Contact lenses through a lifetime

OT’s latest Insights survey, supported and delivered in partnership with CooperVision Ltd, sought to uncover eye care professionals’ (ECPs) attitudes to a lifetime of contact lens wear for their patients.   

For CooperVision Ltd, the online UK survey, which was live in February and was completed by over 1000 AOP members, provided the opportunity to glean insight on how comfortable ECPs are talking to and fitting contact lenses for both children and presbyopic patients.   

“We wanted to explore the attitudes of ECPs for contact lens prescribing, including their comfort levels with fitting contact lenses for both children and presbyopes, in order to help us better understand their viewpoints. The findings from this survey will help us shape the clinical support and education we offer with these views in mind,” head of professional affairs for UK and Ireland at CooperVision, Christina Olner, shared.   

Discussing the survey’s focus on children and contact lenses, Olner told OT that CooperVision Ltd sees an opportunity for more young people to “enjoy the quality-of-life benefits of contact lenses, as evidenced by clinical research.”¹ 

“Getting to grips with any challenges ECPs experience in communicating to this age group is invaluable,” Olner emphasised. 

For patients entering presbyopia, Olner highlighted that their evolving vision needs may be one reason for increased contact lens drop out.  

“Insights from this survey will help us to understand whether we can do more to support ECPs to retain patients in this category as their vision needs change,” she highlighted.  

Here is what we learnt.  

Young eyes

Exploring how comfortable practitioners are discussing contact lenses with parents and their children, the majority of respondents said they were comfortable talking to young patients about contact lenses.   

When asked about the age of patients (and their parents) that practitioners felt comfortable talking to, of the survey’s 1020 respondents, over half (52%) stated they were comfortable talking to children under 10 years old about contact lenses, with a further one third (33%) stating they were comfortable talking to children aged between 10–12 years about this vision correction option.   

Olner said this insight was “reassuring,” given that parental awareness that children can wear contact lenses is low.²  

She revealed that a YouGov survey commissioned by CooperVision Ltd in 2019 found that 70% of parents believed children under the age of 12 were too young to wear contact lenses.²   

However, Olner highlighted this is paired with findings in the same public-facing survey which reported that 85% of parents agreed that ECPs have a duty to advise on the suitability of contact lenses for their children, while seven out of 10 parents would consider contact lenses for their child if they knew they might reduce the risk of associated eye health problems later in life.²    

“These insights highlight that we still have some work to do as a profession to increase parental awareness of contact lens suitability for all children, and talking during sight tests is the ideal time to do this,” she added.  

It may be expected that ECPs are less comfortable with fitting or prescribing contact lenses than they are merely discussing them. This could be rooted in concerns about adaptation or the eye health of the child in question

Unsurprisingly, OT Insights found that practitioners’ level of comfort fell when moving from talking about to prescribing contact lenses for children – less than half of respondents (42%) stated they feel comfortable prescribing contact lenses for children under 10. However, comfort in prescribing to children aged 10–12 years grew, with 37% stating they feel comfortable.  

Olner reflected: “It may be expected that ECPs are less comfortable with fitting or prescribing contact lenses than they are merely discussing them. This could be rooted in concerns about adaptation or the eye health of the child in question.”  

The top three reasons selected by the 968 respondents who answered when asked what they considered the barriers to be when fitting children under 10 years old with contact lenses were: compliance (63%), application and removal (62.5%), and hygiene (61%). Cost, health, and vision were selected far less by respondents, comprising 27%, 16% and 4% of responses.   

Considering these results, Olner highlighted: “ECPs should be reassured that there is ample evidence to support the fitting of contact lenses in children including a large retrospective cohort study of real-world child patients which demonstrated highest levels of compliance in younger children, and overall rates of adverse incidents comparable to those of adults.”³ 

Almost three quarters of respondents (73%) stated they were very confident or quite confident (30% and 43% respectively) fitting suitable under 10s with contact lenses.   

For the three quarters of the 971 respondents who said they were very confident or quite confident fitting under 10s, when asked to select the reasons that were key to ensuring their confidence, the majority stated a combination of: skills and training (66%), first-hand experience (65%), and time (60%).  

Of the 19% of respondents who stated they were not confident, 77% said this was due to patient ability, with 33% stating skills and training, and 27% stating time.   

When it comes to patient ability and deciding whether to prescribe contact lenses, CooperVision encourages ECPs to consider a child’s lifestyle, adherence to wearing their currently prescribed optical appliance, and their level of maturity.   

Olner pointed out that in a clinical study of children in contact lenses, it was found that after the first week of wear, parents had minimal involvement with lens handling.⁴  

She also highlighted: “Research shows that children do not need extra chair time when fitted with contact lenses, instead they might need additional time for the teach (up to 15 minutes longer) on average – this should not deter ECPs from fitting.⁵  

 Olner advised ECPs to “try to stay up to date with the available evidence.”  

In practice with children and contact lenses

Optometrist and Specsavers practice director, Rebecca Troughton, regularly talks to and fits children under the age of 10 with contact lenses.   

When deciding whether to raise contact lenses with parents and a child, Troughton is guided by her assessment of each child’s mannerisms and maturity in the testing room. 

 “Then, supported by their parent’s judgement, I determine whether they are ready for the responsibility of lens wear and care,” she told OT.  

For Troughton, understanding the individual’s motivations for lens wear will then guide the introduction of contact lenses.  

“Getting to know each patient, how they spend their time, what they enjoy, and exploring any potential challenges spectacles may cause, allows a natural introduction of contact lenses as an alternative or complementary correction,” she said.  

“There are so many benefits to be realised through contact lens wear, from unrestricted field of vision, freedom from glasses, confidence or cosmesis. I reinforce my recommendations with benefits tailored to each patient’s specific motivations,” she added.  

When fitting children with contact lenses over the years, Troughton has learnt that it is often the preconceptions formed as a practitioner that are the biggest barrier to success.  

“I aspire to offer the opportunity and a supportive environment to experience the impact of contact lenses to every suitable patient regardless of age. Respectful of the dynamic of each parent-child relationship, parents are involved in the process and on hand to support, but I encourage patient independence particularly throughout the lens handling training to prepare for ongoing care.” 

Children in contact lenses continually surprise me, they are fearless and adept throughout the process particularly in lens handling

Troughton consciously works to maintain her confidence fitting contact lenses for children through both education and practise. “As with any skill, practice makes perfect,” she told OT.  

“Children in contact lenses continually surprise me, they are fearless and adept throughout the process particularly in lens handling,” she shared.  

“Supporting young patients through each stage of the fitting journey bolsters my confidence seeing the success realised and positive impact of lens wear as they progress,” she added.   

For practitioners who do not currently feel comfortable fitting contact lenses for children, Troughton highlighted: “Paediatric contact lens fitting has never been such a hot topic across the entire profession and the support available is huge.”   

She advised: “Take advantage of the wealth of CPD available, particularly since the launch of myopia management. Embrace the use of digital material to support the journey, as children are familiar and engage with this format.” 

Older eyes and change

It is believed that education is key during any eye care journey, allowing patients to understand their vison and the changes they may experience, as well as the product they are recommended.  

As we age, so too do our eyes. During this period as patients enter presbyopia, contact lens wearers will benefit from a change to their lenses to better meet their correction needs. With presbyopia estimated to begin its impact at 40-plus, we asked ECPs when they start talking to patients about it.  

Just over one in 10 (11%) respondents said they start talking to contact lens patients about presbyopia and their possible changing eye care requirements at any age. A further 15% said they begin talking to patients over 35 regardless of symptoms.  

However, 38% of respondents said they only start talking to patients who are over 40 about presbyopia regardless of symptoms, and 28% said they only start talking about presbyopia to patients when they show symptoms.  

Olner encouraged ECPs to prepare patients for the symptoms of presbyopia before they start to experience them.  

She highlighted that a 2021 consumer Verve survey suggested that just 15% of people aged 40–65 years old find out about presbyopia from their ECP before they experience symptoms.⁶  

Stressing the importance of this conversation, Olner shared: “A systematic search review found that presbyopes report symptoms of sadness, anger and fear, and ECPs are perfectly placed to help allay some of these concerns and set expectations with early communication.⁷” 

Presbyopes are more likely to drop out of contact lenses, with one of the key reasons being poor vision

Less than half of respondents (42%) stated they talk to all contact lens patients over 45 years old about presbyopia and multifocal contact lenses.   

For CooperVision, it is important for ECPs to talk to all contact lens wearers about presbyopia in order to reduce potential drop out.   

“Presbyopes are more likely to drop out of contact lenses, with one of the key reasons being poor vision^,8,9” Olner stressed.    

She highlighted that early intervention with multifocal contact lenses “may make adaptation to the optics of these lenses easier for patients.”   

“It’s therefore important to understand a patient’s changing vision needs and offer existing soft spherical contact lens wearers the opportunity to trial multifocals when symptoms arise,” she added.  

When it comes to reasons for not fitting multifocal contact lenses for presbyopic patients, the three most prominent barriers stated by respondents were: patient expectations (76%), vision (46%) and cost (42%).  

Sharing her three top tips for better managing patient expectations when fitting multifocial contact lenses, Olner advised ECPs to: “Discuss goals and determine the most important visual distances with the patient; work with the patient to set realistic vision expectations aiming for patient satisfaction, not vision perfection, and always use manufacturer fitting guides and assess vision with real world targets before measuring visual acuity.” 

When it comes to fitting multifocal lenses, over nine in 10 (91%) respondents stated they felt very comfortable or quite comfortable fitting multifocal lenses for suitable patients. However, for those who admitted feeling uncomfortable (4%), skills and training (45%), product limitations (23%) and practice priorities (20%) were the three most stated reasons. 

Olner reassured that, “many manufacturers report high levels of success with two pairs of lenses or fewer.”  

However, she noted that success is dependent on ECPs using the lenses as intended – with the fitting guide.   
“It’s really important to use the specific fitting guide for each lens. CPD and non-CPD training is available from many sources, including the CooperVision Learning Academy,” she added.

In practice with presbyopia 

For optometrist Troughton, all presbyopia discussions begin with patients when they are pre-presbyopic, in anticipation of symptoms.  

“Rather than shortening clinical recall to pre-empt when symptoms may arise, I focus on sharing information on what to expect and range of future solutions available as they are needed,” she told OT. 

Troughton then encourages patients to initiate an appointment if their existing contact lenses no longer meet the demands of their daily life within their aftercare recall.  

“Spectacle varifocal lenses can have a bit of a bad rep,” Troughton told OT. “To dispel any patient preconceptions associated with varifocal glasses, I avoid labelling contact lenses as multifocal in initial discussions. I simply offer a new contact lens designed for correcting every range of vision whilst reassuring patients that their experience in how they use and care for lenses remains unchanged.” 

Remove any inhibitions or preconceptions you have about multifocal contact lenses, start the discussion and see the results for yourself

Through practice and experience, Troughton has been able to improve her success rate when fitting presbyopic patients with multifocal lenses. Key to this has been offering a same day multifocal lens experience.  

“This has been key to a successful conversion of existing single vision lens wearers, new patients and lapsed lens wearers alike,” Troughton shared.  

The optometrist explained: “The opportunity to experience multifocal lenses for themselves, conveniently without the need for an additional practice visit, has simplified the whole process.”  

“Paramount for success is how the lenses enhance tasks in daily life, so I place the focus on natural vision achieved outside the test room. I supply a trial of lenses and arrange to check in during that supply, either a face to face or remote consultation depending on patient preference,” she added.  

Offering advice to ECPs to improve their confidence when fitting multifocal contact lenses, Troughton encouraged them to look at themselves first. “Remove any inhibitions or preconceptions you have about multifocal contact lenses, start the discussion and see the results for yourself,” she said.   

She continued: “Use the fitting guides available as the framework to simplify the process allowing quick, accurate initial lens selection. Add multifocal lens wear to your personal development plan and make it a focus of this CPD cycle. Particularly useful are the interactive points with peers.”