up-to-date market andconsumer insight and information onnew product innovation.

Support Staff AcademyThe Support Staff Academy has beenwell received by practitioners and therange of resources are widely used, notonly by the support staff themselves, butalso by those who are involved withtraining support staff in practices. TheOptical Assistants Guide to ContactLenses is a DVD presented by Sarah

Morgan and educates staff on the benefitsof contact lenses, what is involved ingetting contact lenses for the first time,and shows how to handle specific patientenquiries.

Another DVD entitled 5 Steps toSuccess, is also available free of chargefrom the Support Staff Academy. It hasproven to be a very useful in-storetraining tool for practitioners, showingstaff how, by following five simple steps,communicating with patients and makingrecommendations can be made easier forsupport staff.

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Differentiating into contact lenses

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Having been in practice now for over15 years I have been able to developa successful contact lens strategy.

In the last 10 years we have grownour contact lens category comparedto spectacle category from around10% to nearly 25% of our totalpractice income. The key to asuccessful contact lens practice hasto begin with the overall attitude of your team.

Through regular staff training ourcommunication skills havedeveloped. We have had in-housesupport, the skills of leadingindustry experts in support stafftraining and also the excellent CETand professional developmentofferings provided by the industryand the BCLA.

All staff must have the ability tolisten, be adaptable, and be positiveand professional, especially in theconsulting room. I know my clinicalroutine, when newly qualified, waspretty rigid. With time my routineand conversation has become morevaried to allow more interaction withthe customer. Discussion on lifestyleevents allows a conversation todevelop and allows an opportunity tooffer a trial of contact lenses. In atleast 95% of occasions a suitabletrial leads to a successful purchaseof contact lenses. This may be for acyclist or the emerging presbyopewho wants to continue with their‘visual freedom’.

The use of diagnostic trial lensesto allow people to choose theirglasses is an excellent way of providing a better service. Ensureyou have a good supply of diagnosticlenses to seize the opportunity whenit arises.

Regular check-ups are excellent

for promoting regular patient careand loyalty but have also given methe opportunity to promote newdevelopments. Including tips oncompliance issues such as rub/rinse,and contact lens case management.There is the additional opportunityin using slit-lamp microscopy andeven digital imaging skills todemonstrate and manage dry eye.

The development of newtechnology has been a huge factor indeveloping our contact lensstrategy. We have been extremelyproactive in offering existingcontact lens wearers upgrades tosilicone hydrogels. When a new lenscomes out check your database andget a number of people (10 or more)to have a trial, this usually gives youa reasonable feel on how a newproduct is performing. Thewidespread use of care schemes,which many practices haveembraced, including the separationof fees and products, has allowed amore transparent pricing structure.A good explanation of the careofferings are usually enough tosatisfy those who are anxious aboutbuying from the Internet orsupermarket. The offering of directdebit payment schemes are in placebut the more flexible cash paymentoption is beneficial in these moreuncertain economic times.

To conclude, the satisfaction of improving the comfort of acontact lens wearer is immense.Such examples and successes willimprove your profile ensuring yourcustomers recommend their friendsand stay loyal to your practice.

The essentials for ahealthy practice andbusinessBy Dr Ian Moss

I qualified from Aston University back in 1985, andspent the first few years of my working life in themultiple and independent sector. In 1995 I joined asmall group of practices in the Bristol area with a viewto buying out the existing partners. However, after 10years working together we were unable to do a deal.

In the winter of 2004, without a job, I went offhoping to have an epiphany on some deserted beachand decide what to do with the rest of life. On myreturn I tried my hand at some locum work and found itcompletely unrewarding. I then started looking intosetting up my own practice, which I finally opened inOctober 2005.

From the outset Itried to create apractice which lookedand felt different. Iwanted to create aboutique styleenvironment thatreflected my personality. It still had to communicateprofessionalism but also make the consumer feelcomfortable and relaxed. I had great help from mywife, a graphic designer, and she created the ‘AmarShah Optometrist’ brand. From in-store graphics to ourwebsite, and all other promotional material, we have astrong corporate image. The practice has grown rapidlyover the last three years, mostly from word-of-mouth.We have actively tried to stock frames that are notwidely available and are more individual. A largeproportion of our patients are contact lens wearersand by using the most up-to-date equipment andproducts we are attracting a lot of disheartenedwearers, and finding solutions for them.

We have used my expertise in sports vision to helppromote the business. Customers are interested inwhat I have been doing since their last visit. The factthat I have worked with Olympic athletes reinforces intheir own mind that they are seeing the rightoptometrist.

One of the most important decisions I made whenstarting my business was in recruiting the best staff.Getting that right has played a massive part in ourongoing success. They are reliable and enthusiasticabout the service we provide. They know how thepractice is doing, and from day one I have been openwith them, so that they feel part of the business.

I think good independent practices will go fromstrength to strength. Identify your niche and then gofor it. There’s no need to try and be all things to allpeople, the market is too congested to make thatsustainable in the long-term.

Striking out alone By Amar Shah

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Black & Lizars’ specialisation insports vision dates back to the1990s when company chiefexecutive, Peter Ivins, set upthe original Sports Vision Clinic.During these early years, Peterwas involved as a lead clinicianin the Olympic screening

programme in Barcelona in 1992. In 1998, I joined the company andtook over as lead clinician for the Sports Vision Clinic. During thisperiod, highlights included working with Great Britain’s OlympicGold Medal curling squad in Salt Lake City in 2002.

During these formative years, it became obvious that one of themajor hurdles is the logistics of getting athlete, practitioner andequipment all in the same place at the same time.

With this in mind it was decided in 2007 to move the SportsVision Clinic to larger premises in South Glasgow. The equipment isavailable all of the time and athletes can visit whenever they like.Current clients include Scotland Rugby and Tennis Scotland.

The practice is set up to provide a unique experience from themoment the client arrives. A separate waiting area for sportsclients helps to emphasise that they are attending for more thanjust a routine sight test. The walls are covered with sports images

and signed jerseys from former clients. In the waiting room a videoshows athletes undergoing a sports vision assessment.

The sight testing programme, using the latest testing equipment,includes automated refraction, anterior and posterior eyephotography. Clients are offered relevant contact lens fitting andsports-specific dispensing, using daily disposables whereverpossible. The clinic’s sports vision assessment and trainingprogramme is designed to be the most comprehensive visionassessment available to any athlete.

The initial assessment includes sight testing. Additionally eachathlete is given a full orthoptic assessment, including measurementof ocular motility, convergence, accommodative speed and range.Also measured are contrast sensitivity and dynamic visual acuity.

Specialist Sports Vision testing equipment includes theAcuvision VTA, the Dynavision 2000, and the SVT (Sports VisionTrainer). This allows assessment of an athlete’s reaction andresponse times, their hand, foot and body coordination and theirperipheral awareness. The recently acquired SVT is the goldstandard for measurements of this kind, allowing accuratemeasurement of hand-eye coordination, down to 0.001 of a second.

Although sports vision is never going to generate huge amountsof revenue it does allow practitioners a good way of differentiatingtheir practice from the competition.

A sporting chance of success By Colin Moulson

I qualified in the early 1980sand was fortunate to havegained a wide experienceworking in practices rangingfrom the small independent tobusy multiples. In the early1990s, I was working as alocum in an independent town-centre practice which had letservice levels slide and had lostany clear direction with regardto eyecare products on offer.

The practice eventuallyclosed down but I felt stronglythat with improved levels of patient care it could havesucceeded even though, at thetime, the country was in thegrip of a recession. The practicedid, in fact, reopen but this timewith my name over the door.

The first policy weimplemented was to offer allpatients a wider choice ofproducts always explaining, atthe outset, the added benefitsof premium products. This had

not been done previously,possibly because the staffthought it to be ‘hard sell’ orthat patients would not want,or could not afford, thinnerspectacles lenses or frequentreplacement contact lenses.

Nearly everyone, whether thesupplier or the consumer,enjoys the benefits of superiorquality goods but if thecustomer or patient is notmade aware of their existencethey are unable to make aninformed choice.

We also regularly heldcontact lens open days, withthe support of Johnson &Johnson, who provided

diagnostic lenses and extrastaff for the day. Potentialcontact lens wearers wouldwalk in with their spectacleprescriptions, discuss theirvisual requirements and beoffered a lens trial there andthen.

The immediate effect was anincrease in revenue per patient.Upgrading to superior qualityfrequent replacement contactlenses saw an increase in thenumber of patients signing upto direct debit schemes.

Secondary to this was anincrease in the number ofpatients who wererecommended to us bysatisfied friends and relatives.

We began to be seen as aproblem-solving practice. “Myfriend told me to come and seeyou because if you couldn’t helpthen no-one could,” was the sortof thing we would often hear.

Being interested in what

someone has to say andoffering a solution, which maybe as simple as offering toriccontact lenses to an astigmat,will result in a loyal patient whowill gladly refer people to you.

Staff are trained to discusscontact lenses resulting in 50%of our appointments beingcontact lens-related. The urgehas been resisted to dropprices during quiet periods andwe decline requests fordiscounts from patients andcustomers. In fact, having moretime is seen as a benefit,allowing even more interactionwith the patients, and mycontact lens business hasgrown by 12.5% per year overthe last two years.

I believe the way forward forour practice, and for otherindependent practices, lies inconcentrating on the premiumend of the market in terms ofcustomer service and products.

Revitalising a practice By Simon Donne

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CooperVision has a single-mindedfocus: developing contact lenses tomeet the needs of all wearers by

utilising its expertise in the developmentof new materials, advanced opticaldesigns and manufacturing processes.

Technological InnovationCooperVision has been responsible forsome of the most significanttechnological breakthroughs in theindustry such as PC Technology – thebasis of the Proclear portfolio of lenses.

Aquaform is a major breakthrough insilicone hydrogel lens technology. Itestablishes hydrogen bonds with watermolecules which creates a naturallyhydrophilic contact lens that retainswater within the lens, therebyminimising dehydration. Aquaformunderpins Avaira, Biofinity and BiofinityToric.

Tomorrow’s Products, Today’s NeedsBiofinity – the next-generation siliconehydrogel contact lensBiofinity and Biofinity Toric lenses areperfect for those who would like theoption of wearing lenses late into the dayor even overnight.

Combining a perfect balance of waterand exceptionally high levels of oxygensets Biofinity apart from other siliconehydrogel contact lenses. Withoutadditives, coatings, wetting agents orsurface treatments, Biofinity offers realcomfort and natural breathability, givingimproved contact lens performance.

Biofinity Toric benefits from anadvanced patented toric design whichdelivers high predictability. And,importantly, Biofinity Toric is availablearound-the-clock in all powers.

Avaira – a naturally wettable siliconehydrogel lens for daily wear Avaira, like Biofinity, utilises Aquaformmaterial technology to provide a contactlens which offers a combination of highoxygen transmission and low modulus.In delivering high oxygen to the eye,


Who are we:

COOPERVISION


Founded in 1979 and employing over7,500 people worldwide,CooperVision is one of the largestmanufacturers of contact lenses inthe world.


Biofinity (silicone hydrogel) monthlydisposable and the Proclear portfolioof contact lenses including Proclear1-Day.


for eye care

professionals:

CooperVision offers a wide range of resources and support for eye careprofessionals. This includeseverything from branding solutionsto clinical and commercialworkshops; marketing support tobusiness administration solutions.

What are our major

developments:

The development of AquaformComfort Science has set thebenchmark for next-generationsilicone hydrogel materialtechnologies. It has enabledpractitioners to offer contact lensesthat overcome the compromise of previous silicone hydrogels.

What are our future

projects:

CooperVision’s significantcommitment to research anddevelopment has allowed thecompany to plan an exciting pipelineof products and technologies whichwill continue to enhance the wearerexperience in the future.

Website:

www.coopervision.co.uk


Avaira maintains a high water content of 46%, thereby overcoming thecompromises that have been associatedwith first and second-generation siliconehydrogel lenses.

Avaira is the ideal daily wear upgradefor monthly hydrogel wearers.

Proclear – allowing practitioners to fitover 99% of all patient prescriptionsThe Proclear family of lenses offersoutstanding all-day comfort. Thanks tounique PC Technology, they stay moistand comfortable all day long.

Proclear is the perfect material foranyone looking for more lens comfortand outstanding vision quality.

The Proclear family of lenses boasts,not only a wide range of products, butalso the parameters that allowpractitioners to fit well over 99% of allpatient prescriptions:Proclear – Premium monthly sphericaldisposable lens available in a +/-20.00DS.Proclear 1-Day – Daily disposable lens,provides outstanding all-day comfort.Proclear Multifocal – Monthly disposablelens available in +/-20.00DS and +4.00add.Proclear Toric – Monthly disposable toricwith cylinder powers up to -5.75DC.Proclear Multifocal Toric – The world’sfirst monthly multifocal toric withpowers up to -5.75DC and +4.00D Add.Proclear EP – For the early presbyope. � CooperVision’s commitment is toprovide the eye care professional withthe product expertise that allows them to offer more patients the opportunity of wearing contact lenses. That benefitsthe patient, the practitioner, and,ultimately, the whole optical industry.

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Meeting the needs of all wearers

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Thomas Young was the first to use a lens filled with liquidin contact with the eye, demonstrating in 1800 that thecornea was not involved in accommodation. In 1827 Sir

John Herschel suggested that corneal distortions could beneutralised by the application of a glass shell filled with animaljelly. There is no evidence that Young or Herschel ever tried tocorrect vision in this way.

In 1887, a glass shell was blown by artificial eye makers F AdM�ller Söhne in Wiesbaden, Germany, to protect the eye of apatient who was already blind in one eye and was about to losethe other due to exposure. Lenses were also made for AdolfEugen Fick, a German ophthalmologist working in Zurich, andEugene Kalt, a French ophthalmologist working in Paris, bothwere trying to fit keratoconic patients but with little success.The first to correct myopia was August M�ller, but, even withcocaine, wearing times were very short.

Carl Zeiss produced fitting sets of ground glass scleral lensesfrom 1911, giving wearing times of around four to five hours.

Adolf M�ller-Welt in Stuttgart improved things from 1928fitting blown glass lenses with a very thin layer of tears underthe lens, greatly increasing wearing times. He fitted extensivelyin Germany before moving to Canada and then Chicago, formingthe Breger M�ller-Welt Company.

In the late 1920s, Hungarian ophthalmologist Josef Dallosestablished a technique for making lenses from moulds of livingeyes. When the physiological needs of the cornea wereaddressed wearing times increased. He arrived in London in1937 where, with Theodore Hamblin Ltd, he set up the firstcontact lens only practice in the UK.

New York optometrist Theodore Obrig discovered thecombined use of fluorescein and UV light in lens fitting, beforefounding the Obrig Contact Lens Laboratory in 1939 and writingthe first contact lens text book in 1942.

The commercialisation of Perspex by ICI in 1932 heralded anew era in contact lenses with Theodore Obrig, Ernest Mullenand Istvan Györrfy all claiming priority.

In 1912, Zeiss was unsuccessful with glass corneal lenses butin 1948 Kevin Tuohy, working with Solon Braff in SanFrancisco, accidentally found the optic section of a scleral lensmore comfortable so started making lenses 10-11mm indiameter. Although Tuohy gained the US patent in 1950,Heinrich Wöhlk had similar experiences in 1946 in Germany

leading him also to makecorneal lenses.

In 1952 the Microlens waslaunched by Frank Dickinson,Wilhelm Söhnges and JackNeill with a diameter of only9.50mm. Lots of variations of diameter and curvaturefollowed.

Also in 1952, Czech chemistOtto Wichterle discovered

HEMA initially intended as asurgical material. On Christmasafternoon 1961 he successfullymade soft lenses by spin-casting using a Meccano devicepowered by a bicycle dynamo.The National PatentDevelopment Corporationacquired a licence, and aftermuch research required by theFDA, Bausch & Lomb launched the Soflens in 1971.

In 1970, US polymer chemist Norman Gaylord, working foroptometrist Leonard Seidner, patented the first rigid gaspermeable material, launched in 1974 as the Polycon lens.

The Griffin Naturalens, the first higher water lens, wasinvented by chemist Ken O’Driscoll and optometrist Allan Isen,owner of the Frontier Contact Lens Lab in Buffalo. The lens wasmade by Griffin Contact Lenses in Toronto to avoid the US FDAregulations.

Overwear was a recurrent problem so London optometristJohn de Carle developed a higher water content soft lens. WithGeoff Galley he formed Global Contact Lenses, producing thePermalens in 1971, the first lens specifically for extended-wear.

As spin-casting was restricted by patents and lath cutting wasslow and inconsistent, many workers started looking at castmoulding. Professor Wichterle had already tried this but TomShepherd was first to patent a usable process. Problems withthe formation of the edges were solved by Geoff Galley,allowing increased accuracy and yield.

Danish ophthalmologist Michael Bay found that dirty lensescaused problems so launched Danalens, the first disposablelens, in 1982. Johnson & Johnson bought his uniquemanufacturing process, changed the material to etafilcon A,added packaging and marketing from the pharmaceuticalindustry and Acuvue was born.

Working in his garden shed, Ron Hamilton found he couldincrease yield and reduce costs, making daily disposabilityviable. He launched daily disposable lenses in early 1995through Boots Opticians whilst Johnson & Johnson launched 1-Day Acuvue to the world.

In 1999, Bausch & Lomb and CIBA Vision gained Europeanlicences for 30 night continuous wear for silicone hydrogellenses. The first major change in soft lens materials in over 40years was a complex fusion between the hydrogels of ProfessorWichterle and the silicon elastomer lenses proposed by WalterBecker, a Pittsburgh Optometrist, in 1956.

Present modalities in hydrogel and silicone hydrogel includedaily disposable, weekly extended wear, daily wear with twoweek discard, daily wear with monthly discard and monthlycontinuous wear with spherical, aspheric, toric, bifocal,multifocal, UV blocking, tinted and coloured variants. Contactlenses are also available for corneal remodelling.www.contactlensesthestory.com

Contact Lens LandmarksTim Bowden, author of Contact Lenses: The Story

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David Cantor, managing director ofCantor + Nissel Limited, the leadingUK manufacturer of specialist contact

lenses, is convinced that in order tocontinue as a leading supplier of specialistsoft lenses the company must continue toinvest in the best available technology anduse this significant investment to deliveradded value products to the company’sclient practitioners.

In the past year, Cantor + Nissel hasinvested substantially in new automatedmanufacturing technology with thepurchase of several Optoform 40 lathes fromSterling Ultraprecision Inc. The Optoform40, complete with its ground-breaking fasttool servo, is widely regarded as the mostsophisticated contact lens manufacturingplatform now available. Cantor + Nissel usethis combination to deliver high accuracytoric lenses to its worldwide client base.

Wavefront technology now availablein any Cantor + Nissel soft lensAn immediate benefit to practitioners is thatthe new technology has enabled Cantor +Nissel to include high accuracy asphericwavefront optics as an option across thecompany’s complete range of soft lenses,including toric soft lenses. When applied tosoft contact lenses, the terms aspheric opticsand wavefront technology mean that thepower profile of the lens has been modifiedto reduce the spherical aberration when thelens is worn; usually this feature is onlynoticeable in cases when the wearer’s pupildiameter is relatively large. David Cantorbelieves that by providing practitioners withthe choice of having any Cantor + Nissel softlens delivered with wavefront technologyoptics, he is providing added value whichwill benefit many wearers.

While acknowledging that, although therehas been some discussion as to the clinicalbenefits such lenses may offer1,2, it is alsoclear the lens design is a factor in theclinical outcome3. As a significantproportion of the soft lenses supplied byCantor + Nissel have higher powers, thebenefits of controlling spherical aberrationwill be noticed by many wearers. While

Cantor + Nissel invests incontact lens development

Who are we:

CANTOR + NISSEL


David Cantor formed the originalcompany in 1964 in London andit relocated to Brackley inNorthamptonshire in the 1970s.


A very comprehensive range of specialised contact lenses for all applications as well as ocularprostheses, scleral shells andartificial eyes.


for eye care

professionals:

We have a dedicated professionalservices consultant, Karen HughesFBDO CL, as well as a highlytrained and specialisedmanufacturing team who havegrown with the company and whobring many decades of experience.

What are our major

developments:

ChromaGen: a range of colouredfilters available as contact lenses or spectacle lenses for themanagement of colour visiondeficiency and dyslexia. Handpainted soft and hard contactlenses for prosthetic application.

What are our future

projects:

In the immediate future we aim tooffer aberration control on all softlenses at no additional cost andsingle-use injection mouldingshells for artificial eye and sclerallens fitting.

Consumer website:

www.cantor-nissel.co.uk. Weprefer to answer individual queriesas they are addressed. Telephone01280 702002.


many wavefront technology products donot specify clearly what it is that the lensis designed to correct, the Cantor + Nissellens is well defined and has beenmeasured to be exactly as it says on thelabel.

The optics of the new lenses are basedon a development of the company’s EVproduct range. The new design hasdeveloped the EV concept further, basedon recent work in the analysis ofwavefront controlled aspheric soft lenses.The standard Cantor + Nissel asphericoptics lens is calculated to have negativespherical aberration of 0.12 dioptres at anoptic zone diameter of 6.00mm; this isintended to neutralise the averagespherical aberration of the human eyewhich is about +0.12 dioptres at a similarzone diameter4,5. This powermanagement is achieved by using anaspheric front surface which controls thepower profile across the optic zone.Cantor + Nissel has used power mappinginstruments to measure a very large rangeof lens powers to confirm that the powerprofiles are as intended. The qualitycontrol system at Cantor + Nissel willguarantee that every wavefronttechnology lens will be measured using a power mapping instrument to confirmthat its power profile matches thespecification.

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Left to right: David Cantor with senioroptometrist Annette Parkinson, Dr EdMallen and Professor Bill Douthwaite of the Department of Optometry atBradford.


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Surface No.

Apical radiusordered

p-value ordered

Talysurf apical radius

Talysurfp-value

1 7.60 0.40 7.600 0.401

2 7.60 0.80 7.597 0.796

3 7.80 0.20 7.791 0.194

4 7.80 0.60 7.796 0.605

5 8.00 0.00 7.995 0.006

6 8.00 0.40 7.998 0.397

7 8.20 0.20 8.207 0.203

8 8.20 0.60 8.195 0.585

9 8.30 0.80 8.303 0.796

10 8.40 0.00 8.401 0.014

Table 1. The results of Form Talysurf measurement on 10aspheric surfaces confirm the accuracy of the Cantor + Nisselmanufacturing technology

Custom wavefront technology lenses also availableThe Cantor + Nissel lens design system has the additionalfeature that, if specialist practitioners have either anaberrometer or a topographer which includes aberrometry, thenthe mapped values can be used to calculate a customisedwavefront controlled lens for that patient – this feature isoffered by Cantor + Nissel at no extra cost to the practitioner.“Adding value has been the key driver for this investment,” saidDavid Cantor, “our new system of lens design and manufactureenables us to deliver customised wavefront lenses at the sameunit cost as standardised wavefront lenses – we simply take theaberrometry data and key this into our lens design software. Itmakes commercial sense to have this very advanced featureavailable to our practitioners.”

Aspheric surface accuracy confirmed by independentmeasurementThe accuracy of the new system has been confirmed by researchwork carried out by the University of Bradford. The geometry of Cantor + Nissel’s proposed EV lenses is similar to surfaceswhich Professor Bill Douthwaite at the University of Bradfordrequired for a project to measure aspheric convex surfaces.Cantor + Nissel therefore took up the challenge ofmanufacturing a range of test surfaces which ProfessorDouthwaite could use as reference surfaces. ProfessorDouthwaite specified a range of conic section aspheric surfacesand these were cut using Cantor + Nissel’s new Optoform 40lathes. The lathes were equipped with controlled radiusdiamond tools supplied by Apex Diamond Products. Optoformlathes are recommended to use ‘minifiles’ which were generatedin this case using algorithms developed by CLS SoftwareLimited based on new mathematical strategies to control thesurface asphericity during the cutting process.

The surfaces were measured independently by Taylor HobsonLtd using its form Talysurf instrument. The results demonstratevery high accuracy across the complete range, as shown in table 1.

“This level of accuracy and consistency across a wide range

will enable practitioners to be fully confident that the asphericoptics in Cantor + Nissel’s soft lenses are exactly as the company intends,” said Professor Douthwaite when he met David Cantor recently.

At the meeting, Mr Cantor and Professor Douthwaite also took the opportunity to review ways in which the universitymight cooperate with Cantor + Nissel in future projects.

References1. Dave, T. Aspheric contact lenses – what’s the deal? Part 1. Optician 2008 Vol 236;

No 6177. 07.11.08: 22 25.

2. Dave, T. Aspheric contact lenses – what’s the deal? Part 2. Optician 2008 Vol 236;

No 6181. 05.12.08: 26 30.

3. Kollbaum P, Bradley A. Aspheric Contact Lenses: Fact and Fiction. An examination of

whether soft aspheric contact lenses can correct astigmatism and spherical aberration.

Contact Lens Spectrum. http://www.clspectrum.com/article.aspx?article=12770

4. Thibos L, Hong X, Bradley A, Cheng X. Statistical variation of aberration structure and

image quality in a normal population of healthy eyes. Journal of the Optical Society ofAmerica 2002;19(12):2329-48.

5. Wang Y, Zhao K, Jin Y, Niu Y, Zuo T. Changes of higher order aberration with various pupil

sizes in the myopic eye. Journal of Refractive Surgery 2003;19(March-April (Suppl. 2):S270-4

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Contact Lenses and Children: TenGolden Rules for a Successful Practice

Keith C Holland BSc, FCOptom, FCOVD, FBABO, FAAO, DipCLP

1. Understand where contact lenses will bea positive benefit when compared withspectaclesA high percentage of child patients under the age of 12 will beattending the practice because of significant levels ofhypermetropia, astigmatism and anisometropia. In all of thesecases, it is the practitioner's desire that as stable a prescription aspossible is being worn as much of the time as possible. Yet we allknow that spectacles get bent, work loose and in many casesspend much of their time being taken off and not used. Switchingto contact lenses ensures a child has a stable and consistentprescription that is correctly fitting on a full-time basis. For anyprescription over three dioptres, or where there is more than twodioptres of anisometropia, poorly fitting spectacles are likely tolead to a significant loss of visual performance which can in turnenhance and entrench amblyopia and lead to reduced stereopsis.

For spectacle-wearing children playing sport, moving to softcontact lenses should greatly enhance their ability to enjoy thegame – and to perform better with improved stereopsis andspatial awareness, as well as the obvious safety benefits of nothaving spectacles on. Two exceptions to this are swimming, andplaying squash. In the latter case it is much cheaper and safer for achild to wear plano safety squash glasses than to invest inprescription squash glasses. For swimming, this is one of the fewsituations where contact lenses are unacceptable, but modularswimming goggles are cheap and widely available for these specialsituations.

2. Consider a longer term strategy for childcontact lens patients We generally try to fit children with daily disposable lensesinitially in order that they can become used to lenses without theproblems and expense associated with replacing monthly ordurable lenses that have perhaps been damaged during the earlystages of wear. Where appropriate, we prefer to keep children in

daily disposables rather than move to monthly lenses where theremay be more issues with cleaning. However, with higher poweredlenses, accurate prescription may only be available in monthly ormore durable lens forms. In these cases, we will sometimes startby fitting a daily disposable in the short-term before moving to afull prescription lens after a few weeks. In these cases, we wouldexplain that there will be some reduction in acuity in this firststage before children move on to their ‘final’ lens form, which maybe a custom-made toric or extended prescription lens. Parentsappreciate this, and know that accidents to lenses in those firstweeks of wear are not going to be a disaster.

3. When introducing contact lenses forchildren, include both children and parentsfully in the discussionsSo often, the discussion is held with either the child or the parent,leading to uncertainty, confusion and sometimes refusal toproceed. Explaining to parents and children together that contactlenses will be the best clinical option for the correction, and thenexplaining how and why they work can remove these worries andleads to better compliance. Parents in particular will often be

area of practice. But why is it that so many practices arenervous fitting children? Is it because of the feeling that theymay do irreparable harm? If this is the case, then they wouldnot be fitting adults either. Is it from a fear of hurtingsomebody? If this is the case, why would children feel painwhen adults do not? Or is it simply because they do not likeworking with children? If so, then surely a colleague shouldbe employed who does? In order to encourage morepractitioners to work with children and contact lenses,consider the following points and then look at what you aredoing in your practice.

Children make great contact lens patients. Yet for somereason, many practices demur at fitting children withcontact lenses, and tell parents that children cannot

wear lenses until they are teenagers – or sometimes older. Inthis, they are doing a huge disservice both to their patientsand to our profession. There is no clinical reason why youngchildren (in our practice we fit children from the age of fiveupwards) should not make very successful contact lenspatients and be visually better off as a result. As with so manythings in optometry, it is perhaps the reticence of thepractitioner that holds the public back from embracing this

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negative initially until the clinical benefits and lack of fearedpitfalls are explained. It is useful to have a leaflet available thatcovers the salient points. It is important too to explain thepotential pitfalls of lens wear and the need for hygiene andattention to detail.

4. Nervousness in the practitioner leadsto nervous patientsIt is important that parents see contact lens fitting as astraightforward and routine part of practice with thepractitioner clearly being in control and knowing what they aredoing. This is especially important when inserting and removinglenses for the first few occasions, where children may naturallybe more apprehensive than adult patients (although they canoften be surprisingly relaxed about this). Giving children someold lenses to handle and play with can be a useful way ofintroducing handling, and showing how thin and light lenses can be.

5. Demonstrate handling on a ‘third-party’ An essential tool in our contact lens teaching room is a largestuffed bunny rabbit (pictured on page 14) with particularlylarge eyes which are appealing to children – and ideal forinserting a contact lens onto. Although the bunny does not havelids which keep trying to close, it is nonetheless great forseeing how the lens can go on the eye, and how to ‘pinch off’ alens, and what force is required . Obviously, use old lenses inthis situation and not the patient’s prescription ones.

6. Teach the parents as well As well as teaching the child patient, teach a parent or carer atthe same time. With younger children, we always ensure thatthe child is able to remove their own lenses, even though theymay not be able to insert the lenses themselves. A parent isalways taught both insertion and removal, so there isconfidence in the home about handling.

7. Teaching is the keyAs children may often be very nervous about contact lenses, we will sometimes reverse the fitting process and teachhandling before an actual fitting is carried out. Really good tuition can make the difference between a successfulfitting and a failure, and the staff you use for this are key. Ourtraining staff will sometimes use coloured contact lenses ontheir own eyes to show children just what to do, and are quiteprepared to spend long periods of time, often on severaloccasions to ensure that both the patient and parents areconfident and comfortable about what is needed. This thenmakes the practitioner's job much easier, and ensures moresuccessful fitting.

8. Ensure out-of-hours cover is availableWith many new contact lens patients, but especially withchildren , a mobile phone number is provided for patients to useif needed. Although this service is very rarely used, it provides areassuring backup for concerned parents, who know they canreceive help outside office hours when there is a panic!

9. Becoming a contact lens patient doesnot remove the need to monitor binocularvisionMany children fitted with contact lenses have manifest binocularvision issues, such as anisometropia, amblyopia and strabismus.Others, often with significant myopia, may have issues associatedwith near vision and reading, and it is essential that full binocularvision assessment is carried out both before fitting, and afterfitting as well as on an ongoing basis during follow-up. Often,visual acuity in anisometropia will improve by one to two linesfollowing contact lens fitting, not only increasing stereopsis, butincreasing the chances of stabilising binocular vision withappropriate vision training. The need for this should be monitoredcarefully. It is so easy to ‘pigeonhole’ patients as contact lenspatients, and ignore other aspects of their visual needs.

10. Take longer and charge moreFitting children is rewarding and great fun, but also takes longer. Ifwe are truly working in a professional fee-based situation, then itis entirely appropriate to charge more in such situations, and wefind that this has the effect of increasing the perceived value of our services, with parents appreciating that we are taking extratime and care – on average, we expect to spend an additional onehour with our child contact lens patients over the first year.

Fitting children with contact lenses is an important, if under-practised area of optometry, but the rewards are great, both inquality of life terms for our patients, and in the additional familyreferrals and loyalty that are generated. With a few simplemodifications to general practice routines, and a preparedness forflexibility, child contact lens fitting can easily be incorporated intobusy practices in the knowledge that both patients andpractitioners will benefit.

� Keith Holland runs a busy independent practice in Cheltenham,Gloucestershire, where well over half of the patients are children.With a particular interest in children's vision, Mr Holland haslectured and written widely on vision and learning, and on contactlens practice.

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Using Lo-Torque technology andadvanced aspheric optics, Bausch & Lomb has now designed SofLens

daily disposable Toric for Astigmatism.The new lens can provide wearers withincreased confidence, thanks to the clear,stable vision achieved through itsorientation, rotation and reduced sphericalaberration. This is the first time that thisunique design has been offered in a dailydisposable lens for astigmatic patients,helping to ensure an easy fit and all-daycomfort.

A group of eight leading eye carepractitioners from around the UnitedKingdom were recently given theopportunity to experience the new lens onuncorrected astigmats and spectaclewearers. They met in Birmingham toreview their experiences of fitting the new lens.

The meeting commenced with adiscussion on spherical aberration led byDr Shehzad Naroo – a lecturer from AstonUniversity, Birmingham. Dr Narooexplained what causes sphericalaberration with emphasis on the benefitsof correcting this on the quality of vision.

“Spherical aberration can be one of themost disturbing higher order aberrationsin terms of quality of vision. Typicalfeatures of spherical aberration include areduction in contrast sensitivity and halo-effects around light sources, which can beparticularly troublesome when the pupilis large such as in night driving,” said DrNaroo.

Lenses such as the SofLens dailydisposable family and PureVision familyare designed to control both the inherentand induced aberrations – therefore,helping to promote crisp, sharp visionespecially in low light conditions.

The session was then followed by NickDash (pictured above), Director of VisualEdge Optometric Practice in the UK – whochallenged five myths which may be thereason why some eye care practitionerscurrently choose to mask astigmatism inlow cylinder patients rather than use a softtoric contact lens.


Fitting More Astigmatic Patientsthe Right Way – A Review

Who are we:

BAUSCH & LOMB


The company began in 1853 inRochester, New York.


Our core businesses include soft and rigid gas permeable contact lensesand lens care products, ophthalmicsurgical and pharmaceutical products. Contact Lenses: Our offerings span theentire spectrum of wearing modalitiesand include such well-known brandnames as SofLens daily disposable and PureVision. Lens Care: Our lens care productsinclude the ReNu brand, EasySept andthe UK’s number one selling RGPsolution brand Boston.

What are our resources for

eye care professionals:

We provide a wide range of supportthrough our Professional Servicesdepartment including the Bausch &Lomb Academy of Vision Care.

What are our major

developments:

A recent launch is SofLens dailydisposable Toric for Astigmatismwhich builds on our rich heritage intoric lens design.

What are our future

projects:

We are continually working to develop new materials, engineer newtechnologies, and create pioneeringways to help perfect vision.

Consumer website:

www.bausch.co.ukwww.thinkeyegiene.comwww.winning-look.com


www.bausch.co.ukwww.academyofvisioncare.co.uk


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Is vision with torics significantlydifferent to single-vision spherical(SVS) lenses for low astigmats?Mr Dash commented on a controlledclinical study in which a group ofrandomly selected low cylinder astigmaticpatients wore a monthly toric lens with an- 0.75 cylinder correction for one week.The following week, patients switched tosingle vision spherical correction. At theend of each week, visual acuity wasevaluated. The results showed a significantreduction in all acuity and visual functionmeasured with monthly toric lenses, bothstatistically and clinically1.

“We should no longer be reluctant to fitlow cylinder patients. I think a toric lensis a first choice for ≥0.75DC,” said MrDash.

Is the higher cost of toric lenses abarrier to patient acceptance?Mr Dash discussed that the higher cost oftoric lenses is not a barrier to the patient’sacceptance.

“Second best is not good enough. Sightis the most valuable sense we have, and tocompromise its quality for a couple ofpennies per day is nonsensical,” said Mr Dash.

Is vision with aspheric SVS lensesgood enough to correct low levels ofastigmatism?Mr Dash discussed a study reported in

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2005 by Morgan et al2. which evaluatedhigh and low contrast vision with apopular aspheric lens and toric lens onpatients with 0.75D or 1.00D astigmatism.Because spherical aberration increases aspupil diameter increases, the studyevaluated vision achieved through 2mm,4mm and 6mm diameter pupils.

The toric lenses provided 6/6 highcontrast acuity and 6/9 low contrastacuity to significantly more patients with4mm and 6mm pupil diameterscompared to Aspheric lenses.

“We should be looking to correct lowcyl patients fully and not try to maskthem with aspheric or SVS lenses.SofLens daily disposable Toric forAstigmatism can correct not only myopiaand astigmatism, but also sphericalaberration. This is unique within thedaily disposable format,” exclaimed Mr Dash.

Are toric lenses as comfortable asSVS lenses?Mr Dash highlighted a clinical evaluationwhich was performed on over 800astigmatic patients who were previouslywearing a hydrogel SVS lens and wereswitched to the Lo-Torque SofLens Toriclens for a period of 2 weeks1. They werethen asked (forced choice questionnaire)which lens was more comfortable.Significantly more patients preferred thetoric lenses to their previous SVS lenswhen asked about comfort upon insertionand end-of-day comfort.

Mr Dash reported “excellent” comfortwith SofLens daily disposable Toric forAstigmatism both on insertion and at theend of the day.

“I now have no hesitation in using aSofLens daily disposable Toric forAstigmatism lens in one eye and aSofLens daily disposable SVS lens in theother, as I know patients will not noticeany differences in comfort,” said Mr Dash.

Do toric lenses require more chairtime?Mr Dash highlighted that somepractitioners feel that a toric lensconsultation may require more chair time.Mr Dash believes that the availability of new toric lenses with innovativedesign features which improve their

SofLens daily disposable Toric forAstigmatism was also discussed.

David Goad said “The lens isincredibly stable on the eye and doesn’trotate. And stabilisation is very quick,almost instantaneous.”

The group also commented on thecomfort and easy handling of SofLensdaily disposable Toric for Astigmatism.

“We may have a preconceived ideathat another brand will probably be themost comfortable. However, when Iexamined SofLens daily disposable Toricfor Astigmatism against the marketleader for comfort, SofLens dailydisposable Toric for Astigmatism wasliked just as much,” said Ian Chalmers.

“One of my patients was wearing aspherical daily disposable. I switchedthem to SofLens daily disposable Toricfor Astigmatism and they said how muchbetter it was to handle,” added AmyClarke.

The group concluded that lowastigmats masked with spherical dailydisposable lenses may not receive theastigmatic correction they need.

“The lens works extremely well, if thepatient’s prescription is suitable, SofLensdaily disposable Toric for Astigmatismwill be my first choice lens for the lowastigmats,” concluded David Goad.

“The vision was excellent especially inlow level lighting and my patientsnoticed how comfortable the lens was,”said John Stevenson.

Meeting participants agreed that dailydisposable toric lenses have had a reallypositive impact on their businesses, andare in great demand.

After having the opportunity to trySofLens daily disposable Toric forAstigmatism on uncorrected astigmatsand spectacle wearers, the attendeesreported SofLens daily disposable Toricfor Astigmatism was easy to handle, hadexcellent comfort and vision, and waspredictable in performance and stability.� To request a copy of the full roundtable meeting report, “Fitting MoreAstigmatic Patients the Right Way”,please call Bausch & Lomb CustomerService on 0845 602 2350 (UK) or 1800409 077 (IRL)

References and AttendeesSee www.optometry.co.uk/references

rotational stability and predictability will actually reduce chair time in thelong-run.

“It takes no more time to fit toriclenses than spherical lenses,” Mr Dashtold the meeting. “Over 90% of patients I fit empirically from their spectaclecorrection orientate correctly, and thispredictability reduces initial chair timeand reduces unscheduled visits.”

Practitioners’ experiences with the new lensThe attendees then discussed theirindividual experiences with the newSofLens daily disposable Toric forAstigmatism.

When commenting on enhanced visualacuity and performance of the SofLensdaily disposable Toric for Astigmatism,the group confirmed the importance of vision quality for all astigmats but inparticular those patients who have alower level of astigmatism. Theydiscussed whether a lens that combinedboth toroidal correction along withspherical aberration control would be ahelpful addition to the group’s contactlens portfolio.

“In visually demanding, low light,situations, SofLens daily disposable Toricfor Astigmatism will correct mostpatients optimally,” said Mr Dash.

“I had one patient who was veryhappy wearing another daily disposablefor astigmatism. We swapped him toSofLens daily disposable Toric forAstigmatism. He then achieved a wholeline better in vision and was just bowledover by his night vision. He would not goback to his previous lens,” saidChristopher Kerr (pictured above).

The ease and predictability of fit of

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Fitting soft contact lenses is a daily part of the workload of most optometrists. However, the evaluation of softcontact lenses varies greatly between individual

practitioners and the record of lenses trialled is often limited todescriptions such as “good”. It is acknowledged thatpractitioners have limited time for evaluating and recordingcontact lens fit. However, accurate recording fit characteristics isimportant legally in case of future contact lens complicationsand to assist in overcoming contact lens discontinuations whichare common (Young et al., 2002) and rely on knowledge ofprevious unsuccessful lens details.

If you look through the common contact lens textbooks thereis no consensus on soft contact lens fit evaluation andrecording. Most, such as Contact Lenses (Editors: AJ Phillipsand L Speedwell) and Essential Contact Lens Practice by JaneVeys, John Meyler and Ian Davies imply describing movementsin terms of millimetres and tightness of push-up (although it isnot clear whether this is tightness or recovery speed) as apercentage. This article was developed from a recent paper inthe journal Contact Lens and Anterior Eye by the author(Wolffsohn et al., 2009) which provides evidence of which arethe most important measures of contact lens movement.

Lens Details The stated lens parameters and name should be carefullyrecorded, particularly with the development of newergenerations of the same lens material, eg Fictitious DailyDisposable with Enhanced Comfort 8.5BC: 14.2mm; -3.75D.

Settling TimeMost studies have shown a decrease in lens movement over theinitial 10 to 15 minutes post-insertion (Schwallie and Bauman,1998; Brennan et al., 1994; Golding et al., 1995; Maldonado-Codina and Efron, 2004). However, movement increases againduring the day’s wear, with the movement after eight hours wearequating to the movement measured five minutes after insertion(Schwallie and Bauman, 1998; Brennan et al., 1994). Thereforeit would seem appropriate (and perhaps beneficial to thepractitioner’s limited appointment time) to assess soft lens fitabout five minutes after insertion. If there has been a lot oftearing with lens insertion, then the lens can tighten-up

dramatically (also thecase with wearing lenseswhen showering orswimming; Little andBruce, 1995).

Test order andIlluminationAs lens fit can be affectedby invasive techniques and stimulated tearing, theexamination should be conducted under sufficient, but minimalillumination. Tear film should be evaluated first and the push-up test should be performed last.

Pre-Lens Tear filmDry eyes, as determined by non-invasive break-up time, tearmenisus height and the number of symptoms are an importantdeterminate of comfort wearing contact lenses (Glasson et al.,2003). The tear film on the front surface of the contact lensappears to relate to contact lens comfort, but not to predictthose who would remain comfortable in their contact lenseswith continued wear (Fonn et al., 1999). Non-invasive break-uptime assesses contact lens surface wettability, responsible forlimiting the friction with the upper lid and should be recordedas part of the evaluation of lens fit (Figure 1).

Centration and CoverageDespite the limited published evidence for the proposed damagecaused by contact lenses repeatedly crossing the limbal area, asassessed by lens centration and coverage, the change in surfacecurvature, end of the corneal avascular area and stem cells inthis location suggest this is an important aspect of soft contact lens fit (Barramdon, 2007). Some practitioners indicate thecentre of lens with a cross with the centre of the lens marked by

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Evaluating and RecordingSoft Contact Lens Fit Professor James Wolffsohn, Ophthalmic Research Group, Life and Health Sciences, Aston University

Figure 1: Pre-lens tear film break up showing distortion in the firstPurkinje image with increasing time after blink

Figure 2: Fitting cross indicating thecentre of the cornea with a circlemarking the slightly inferior lensposition which crosses the limbus withthe superior edge

Figure 3: LEFT: A 0.3mm slit beam height placed on the lower contactlens margin with patient looking up. RIGHT: Immediately after the blinkthe lens appears located above the beam by another third of the beamheight (therefore equivalent to 0.4mm)

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a small cross as this is easier to draw accurately rather than acircle. I suggest a cross to indicate the centre of the cornea, with a circle to mark the relative position of the lens, which hasbetter face validity and allows the position of any crossing of the limbus by the lens edge to be marked (Figure 2).

ComfortAlthough contact lens comfort and fit are not strongly related(Young, 1996), the prescribed lens must be comfortable for thewearer as discomfort is the major cause of discontinuations(Young et al., 2002). Some record discomfort on a Likert scalesuch as 0 (need to remove) to five (can’t feel), while a yes/noresponse may be sufficient as one is unlikely to fit anuncomfortable soft lens.

Lens MovementOn BlinkOur research showed that contact lens movement on blink withthe patient looking up was more diagnostic of overall lensmovement as well as being easier to observe than movement onblink in primary gaze (Wolffsohn et al., 2009). Moderatemagnification of 16-25x should be used. The movement of thelens can be estimated compared to the proportion of lensoverlap onto the sclera relative to the diameter of the contactlens and patients HVID (eg overlap of well centred 14.2mm totaldiameter contact lens = 1.1mm if the HVID is 12mm, therefore a movement on blink of 1/3rd of this distance would be 0.3-0.4mm). Alternatively, the height of the slit-lamp beam canbe reduced to the smallest setting (eg 0.3mm) and this distanceused as a comparator to estimate the size of movement (Figure 3).LagLag refers to the resistance of the lens to move with the eye onexcursions away from primary gaze. If the lens is mobile, thenthe lens will tend to shift centration away from the direction of gaze due to the architecture of the lid anatomy. Our researchshows that only horizontal lag is diagnostic of overall lens

movement (Wolffsohn et al., 2009). Although some refer to lenssag rather than lag, this describes the distortion or geometry of the shape of the lens, not its movement, although the two arerelated.

Due to the movement of the eye on changing gaze, the actualmovement of the lens is not easy to estimate. Instead, with thepatient looking straight ahead, the slit-lamp beam can beadjusted to match the width overlap of the contact lens onto thesclera (Figure 4: left). When the patient looks to the nasal andtemporal side, the slit-beam can be relocated to the new overlap,for comparison (Figure 4: right). Presuming the overlap is ~1mm(see above), then an average 50% increase equates to a 0.5mmlag.Push-up TestThe importance of the push-up test in evaluating soft contactlens movement and adequate fit has been previously highlighted(Young, 1996) and was supported by our research (Wolffsohn etal., 2009). However, our findings suggested the speed ofrecovery was more important than the difficulty in dislodgingthe lens as has been previously evaluated (Figure 5).

Recording of Contact Lens Movement ParametersMovement on blink in up-gaze and lag on horizontal excursioncan be recorded in millimetres, but the push-up recovery speedis more difficult to assess as it involves both movement andtime. Professor Wolffsohn and colleagues showed that a

three-point scale was just as descriptive of lensoverall movement and recommended (Figure 6):

• if blink movement =0.25-0.50mm (as in this case) then recordB0, if less then B- and more B+. • if the sclera centration overlap increases by on average 0.5-1.0mm between nasal and temporal lag, it should be recorded asL0, if less then L- and more L+.• an instantaneous drop to the original position on push-updisplacement of the contact lens should be recorded as P+, aslow relocation as P- and a steady relocation (2-4mm/s) as P0.

Outcome of Lens EvaluationThe decision on whether contact lenses should be trialled onthe eye is based on clinical judgement, and may depend on thelens material and thickness. However, it would not be normal toaccept more than two ‘minus’ grading in movement on blink,lag and push-up, or limbal incursion. Comfort must also beacceptable to the patient and acuity good and stable, with theprescription checked by over-refraction.

AcknowledgementsThe British Universities Committee on Contact Lens Educatorshelped to formulate this article.

Referenceswww.optometry.co.uk/referencesFigure 5: Digital displacement in the push-up test

Figure 4: LEFT: Adjusting the slit-lamp beam width to match the lenssclera overlap in primary gaze. RIGHT: Comparison of this beam widthto the overlap in temporal gaze

Figure 6: Lens schematic indicating a slightly lowlens centration, with no limbal incursion, movementon blink in up-gaze of 0.25-0.50mm, horizontal lag of 0.5-1.0mm, but a sluggish push-up recovery

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Shouldn’t astigmats be able toexperience clear, stable vision outsidethe consulting room? A study involving

335 people with astigmatism found that 98%of people wanted clear vision and comfortfrom their soft contact lenses, but one-in-foursaid their current lenses failed to provide that.Nearly half said they had blurred vision andthree-quarters said that the quality of theirvision changed throughout the day2.

Also as 65% of all contact lens drop-outs have astigmatism3, many astigmaticpatients are demanding more. This is whyJohnson & Johnson Vision Care recognised aneed to continue to innovate in the toriccategory and in listening to the needs of eyecare professionals, they developed AcuvueOasys for Astigmatism, to create anopportunity for practitioners to furtherimprove astigmatic patients’ vision andcomfort satisfaction.

Increasing the Acuvue range = Increasingpatient satisfactionWith the addition of Acuvue Oasys forAstigmatism to the Acuvue range forAstigmatism, Johnson & Johnson Vision Carenow offers astigmatic patients further choice.

New Acuvue Oasys for Astigmatism,launching in the UK in May 2009, combinesJohnson & Johnson Vision Care’s uniqueAccelerated Stabilisation Design with itspatented Hydraclear Plus technology to givepatients crisp, clear vision and comfort whichlasts throughout the day.

Exceptional stability and comfortThe technology behind AcceleratedStabilisation Design harnesses the naturalpressure of the blinking eye to balance thelens in place; quickly realigning the lens if itrotates out of position. In a recent peer-reviewed study Accelerated StabilisationDesign was found to be significantly morestable than a leading prism ballasted lensduring certain important eye movements4.


Who are we:

JOHNSON & JOHNSONVISION CARE


Johnson & Johnson Vision Care wasformed in 1988 in the USA.

Top selling product:

1•Day Acuvue Moist with LacreonTechnology is designed to givepatients the freedom of dailydisposable lens wear that is freshand comfortable, letting patients’eyes stay moist and fresh even atthe end of the day.


for eye care

professionals:

The Vision Care Institute, anindependent training facility forpractitioners to enable them tolearn more about the latestdevelopments in the optical fieldunder the leadership of top eyecare professionals. The first VisionCare Institute in the UK opens thismonth (March 2009).

What are our major

developments:

Johnson & Johnson Vision Carecontinually strives to create newand innovative products, such as1•Day Acuvue TruEye.

What are our future

projects:

The new toric lens, Acuvue Oasysfor Astigmatism, is launching inMay 2009.

Consumer website:

www.acuvue.co.uk


www.acuvue.co.uk (See section forprofessionals)


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Now astigmatic patientsneed never miss a moment1

“.. it is the best toric product on the market.My patients comment that it is the mostcomfortable lens for astigmatism too.” Martin Lea, contact lens specialist

“Acuvue Oasys for Astigmatism offersoutstanding visual acuity and fit forastigmatic patients, providing clear,consistent vision and comfort throughoutthe day. We are confident that no othertoric lens has all the benefits of thisproduct,” said Ian Pyzer, professionalaffairs manager, Johnson & Johnson Vision Care.

This exciting new lens is the smoothesttoric lens on the market and issignificantly more flexible than severalcurrent silicone hydrogel toric lenses5.

The lens also offers high oxygenavailability resulting in an oxygen delivery which is significantly greater thancurrent hydrogel toric lenses, helping tokeep eyes white.

In addition to these benefits, AcuvueOasys for Astigmatism has received theWorld Council of Optometry seal ofacceptance for UV absorbing contactlenses6, offering Class 1 UV block, thehighest UVA and UVB blocking of any softtoric contact lens in today’s market7.

New Acuvue Oasys for Astigmatismoffers a winning combination, allowingmore patients to choose a lens that enablesthem to live their lives with fewermoments of blurry vision and in excellentcomfort. No other toric lens offers yourpatients all these benefits. Offer AcuvueOasys for Astigmatism to your patientstoday and let them see the results!

ReferencesSee www.optometry.co.uk/references

“It’s a superb lens, all astigmatic patientsshould use it!” Jonathan Rodgers, contact lens specialist

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Exceeding expectations

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ACLM’s secretary general Simon Rodwell discusses the future of the sector

The contact lens industry today has an increasingly globalfeel about it, and there is more product choice for thewearer than ever before. Manufacturing methods continue

to become increasingly sophisticated, and more technicalinnovation in materials and lens care solutions accelerates thistrend. Techniques such as Ortho K and new materials likesilicone hydrogels are cases in point. Almost every refractiveerror is covered today, providing a fully reversible alternative tolaser surgery, and the correction of presbyopia – which is thebiggest potential market for existing wearers as they age – willincreasingly be serviced by an ever-wider range of contact lenses.Sometimes the marketplace does look like a free-for-all, but thisis the inevitable outcome of increasing consumer choice anddeveloping sales channels.

There is no need to reinforce all the gloomy predictions wedaily hear about on the news, but it is worth reiterating some of the messages which are borne of real research.Firstly, the Internet is here to stay so practitionersneed to adapt by charging for their professionaltime and resisting the temptation to load costsonto the products they sell. Secondly, althoughbuyers are cautious, there is still plenty of wealthabout and contact lenses are still regarded as anessential rather than a luxury item. The market ispolarising to some extent, so it is important tostress the benefits of premium products and notjust cut prices. In the same way, it is also worthoffering enhanced services such as are nowavailable through local PCT initiatives. Thirdly,what to many practitioners is a patient is actually a consumer,and needs to be managed properly and encouraged as one. We allhave experience as consumers, so imagine yourself in theirposition and critically appraise what you are offering them.

It is easy to fall prey to what commentators call ‘the rumour’:“in the time it takes to sell contact lenses I could sell two pairs of spectacles”. The London Business School (LBS) clearlydemonstrated how very misleading this was in 2001 when itproduced a contact lens business model for the ACLM. The LBSspelt out the absolute need to encourage patient loyalty with theconcept of lifetime value, and discouraged practitioners fromthinking in the short-term. Exceeding patient expectations will bevital in this recession, but it takes time, training and hard work.The most successful practices already spend a good deal morepractitioner time on contact lenses, especially in the pre-sale timeand in aftercare. They are looking to the medium and long-termbenefits of patient loyalty. But the longer term rewards are therefor those who persevere, as contact lenses generate more incomeand offer greater interest to the practitioner’s day.

The difficult areas with contact lenses can nearly all beovercome by greater practitioner diligence. Drop-outs are toonumerous, although still fewer than the growth in new wearers.But drop-outs can be reduced to a quarter of the current level by

improving fitting skills, increasing product knowledge andrevitalising communication techniques with patients. The ever-present risk of counterfeit products can be removed if patients aregiven the incentives to purchase from their practitioner and notdrawn to the Internet. Substitution can be virtually eliminated ifpractitioners follow professional guidelines and specify the exact(manufacturer and brand) contact lens on the specification.

There have been plenty of well-written and concise businessarticles in the optical press over the past few years, andpractitioners are encouraged to absorb and implement theexcellent practical advice they give. Some of these articles havediscussed the need to be ‘sales-aware’. Everyone who walks intothe practice is a potential contact lens customer, but the wholeteam has to be well-trained and committed to the consistentobjective of promoting contact lenses. And selling is not a dirtyword – we all have to sell ourselves to get a new job, to create

relationships and to retain patients. Most of usare definitely not good at it, and it does requireboth effort and practice, but it is certainlyrewarding and arguably the most essential lifeskill. We are not talking about ‘box-shifting’here, but an altogether much moresophisticated sell of our capabilities, our energyand our integrity. It is said that 90% of ourthoughts and decision-making processes aresubconscious. It therefore follows that bycreating a bond of trust with our patients wewill be encouraging them to reward us withtheir business.

Manufacturers in the UK are only successful whenpractitioners are successful. A casual trawl through theirmarketing material and websites clearly demonstrates theircommitment to practitioners with a large range of offers,specialist clubs, road shows, training opportunities and otherinitiatives. Many of them exhibit at the BCLA exhibition and atOptrafair. Their contact lenses, solutions and eye-drops are listedin the ACLM Contact Lens Year Book, voted recently bypractitioners as the top benefit of BCLA membership. There aremany opportunities to be gained from this range of support, andeven to come up with new and more innovative joint ideas.

ACLM member companies are committed to supportingpractitioners and the growth of the contact lens category. Throughcontinual investment in new products and initiatives they areworking to create a prosperous future. In a welcome move, theoptical bodies recently announced their intention to work moreclosely together in a Confederation of Optics for the greaterbenefit of practitioners. For those who like acronyms then thiswelcome initiative supports three important ‘Cs’ highlighted inthis article: Cooperation, Communication and Customer Service.As we move from unbridled consumerism to a more realistictrading environment, readers might like to reflect on the ‘twoCLs’ – Contact Lenses create Customer Loyalty.

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Although contact lens wearersgenerally have healthy normal eyesand ocular tear films, they still

frequently complain of ocular discomfort,usually irritation or dryness.

While some tolerate this discomfort,believing it to be normal and blamingexternal factors like computer use, othersstop using their lenses altogether. Wearersoften continue to experience dissatisfactionor discomfort even after changing lensbrands. Opti-Free RepleniSH from Alconoffers contact lens wearers a whole newlevel of patient satisfaction. It is the onlysolution with TearGlyde, the world’s firstTear Actuating Complex, whichreconditions lenses to retain surfacemoisture for at least 14 hours. This prolongscomfort of all silicone hydrogel and softlenses, in addition to providing unsurpassedcleaning and disinfection efficacy.

Opti-Free RepleniSH meets the highestFDA “stand-alone” standards for multi-purpose disinfecting solutions. Opti-FreeReplenish also contains the tried andtrusted preservative system of Polyquad andAldox, delivering 20 years of efficacyhistory.

It’s a winner with contact lens wearers1

• 82% of contact lens wearers felt that Opti-Free RepleniSH gave their lenses longlasting comfort• 92% agreed that their lenses felt clean• 94% agreed that the solution was gentleon their eyes• 77% stated that the whites of their eyesappeared free from redness during the daywhen using the solution.How does TearGlyde work?While lenses soak, TearGlyde absorbs aproprietary wetting agent to their surface.When lenses are inserted in the eye, this

Who are we:

ALCON LABORATORIES INC


Alcon was founded in 1945 and isthe world's largest eye carecompany employing over 15,000employees. Alcon’s portfolio of specialist eye care productsincludes leading surgical,pharmaceutical and consumer eyecare products.



for eye care

professionals:

Dedicated territory managers andcustomer service for opticians,marketing support, educationalliterature and CET, point of salematerial and free starter packs.

What are our major

developments:

We have large investment in R&D with a strong product pipelinefor contact lens care, dry-eye,nutrition and therapeutics.

What are our future

projects:

The majority of our customers havealready upgraded to Opti-FreeReplenish and look out for moreexciting new additions later thisyear.

Consumer website:

www.Opti-Free.co.uk


www.alconlabs.com


The majority of optometrists have nowupgraded their patients from Opti-FreeExpress to Opti-Free Replenishdesigned for today’s lens modalities

works with the patient's own tearcomponents to retain moisture on thelens surface, allowing for a continuousshield of moisture between the lens andthe eye which provides comfort all day.TearGlyde is a combination of Tetronic1304 and C9-ED3A which interacts withnatural components of the human tearfilm to further enhance the wettingproperties of this unique solution.Fact Opti-Free RepleniSH makes contactlenses more comfortable for wearers of the most common soft lens material2

Fact: Opti-Free RepleniSH is the onlylens care solution with TearGlyde torecondition lenses for outstandingsurface wetting ability2

Fact: Opti-Free RepleniSH means lessuse of rewetting drops for patients usingsilicone hydrogel lenses2

Fact: Opti-Free RepleniSH rids lenses ofbacteria, fungi and kills Acanthamoebaand keeps disinfecting as long as lensesare stored, for up to 30 daysFact: Opti-Free RepleniSH moistureshield helps keep eyes free from rednessand helps promote clear vision.3

For further information, visit www.Opti-Free.co.uk. To request Opti-Free RepleniSH starter kits, pleasecontact your local territory manager orAlcon direct on 0800 092 4567.

References1. Data on file

2. Potter B, Stiegmeier MG et al. A clinical evaluation

of solutions. Review of Cornea & Contact Lenses.

2005;32-36

3. Opti-Free RepleniSH Package insert

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A proven solution for contact lens wearers


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Specialist contact lenses – Meeting theneeds of your non-standard prescriptions


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What I would like to address in this article is how youmake the jump from fitting standard mass producedcontact lenses to fitting the more challenging cases that

present in your chair. I am not going to discuss really complexcases, like advanced keratoconus that may require a scleral lens,in any detail. I am going to concentrate on the five to 10% ofcases that do not fit into the ranges of the mass produced lensesbut where, with some effort, a huge improvement can be made tothat individual’s quality of life.

Thinking of some of my most grateful wearers, I can come upwith examples of people with astigmatism who found that themass produced soft lenses just did not perform to give reallycrisp and stable vision, early keratoconics, some with steeper orflatter corneal profiles than average, scarred and disfigured eyesneeding prosthetic contact lenses and post surgical cases withsmall residual refractive errors and corneal irregularities. Throwinto the mix several older people with anisometropia who copeduntil they hit presbyopia and then found that spectacles just didnot work for them – who not only discovered the freedom of multifocal contact lenses but also the joys of being able towalk around seeing clearly and not feeling sick.

How do you make yourself into a contact lensspecialist? First of all, open your eyes to the wonder of vision with contactlenses rather than glasses. Remember the face that lights up thefirst time you apply a contact lens and the person sees the worldas it should be – clear and undistorted – for the first time inmany years. That should be motivation enough to help all thosewho have previously not been offered contact lenses or havebeen told their eyes are too bad for contacts. You can then startviewing everyone who requires vision correction as a contactlens wearer. Then it helps if, like me, you find it difficult to say“No,” to people. Now, this can take you to some interestingplaces but you will learn a lot getting there. And remember thatpeople with complex prescriptions generally know they have“bad eyes” so do not expect instant solutions – this gives youvaluable thinking time.

If you really want to challenge yourself then contact your localhospital eye department and see if they have any sessional workavailable. There really is no substitute for hands-on experience,but sound background knowledge is essential and there aremany courses run to help enhance specialist fitting skills of gaspermeable lenses. There is contact lens tuition available fromContact Solutions Consultants, which will offer one-to-onetraining in your work place where your own patients can befitted under the watchful eyes of an experienced practitioner.

So what is a specialist lens? It could be a simple rigid gaspermeable or a complex bi-toric multifocal rigid gas permeable, a specially design keratoconic lens or an orthokeratology lens. Isuppose it is what ever the practice up the road is refusing to fitbecause they view it as too complicated or too time consumingfor them to bother with.

All the suppliers of these more exotic lenses have professionaland technical help on hand at the end of the telephone to advisein lens and material selection and to troubleshoot when thingsdon’t go quite how you expect – don’t be too proud to use them.

In the last few years there have been some exciting advancesin specialist lenses that have really helped make our job easier.Many of us think of specialist lenses being rigid, however thereare some pretty special soft lenses out there too. Severalcompanies are now manufacturing tailor-made silicone hydrogellenses which can be made in a wide range of diameters and radiiwith powers up to +/- 30DS with cyls to 11DC and adds to3.00DS if you want a multifocal which should cover mosteventualities. And in case it doesn’t, there is even a version forkeratoconics.

Rigid lenses are keeping up and can now be manufacturedwith asymmetric peripheries – this means that if a lens fit looksreally good except in one area (where it might stand off toomuch) you can get the lens made with a steeper periphery inthat area to improve the fit. Comfort with RGPs need not be somuch of an issue – with the advent of extremely oxygenpermeable materials, several companies are manufacturing verylarge 13mm to 15.5mm rigid lenses which give excellentcomfort, not to mention a new hybrid lens with a soft skirt and ahigh Dk rigid centre which is available in many more parametersthan its predecessors.

I haven’t even mentioned topographers and lenses madedirectly from the data downloaded so that the corneal shape isreflected in the back surface of the lens. Which leads me on toorthokeratology or CRT (Corneal Reshaping Therapy) lensesworn while you are asleep, then taken out in the morning bywhich time they will have corrected your vision and allow youto see clearly all day – now that is something special.� For more information, email Contact Solutions Consultants: [email protected]

Andrew J Elder Smith MSc FCOptom DCLP FAAO FBCLA

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