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The discussion

The silicone hydrogel choice

Eye care professionals discuss how their fitting habits have developed to reflect developments in silicone hydrogel daily disposable contact lenses

05 Mar 2019 by John White, Laurence Derbyshire

Meeting patients’ expectations is a much-repeated phrase, but what does it mean in practice? In the contact lens category, data suggests that a gap remains between what wearers want and what is prescribed by practitioners. Why that is, and what the steps are to ameliorate the situation, were explored by four eye care professionals (ECPs) in a roundtable discussion, hosted by CooperVision and OT .

Focusing on the growing silicone hydrogel (SiHy) daily disposable contact lenses market, the practitioners offered their frank views on what they believe patients expect and how their fitting habits reflect the needs of the patient.

Talking health benefits

In a series of studies in 2018 sponsored by CooperVision, 147 UK ECPs and 971 UK contact lens wearers were surveyed about attitudes towards SiHy daily disposable contact lenses.

Within the findings, 81% of ECPs agreed that SiHys should be the “standard of care” for daily disposable wearers.

Vision Express Leeds contact lens optician, Amanda Moore, told the group she was with this majority opinion.

“At the forefront of everybody’s mind is ocular health. The customer has the right to know what the best options are for their eyes – and that includes the healthiest contact lens options. For me, with silicone hydrogels, you get comfort. We know that customers are wearing their contact lenses for long periods in challenging environments. Silicone hydrogel daily disposable contact lenses meet the oxygen and comfort requirements. It is the gold standard for contact lens fitting.”

Ms Moore added that it is important for practitioners to highlight the broad range of parameters to choose from in the SiHy daily disposables, including torics and multifocals. “This means we can fit more customers.”

“Silicone hydrogel daily disposable contact lenses meet the oxygen and comfort requirements. They are the gold standard for contact lens fitting”

Amanda Moore

Asked about the minority of practitioners who might not consider SiHys as the standard of care, the group noted several factors, including perceptions about time constraints, the expense, and a lack of awareness about the clinical benefits.

Bennett & Batty (Hakim Group) Liverpool optometrist, Neil Hilton, challenged the validity of these factors, explaining: “SiHys are my first choice; hydrogels are my fallback. There are enough lens options out there in the SiHy daily disposable and reusables category.”

Boots Opticians Bournemouth optometrist, Zabir Ali, added that it is important to be wary of a ‘if it ain’t broke, don’t fix it’ mentality.

“Remember that just because a patient is happy with what they have, it does not mean that the practitioner should not offer something different,” Mr Ali advised. “Patients are often happy with their hydrogels, but they could be even happier in SiHy – and they may experience increased comfort.”

For Ms Moore, there is likely to be a perception among some older ECPs who remember clinical complications, “such as giant papillary conjunctivitis,” that came with the earlier generation of SiHys. “The lenses were stiffer and the modulus was higher – but this is no longer the case,” she said.

“Patients are often happy with their hydrogels, but they can be even happier in silicone hydrogels – they can experience increased comfort”

Zabir Ali

Ms Moore added that practitioners today should not be deterred from upgrading their customers because of a perceived issue that SiHy daily disposable contact lenses might not be as comfortable straightaway.

“We need to expect patients to take time to adjust to a new lens,” she explained. “We will all have had an instance where that’s been the case, but if the patient sticks with the lens for a short period of time, the issue is quickly overcome.”

Specsavers Lakeside optometrist, Shakeel Hirani, explained to the group that SiHy daily disposable contact lenses cater for the changing demands of the patient.

“For me they are a healthy option, and patients can wear them for long hours without complications. Patients are busier than ever: they don’t want to think at 5pm, ‘I have to take my lenses out.’ They don’t have the time or patience,” he explained.

Reflecting on the process of moving patients from hydrogels to SiHys, the group identified business opportunities for the practice.

Mr Hilton said that at the Hakim Group he had looked at the pricing structure of contact lenses, noting it is not unusual for a practice to have a pricing structure that is 20 to 30 years old, and due a refresh.

The group also agreed that practices need to consider self-employed practitioners and make sure they are up to date with the fitting habits in the practice.

Frequency matters

Reflecting on the needs of a daily disposable contact lens wearer versus a monthly wearer, the group were asked if and why their prescribing habits would change.

“I would challenge the reasons for fitting a hydrogel over a SiHy for monthly wearers,” Mr Hilton told the group, to collective agreement.

“I would also challenge the mindset, ‘It does not matter what I put in’ when thinking about occasional wearers. At the end of the day, the patient wants the healthiest lens,” he added.

For Mr Hirani, it is a question of habit for some practitioners. “If they have not got the evidence of the success using silicone hydrogel daily disposable contact lenses, and they have not tested out a SiHy on a patient, they won’t change their approach,” he argued.

Ms Moore noted that the data from CooperVision reveals that 88% of ECPs agree that SiHy daily disposable contact lenses are better for long-term eye health. “It shows we are on the same page. That is reassuring,” she said.

She explained: “For me, if I know a patient is wearing a silicone hydrogel, I am happy. I know that they can walk out of the practice and spend 16 hours doing whatever they want in the lens and I do not have to worry.”

CooperVision roundtable delegates

Counting the cost

The group were asked to consider the perceived cost of SiHy daily disposables and the barriers this might create in the minds of practitioners and patients, as well as what steps could be taken to overcome this issue.

Ms Moore shared that she describes the range of contact lenses on offer to the patient from entry level to “premium,” highlighting the difference in price.

Mr Hilton explained he preferred a different approach, noting that, “I don’t believe you can categorise lenses as ‘good, better, best.’ The only reason we charge the patient more is because the lenses cost us more to buy from the manufacturer.”

He added: “For me, if I don’t recommend my patient the healthiest lens, I am doing them an injustice. It might be unaffordable for the patient, but I will still recommend it. I have no qualms doing that. I don’t want a patient coming back and asking, ‘Why did you not offer me this product?’”

For Mr Hilton, practitioners should remember that “patients come to us for a reason. They trust our opinion. When we go to the doctor and they prescribe a cream or tablets we don’t challenge them and ask if they have something different. We worry too much about what patients think.”

He added: “I think as clinicians we get stuck on the features and advantages of different lens technology, but all the patient is interested in is the benefits. And if the cost is broken down to a daily wear amount, it is pence.”

“Patients are busier than ever: they don’t want to think at 5pm, ‘I have to take my lenses out.’ They don’t have the time or patience”

Shakeel Hirani

Mr Ali told the group that he was “completely guided” by the needs of the patient and what he thinks will best fit their needs. “If they are outdoors a lot, I would go for a silicone hydrogel daily disposable contact lens with UV blocking. I avoid giving them a lot of different lens options,” he said.

Mr Hirani explained that the practitioner has to begin by having “a really good conversation with the patient,” adding: “I do agree that we should discuss the range of lenses and talk them through the price options. But I think we need to focus on putting them into the right lens. We need to understand what the patient wants.”

With this insight, he explains, he does not find that “the cost comes into the conversation as much.” However, he offers the caveat that “there is no point fitting a lens if the patient cannot afford the product – it is wasting their time and your chair time.”

For Ms Moore, the cost barrier also remains an issue, highlighting the link to the trend for people purchasing their contact lenses online.

“I think it is important to have a conversation with each patient about the best options, but not everyone has the best budget. This means we need to give patients the right lens at the right budget. Patients will go online and check prices online – and they are looking for value for money,” she stated.

Ms Moore added: “Some lenses command huge tickets prices, but it is important to remember that there is a range of good, affordable products available for customers in the silicone hydrogel contact lens market.”

The group agreed that practitioners should distinguish between ‘cost’ and ‘value’ when speaking to patients.

“Once you have explained the benefits of the lens, the patients will often not question the cost of the lens because they prioritise the ‘value,’” Mr Ali said. “Patients are happy to accept and trust that you have made the right decision for them.”

The comfort factor

Since SiHy monthly lenses first launched in the late 1990s, the modulus of the more recently introduced lens materials has dropped, making current SiHy daily disposable lens modulus values more comparable to hydrogels.

While the group believes that this is recognised by the profession, they concluded that practitioners need to engage with manufacturers in order to keep up to date with the latest technology.

Mr Ali said he recommended organising regular coffee mornings with contact lens suppliers, noting it helps to “make teams feel confident.”

Mr Hirani added that practitioners should “try wearing the lenses in order to be able to relate the experience back to the patient.”

When switching patients from hydrogel to SiHy, the group said that their own experience suggested patients find the comfort is just as good.

“Our language has changed since we first started fitting silicone hydrogels,” Mr Hirani said. “Today we can highlight that the comfort of SiHys is as good as hydrogels, if not better for some, and the cost is the same if not less.”

“I would challenge the mindset, ‘It does not matter what I put in’ when thinking about occasional wearers. At the end of the day, the patient wants the healthiest lens”

Neil Hilton

Ms Moore told that group that she had received questions from wearers about comfort while transitioning from hydrogel to SiHy. Her advice to patients, she explained, was to “wait until the end of the day and ask yourself, ‘How do I feel in the lens after 12 to 14 hours of wear?’ That’s when you will notice the difference if you wear the lenses consistently. Next time you see them, they will be fine.”

Mr Ali agreed, stating: “End-of-day comfort is really important with silicone hydrogels.”

Driving success

The group agreed that SiHy daily disposable contact lenses do meet today’s wearers’ needs, but practitioners need to be able to align the benefits of the product to each patient’s lifestyle.

“I think we have to get to grips with why the patient wants to wear contact lenses. Are they a replacement to glasses, or for flexiwear, or for sports and one-off occasions,” asked Mr Hirani. “You can then talk to them about the benefits of SiHy daily disposable contact lenses, and how there is a silicone hydrogel option that sits in each of those categories and maps their needs.”

Asked to consider the role of aftercare, the group said this stage in the patient journey is undervalued.

For Mr Hilton, some practitioners rush through aftercare. “They see it as a waste of clinic time. In fact, it is a great time to touch-base with the patient,” he explained.

Mr Ali added that aftercare is a “great opportunity to build loyalty and wow the patient. You can talk about the latest tech in SiHy daily disposable contact lenses, and you can ask if they would like to try something new.”

Aftercare is there first and foremost to check the patient’s vision, Ms Moore noted, adding that practitioners should remember to revisit why the patient is wearing contact lenses, as this may have changed since the last visit.

Mr Hirani told the group every aftercare appointment is an opportunity to update a patient if they are not in a SiHy lens already.

“Ask what their end-of-day comfort is like,” he explained. “Are they happy?”

For Ms Moore, it is important to remember the basics in order to truly meet patients’ expectations. “As ECPs we have to dig deeper. There needs to be a two-way conversation with the patient each time we see them.”

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Comments (1)

  • Avatar image of person name

    Daysoft

    It is encouraging that those taking part in the In-Practice discussion, ‘The Silicone Hydrogel Choice’, agreed that the daily-disposable (DD) contact lens modality is the healthiest. However, the starting assumption, which was continued throughout the entire ‘discussion’, was that Silicone hydrogel (SiH) material is better than Hydrogel (Hy) material, with the discussion failing to mention any independent references in support that assumption.
    Of more concern; there is a no reference in the discussion to the increased levels of Corneal Infiltrative Events (CIEs) evident with SiH lens wearers.
    Two papers highlighting the risks of CIEs state:
    1) Silicone hydrogel is a ‘risk-factor’ alongside; extended wear, the use of multipurpose solutions, bioburden and reusable lenses.1 1 KR Steele and L Szczotka ‘Epidemiology of contact lens-induced infiltrates: an updated review’. Clinical and Experimental Optometry Sep 2017
    and
    2) Microbial adhesion to silicone hydrogel lenses occurs and is associated with the production of corneal infiltrative events during lens wear. 2 MD Wilcox ‘Microbial adhesion to silicone hydrogel lenses: a review.’ Eye & Contact Lens Jan 2013.
    Sadly, there are no figures given for the higher cost of silicone hydrogel lenses compared to hydrogels.
    I am sure that the participating ECPs know that they have the legal responsibility to inform patients of the benefits and the risks associated with different product options. This is in order that the patient can make a fully informed choice.
    There is not a single number or research-paper reference in the entire article which makes it read more like an ‘advertorial’ that an informed technical discussion. Where, please, may I ask, is the independent evidence regarding the risks and benefits of SiH over Hy daily-disposables?

    Kind regards
    Ron Hamilton
    Executive Chairman
    Daysoft Limited

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