Contact Lens

Options for
the NonTraditional
Patient
Shane
R. Kannarr, O.D.

Non-Traditional
Patients
for
Contacts

 Dry Eye Sufferer

Astigmatic
Presbyope
Young Myope
Non-Compliant Patients

Benefits
of
Fitting
the
Patients

 Patient Satisfaction
Loyalty

Practice Builders
34 Million current wearers
12 million new fits
11 million drop outs

PROFITABILITY

Contact Lens Fits by

Type
Segment
Total Lenses
SVS
Toric
Multifocal
Colors

Trend
+7%
+4%
+11%
+25%
+6%

Specialty lenses are driving the

category growth
Higher margin --> higher profits
Source: HPR 1H 2003

Comfort and Vision are Top Benefits for both

Current Contact Lens Wearers and Considerers
(% Absolutely Critical Top
Box)

Source:VistakonAttitudeandUsageStudyofVisionCorrectedConsumers2002

Dry Eye

Todays
Choices

HYDRACLEAR

ACUVUE ADVANCE with HYDRACLEAR

Revolutionary Technology
Exceptional Long Lasting Comfort

ACUVUE ADVANCE with

HYDRACLEAR
with
ACUVUE
ACUVUE ADVANCE
ADVANCE
with

HYDRACLEAR
HYDRACLEAR

A
A new
new generation
generation in
in DAILY
DAILY WEAR
WEAR
The
The outstanding
outstanding initial
initial comfort
comfort of
of aa hydrogel
hydrogel lens
lens
Exceptional
Exceptional end
end of
of day
day comfort
comfort that
that outlasts
outlasts the
the
competition
competition
Uncompromized
Uncompromized visual
visual acuity
acuity of
of theACUVUE
theACUVUE
Brand
Brand
Oxygen
Oxygen delivery
delivery and
and lens
lens properties
properties that
that help
help
keep
keep eyes
eyes as
as white
white as
as with
with no
no lenses
lenses

Acuvue Advance

Silicon Lens
Hydrogel Comfort
High Dk/t=83
Daily Wear
2 Week Replacement
Same Design as Acuvue 2

 30 Day Lenses Not Just for

Extended Wear
Consider Low Water Contact
Lenses
Look at Systemic Medications
(BCP and Antihistamine)

Limit Wear Time

Use Artificial Tears
Consider Plugs

Astigmatics
Not Just
for
RGPs
Anymore

Expectations

Residual Astigmatism
(RA)
RA=Refractive Cylinder-Corneal Cylinder
Example on Next Slide
>1D consider RGP

Example:
Refraction -3.00 - 2.00 x 180
K Readings 43.00 x 180 / 44.25 x 090
For Our Purposes:
2 1.25 = .75
(RGP probably not needed.)

 LARS RULE
Left Rotation Add
Right Rotation Subtract
From your vantage point
Each clock hour = 30 degrees

Example
Trial Lens:
-3.00-1.25x090----OD rotates 20 degrees left
-3.00-1.25x090----OS rotates 20 degrees right
NEW TRIALS
OD -3.00-1.25x110
OS -3.00-1.25x070

Fuzzy Math..

Soft
Contact
Lens
Options

A. Less than -3.00

D of Cylinder
Acuvue Advance and Purevision
are nice compliments.

 Both are -0.75 to -2.25 Cyl in

-0.50 Increments.
Both are Axis 0 to 180 in 10
Degrees Increments.
Good Stability.
2 Week to 1 Month Replacement.
Avg. Sale Price/Box $42-45

 Profit / Patient / Year =$93.00/$186

Let Patients See the Improved Vision
for Themselves.
Up to -3.25 D of Cyl use Spherical
Equivalent for Remainder.
(example on next slide)
Other Options:
Frequency 55 Toric/Vertex Toric

Example
Refraction: -2.00 -3.25 x 090
Closest Lens: -2.00 -2.25 x 090
Uncorrected Astigmatism (UA)
-3.25 2.25 = 1.00D
Spherical Equivalent of UA

-1.00 / 2 = -0.50
Add to Sphere of Refraction
-2.00 0.50 = -2.50
New Contact Script = -2.50-2.25x090

B.Greater than
-3.50D of Cylinder

 UCL, Sunsoft Toric, and

Preference Work Well Together
Parameters Sphere:+20.00/20.00
Cylinder:7D
Axis is in 5 Degrees Steps
Educate Patient about Possible
Fluctuations in Vision
Order with warranty

**********IMPORTANT**********

Charge for your TIME

Can not use standard multiplier
Patient Satisfaction=Practice
Builder

C. Rigid Lens
Options

 Front Surface Toric:

Correction on the front of the lens
Low Residual Astigmatism

Back Surface Toric:

Back of lens shaped to match
cornea
High Residual Astigmatism

Excellent Vision
Comfort is the Issue

Presbyope

No One likes Growing

OLD

A. Monovision

 Start the Patient Early in

Presbyopia
Educate the Adaptation Time
Start with the Non-Dominate Eye
as Near (may switch)
Return the Patient in 7-14 Days
Manage Expectations

 NO Contact Lens Salute

Cost Effective for the Patient
(any single vision lens will work)
No Intermediate as Presbyopia
Progresses
Trouble in Low Light Conditions
Trouble over 2.00 D of add

KEY POINTS
Will require chair time
Inexpensive to patient
Easier to start early in presbyopia
Patients are happy that lens cost doesnt
increase
Works for the majority of the patient
Decrease Depth perception
(consider 3rd lens)

B. Soft Contact
Bifocals

 Usually Provides All Ranges of

Vision
Comfort Over Rigid Lens
Maintain Stereo Vision
Works at All Add Powers
Can be Costly
Some Report Constant Blur

 Halos at Night
Let Lens Settle Before
Rechecking
10-15 minutes is good

Manage Expectations
Return to Check After Wearing
Use Trial Lenses

** Great Options **

Multifocal Market by
Brand
Multifocal Shares

Brand Share

Share vs YAgo
Acuvue Bifocal
40.7
(21.1)
SofLens Multi-Focal
34.3
+34.3
Focus Progressives
12.1
(13.8)
Frequency 55 Multifocal 5.9
+4.2
Dailies Progressives
1.9
(0.2)
Source: HPR Q2:2003

In only 9 months,
SofLens Multi-Focal is
the fastest growing
product in the
category.

Soflens 66 Multifocal
Base Curve 8.8 / 8/5
Powers:
Add: Low (< +1.75)
High (> +1.75)
Design:
Watch Pupil Size in High Adds

 Consider Modified Monovision

Cost / Box:$31.25
Avg. Price / Box: $60.00
Profit / Patient / Year:$119.00

Exceptional Visual Acuity

Natra-SightTM Optics
Broad near to distance power
transition to provide crisp, clear,
natural vision
Aspheric center-near with broad add
profile across optic zone

Equalized Mass Distribution

Facilitates lens centration essential for
effective functioning of the aspheric
optics

Natra-Sight TM Optics

Not all aspherics are the same

Power Profiles
Power Profiles

SLMF Low
ADD

SLMF High
ADD
Ciba Progressives
Single Steep Add

Basic Fitting Tips

Know the Distance/Near Demands
Control Expectations
Add power <= +1.75/Start with low add
Add power > +1.75/Start with high add
Always use 8.5 BC with high add
Aspheric Design offsets low amounts of
Astigmatism

Rule of Thumbs for Add

Powers
< 47 Low Add in Both eye
> 47 Low Add in Dominate eye
High Add in non Dominate eye
Be a little Creative
Tailor your fit to your patients needs

Fits for Normal

Demands/Distance
Demands

Find Prescription
Fit on Rx OU/Low Add OU
Let Settle 10-15 Minutes Before
Checking

Aim for 20/25 at Distance/20/40+ at Near

RTC 1 week (Patient to bring list of were
lenses do and do not meet expectations)

Difficulties
Difficulties with Near
Dominate Eye Remains the Same
Non Dominate Eye
Distance is Rx + of Add
Low Add

Difficulties with Distance

Check Over Refraction with Trial Lenses
Look at Base Curve

Example
Refraction -3.00DOU +2.00 AddOU
OD is Dominate
Initial Fit------- -3.00/Low Add OU
1st F/U--------- -3.00/Low OD
-2.00/Low OS

Excessive Near
Demands
Refraction

Week 1 Fit on Refraction OU/Advise Readers

Week 2 Dominate On Rx / Low Add
Non-Dominate On Rx / High Add
Week 3 Add + to Non-Dominate with Trial
Lenses until Near is Adequate

Example
Refraction -3.00 OU +2.00 Add
OD Dominate
Week 1 -3.00/Low OU/Readers
Week 2 OD -3.00/Low OS -3.00/High
Week 3 OR OS +0.50
OD -3.00/Low
OS -2.50/High
Think before you use High Adds OU

FREQUENCY 55 MULTIFOCAL

LENS DESIGN

FREQUENCY 55 MULTIFOCAL

PARAMETERS

BC/Diam.: 8.7/14.4 mm
Sphere power: +4.00 to -6.00D
Add:+1.00 (NEW) +1.50, +2.00, +2.50 D
Optical Design
D lens for dominant eye
N lens for non dominant eye
Handling tint: light blue edge-to-edge
Packaging: blisters in 6-packs, single
blister trials
Modality: recommended for monthly
replacement

FITTING PHILOSOPHY
Determine Spectacle Rx and Best Vision Sphere.

Determine Contact lens power adjusting for vertex distance, if

required.

Determine the dominant eye. Consider fogging with a +2.00 lens

test to determine dominancy.

Place the D lens on the dominant eye and the N lens on the nondominant eye. Wait 10 minutes for the lenses to equilibrate.

Under normal illumination conditions, evaluate visual acuities for

distance and near, first monocularly then binocularly

FITTING PHILOSOPHY
Acuity expectations:
D lens Distance 20/20
Near 20/40 or better
N lens Near 20/20
Distance 20/40 or better
Binocularly Distance 20/20
Near
20/20

* Other Options *
Acuvue Bifocal
Ciba Progressive

C. Rigid Bifocals

 Simultaneous Vision
Concentric Design
Translating Designs
Is Great Vision Trade-Off for
Initial Discomfort?
Educate the Patient about
Adaptation (It will get better!)
Lots of Hand-Holding in the Initial
Phases

In All Options,
Charge Adequately
for Your Time.

Non-Compliant
Patients

 Significant Neo or Corneal Edema

Again Look at 30 Day Lenses
DK / L Comparison
Poor Mans LASIK
LASIK

Rapidly
Progressing
Myope

 Young Child -4.00 or Above

Changing More Than -0.50 D / Year
Fit a Half of a Diopter Flat
Return to Check at 6 Months /
Watch Cornea and Comfort
Inform Patient of Proper
Expectations
Patience, Patience, Patience!