Contact lens wear over a lifetime
OT hears how contact lenses can be a constant companion from childhood to retirement – but the type of lens will change to fit a wearer’s needs
07 December 2023
Remember that photo of an outfit that made you feel like a movie star at the time but now makes you blush?
Hobbies, budgets and lifestyles change. New contact lenses with improved materials, technology and designs come on to the market. Advancements in myopia management and the range of lenses available to older wearers mean people are now wearing contact lenses for a greater proportion of their life.
Keeping this increase in lifetime wear in mind, how should eye care professionals match contact lenses to an individual’s life stage?
Professor Lyndon Jones, alongside co-authors Karen Walsh and Anna Sulley, addressed this topic in the article A Lifetime of Contact Lens Wear: How to Select the Right Lens for the Right Patient at the Right Time.1
Jones shared with OT the value of exploring whether a patient is satisfied with their current contact lenses.
“It is important that practitioners keep in mind that what used to be the best option for the patient 10 or even five years ago, is not necessarily the best option for today,” he said.
ChildhoodAlthough the growth of myopia management has seen an increasing number of younger contact lens wearers, there can still be hesitation among parents around whether contact lenses are suitable for children.
Jones shared with OT that the MiSight 1 day trial of myopia management contact lenses, which now has more than seven years of data, illustrates the effectiveness of contact lenses in children.*
“We have fantastic data now that six, seven and eight-year-old children actually can adapt to contact lenses extremely well,”2 he said.
Jones shared that children are supervised by their parents in their wear of contact lenses, which reduces the chances of complications.
“If you look at the data, it is the young children who have the fewest number of complications,”3 he said.
He added that it does not take a practitioner any longer to fit a child with contact lenses than an adult. However, Jones shared that studies show that it typically takes between 10 to 15 minutes longer on average for a child to become comfortable with application and removal of contact lenses than a new adult wearer.4
Jones shared that one of the considerations for contact lens wearers who are leaving home for the first time is their budget.
“If you imagine a patient going to university, the disposable income they have is pretty small. What they are often looking for is an entry level lens,” he said.
Some patients may only wear daily disposable contact lenses on a limited number of days each week – for example, when they play sport. If the patient does decide they want to be wearing contact lenses more often, then adaptations can be made in line with their budget.
“If money is an issue, you could look at switching to a more cost effective daily disposable or a monthly replacement lens,” Jones advised.
Why don’t you try…
Professor Lyndon Jones suggests three simple ways to help improve your contact lens practice
1. Give patients some trial lenses to take homeUnless you have an alternative to compare your lenses or solution to, you have no idea that there is a better option. Very often what I would say at the end of an appointment is, ‘These new lenses have come out. Would you do me a favour and try these lenses for a few days?’ What is remarkable is the number of times the patient would call back and say, ‘I thought my lenses were comfortable or the solution was working well for me but this new one is so much better.’
2. Keep an open mind about what a patientThere are many patients where we perhaps judge what the size of their wallet is, but it is up to patients to decide how they want to spend their money. Patients don’t mind spending money if it gives them what they want. Our role is to confirm that the money they are spending is good value. Remember that we are in competition with everything else that they are spending their hard-earned money on.
3. A silicone hydrogel lens for patients who struggle with application can afford
With hydrogels, the only way you can increase their oxygen transmissibility is to make them thinner. These lenses are thin, with a high water content that can make them hard to handle. If the patient is struggling, think about giving them a silicone hydrogel lens. Their higher modulus means the lens pretty much sits on the finger and is ready to be put in.
Working lifeWhen a patient enters working life and begins to progress in their career, both their working environment and a stable income can affect contact lens choice.
“For someone who is in their late 30s, their disposable income has changed and they are more likely to be looking for a premium lens,” Jones shared.
“If you have someone who is working in a different, drier environment, they may need to change their lens – perhaps from a reusable to a daily disposable,” he said.
Jones emphasised the importance of making sure that contact lenses are maximising a patient’s vision.
“As patients go along in life, make sure that you always get an accurate refraction. The prescription of patients can change, particularly as we head towards presbyopia,” he said.
What used to be the best option for the patient 10 or even five years ago, is not necessarily the best option for today
Patients may develop astigmatism, or their level of astigmatism may change. Jones shared that practitioners should not be tempted to think that they can mask astigmatism.
“Sadly, there are a lot of practitioners who think that they will prescribe a spherical lens rather than a toric lens for a patient with low levels of astigmatism, as that will be cheaper for the patient, easier for the practitioner and they will see just as well. But that does not happen,” he emphasised.
Jones added that studies show that uncorrected low levels of astigmatism result in reduced satisfaction with lenses.5
Middle ageJones shared that new presbyopes are a group of contact lens wearers who are at a particularly high risk of dropping out.
Alongside correcting any astigmatism with torics, Jones emphasised the importance of following the fit guide.
“One style of multifocal lens, while it may work for 70% of the presbyopes in your practice, it doesn’t work for everyone,” he said.
“This is the crux to ensuring that people stay in lenses right from day one. Don’t think that because you have been fitting multifocal contact lenses for years you can ignore the fit guide,” Jones shared.
In all age groups, Jones highlighted the importance of digging deeper when checking in with patients about how they were finding their contact lenses.
An acronym that has stuck with him from another contact lens educator is the subtext to a patient saying that their lenses are ‘fine.’ “Fine is not good. It stands for ‘Feelings I’m Not Expressing’,” Jones recalled.
Jones shared that the idea that demand for contact lenses dwindles as patients age has been debunked.
“I think that is a fallacy that has disappeared,” he said.
“When we had really crummy multifocal contact lenses, that was probably the case but now we should be looking to be providing our 70-year-olds with comfortable contact lenses that provide good vision,” Jones emphasised.
Jones, who recently turned 60, began wearing contact lenses four decades ago.
He shared that people are maintaining active lifestyles for longer than the previous generation.
“I do not want to be told in 10 years’ time by some young practitioner, ‘You know what, you are getting a bit old to wear lenses.’ I look at what my dad was like when he was 60 and I am hoping that is what I will be like when I am 80,” Jones observed.
Jones highlighted the importance of keeping in mind changes to the ocular surface as patients age.
“Reports of dryness get more common as we get older. The largest number of patients who report dry eye symptoms are post-menopausal women,” he said.
Practitioners need to be mindful of the need to manage conditions, such as meibomian gland dysfunction, blepharitis and demodex infestations.
“All of those conditions influence contact lens wear success. They are all much more prevalent as we get older,” Jones shared.
* On average, for children aged 8-15 at initiation of treatment, there was no indication that accumulated treatment effect gained following 3 or 6 years of MiSight® 1 day wear was lost during a 12-month cessation study. Instead, eye growth reverted to expected, age average myopic progression rates.
1. Walsh, K., Jones, L. Sulley, A., A lifetime of Contact Lens Wear: How to Select the Right Lens for the Right Patient at the Right Time, 2023, Optician online www.opticianonline.net/cpd-archive/6355. Accessed 13/11/23
2. Chamberlain P, Arumugam B, et al. Myopia progression on cessation of Dual-Focus contact lens wear: MiSight 1 day 7 year findings. Optom Vis Sci 2021;98:E-abstract 210049
3. Bullimore M. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. (2017); 94(6):638-646
4. Walline J, Jones L, CLIP STUDY GROUP. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci. (2009); 84(9):896-902
5. Maldonado-Codina C et al. The association of comfort and vision in soft toric contact lens wear. CLAE. 2021; 44(4): 101387.