Caroline Helwick

June 27, 2017

WASHINGTON, DC — Some of the newest multifocal contact lenses have elicited sky-high satisfaction rates in patient surveys, with almost all patients preferring them over their habitual lenses, according to two reports here at Optometry's Meeting by the American Optometric Association (AOA).

The lead author for one of the studies explained the reason for these surveys: "It's one thing to make a difference in your patients' vision in your office. But what we really want to know is that when patients leave, they are also happy and are able to achieve things they were not able to do before," Jill Saxon, OD, senior director of professional strategy with Bausch & Lomb, Bridgewater, New Jersey, told Medscape Medical News.

Dr Saxon led a study of patient satisfaction with the Bausch & Lomb Ultra for Presbyopia multifocal contact lens. Meanwhile, a separate survey on patient and provider satisfaction with the new water gradient daily disposable multifocal lens (DDMF), delefilcon A (Dailies Total 1, Alcon Labs, Inc), was presented by Mohinder Merchea, OD, PhD, MBA, from Alcon Labs, Inc, Fort Worth, Texas.

Approximately 90% of patients in each survey preferred the newer lenses to their old ones, the researchers reported here at the joint conference of the American Optometric Association (AOA) and American Optometric Student Association.

Edward Bennett, OD, MSEd, from the University of Missouri St. Louis College of Optometry, who chairs the AOA Contact Lens and Cornea Section, told Medscape Medical News that the studies are "two great examples of how innovative manufacturing continues to take contact lens to a higher level," especially in addressing the two key areas of presbyopia and dry eye.

"With Dailies Total 1, you see technology that incorporates chemistry within the lens to help with dry eye patients, and boy, do we need this. As for advances in multifocal lens, the biggest untapped population is the presbyopics. So whether it's Bausch & Lomb's or other products coming out, every year we are seeing new designs that provide two benefits: sharper vision and the ability to work longer periods of time because they address drier eyes. Five years from now, we'll see a lot of people able to wear contact lens that could not before." Dr Bennet was not involved in either study.

Novel Water Gradient DDMF

The survey for the water gradient DDMF included 534 participants, all of whom wear contact lenses for presbyopia. Participants were from the United States, Canada, Europe, and Australia/New Zealand (mean age, 52 years) and had been fitted with the water gradient DDMF. This lens is engineered to mimic the aqueous layer of the ocular surface of the eye, with a water content that is 33% at the core and approaches 100% at the outer surface. It is the only water gradient DDMF on the market, Dr Merchea and colleagues noted.

"Patients in the survey were being seen for routine care and were offered the chance to try the water gradient DDMF," Dr Merchea explained. They had been wearing 13 different types of multifocal (61%), monovision (23%), and single-vision (16%) lens. Patients were instructed to use only these lenses for 1 to 2 weeks, replace them daily, and not sleep overnight in them.

The participants completed two surveys in the office of their eye care professional (ECP): a baseline, prefitting survey about their experience and satisfaction with their current (habitual) contact lens, and a survey about the new lenses after 1 to 2 weeks of wear.

"Only 27% of US patients reported (strongly agree/agree) that their habitual contact lenses were comfortable at the end of the day. We showed there's a huge opportunity for improving the patient experience," Dr Machea commented.

The ECPs also completed two surveys: the first before fitting and the second after fitting patients with the water gradient DDMF. They were asked about ease of fit, vision quality, and preference.

Patients reported excellent comfort and vision, plus a high level of satisfaction with the novel water gradient DDMF, delefilcon A. In addition, their ECPs reported that the lenses were easy and efficient to fit and that they would recommend them to colleagues and to their new and existing patients, Dr Merchea said.

Almost all patients indicated a preference for the water gradient DDMF, for a variety of reasons. The following rates are from 155 patients in the North American cohort (responses were similar for the global cohort):

  • 92% said the water gradient DDMF lenses feel comfortable at the end of the day,

  • 81% said that compared with their previous lenses, they feel less dry at the end of the day,

  • 78% reported having clear vision near to far, with smooth transitions in between,

  • 81% said vision is clear when using digital devices,

  • 82% said distance vision is clear when driving,

  • 81% reported feeling less tired when working at the computer, and

  • 85% said they preferred the water gradient DDMF over their previous lenses.

Patients also reported feeling "younger" when wearing the new lenses, and they were able to wear them, on average, 2.5 hours longer than their previous ones.

Dr Machea said the satisfaction with distance vision was especially important to the study's researchers: "With multifocal contact lenses in general, the most frequent reason for failure and criticism is that 'distance vision is affected.' It's a significant reason many patients prefer monovision." he said.

Eye Care Professionals' High Ratings

"And despite research showing that multifocal lenses perform better, even many doctors have the perception that monovision gives better distance vision," he said. "The anecdotal feedback we have received from doctors who try the water gradient lenses themselves is that distance vision is much better than they expected.... The survey results are a good validation of this."

Results from the ECP's survey showed reactions that were similar to the patients', with high satisfaction with the water gradient DDMF, as follows:

  • 100% felt the lenses were easy and efficient to fit,

  • 100% would recommend them to colleagues,

  • 92% said water-gradient DDMF will be the "preferred" DDMF contact lens in their practice, and

  • 92% plan to "proactively recommend" that their presbyopic contact lens wearers switch to these lenses.

Acceptance from ECPs was important, especially as many perceive multifocal lens to be harder to fit, according to Dr Machea. "Chair time is critical to them," he said. "We have shown the speed of fit is fairly quick: in 98% of eyes, they can be fitted successfully within two lenses," he said.

Progressive Lens for Presbyopia

The second survey assessed real-world patient experiences (comfortable vision, satisfaction) with the three-zone progressive Bausch & Lomb Ultra for Presbyopia contact lenses. Dr Saxon presented the poster along with William Reindel, OD, executive director of medical affairs with Bausch & Lomb, Rochester, New York, who was interviewed by Medscape Medical News.

The lens is designed to address the issue of the growing use of smartphones and tablets, "which challenge the vision of the presbyopic patient," according to the authors. Dr Reindel said their product is "an innovation in technology" that takes into account "a lot of different information about visual systems" (such as pupil sizes, residual accommodation, numerous distances) and modeling of hundreds of different designs.

"We focus a lot of light energy in the near zone and in the intermediate zone, and we don't compromise the distance zone," he explained. "What's unique with this product is how we distribute the power change across the surface of the lens.... The computer model allowed us to manipulate the optical characteristics of the lens to determine which design would optimize outcomes for a large population of patients."

Their survey aimed to determine how this product is meeting patients' needs: specifically, whether it satisfies patients in terms of near vision, intermediate vision, and comfort in switching back and forth, the three factors considered most important to patients.

Independent ECPs were asked to prescribe Bausch & Lomb Ultra for Presbyopia to their presbyopic patients as part of their routine clinical practices. Patients were asked to complete an online survey after wearing the new lenses for at least 5 days. "Comfortable vision" was defined as "being able to see clearly without a compromise in the comfort of your contact lenses."

Of the 608 participants (mean age, 51 years), 468 were previous contact lens wearers and 140 wore eyeglasses only. They reported spending more than 6 hours a day using a computer at work and at home.

Patient Satisfaction: 95%

"We put patients in a three-zone progressive multifocal contact lens and asked them to report outcomes in a real-world environment. We saw some dramatic improvements over their habitual lenses," Dr Reindel said.

For the previous contact lens wearers and patients who wore eyeglasses only, 96% and 94%, respectively, gave overall favorable ratings for the Bausch & Lomb Ultra for Presbyopia lenses. The results contradict the perception of many practitioners, "that people who wear spectacles would not be good candidates for multifocal lens," he said.

The proportion of all patients reporting "comfortable vision" for various situations was as follows:

  • 86% for all distances,

  • 89% for near vision (smartphone, tablet, book),

  • 92% for intermediate vision (working at computer),

  • 90% for distance vision (seeing street signs),

  • 93% during physical activities,

  • 87% in low light conditions, and

  • 92% in bright light conditions.

Ease of seeing objects at various distances was assessed separately for the 468 previous contact lens wearers and the 140 eyeglass-only wearers, and in all endpoints the new lenses were preferred over the habitual lenses. Most strikingly, among previous contact lens wearers, 76% of patients reported "ease" at near distance with the Ultra Presbyopia lenses, whereas only 27% reported this for their habitual prescription; "ease" at intermediate distance was reported by 80% and 46%, and "ease" with distance vision was reported by 77% and 61%, respectively.

Previous eyeglass-only wearers also preferred the new product over their eyeglasses, but numerical differences were slightly less. "Their near vision should be decent already, but we even saw significant improvements in vision for near and intermediate," Dr Reindel noted.

Attendees Impressed With Results

Omar Lenfesty, OD, of Lansdale, Pennsylvania, commented on the importance of having better options for presbyopia. "The demographic in 2014 shifted to having more patients in the 65 to 85 age bracket than in the 45 to 65 bracket, and this is an issue for all optometrists," he said. "It's amazing that they are now using computer modeling of the process. With modeling data they can modify multiple parameters — tweak things and see what happens — which makes a huge difference. With this [Bausch & Lomb Ultra for Presbyopia,] it appears that they've nailed it on the head for getting the ability to see at different distances and not have a problem accommodating. But the mean age was 51 in the study, and that's very early presbyopia. I'd like to see results on older patients."

Mile Brujic, OD, from Bowling Green, Ohio, said the Bausch & Lomb product is the first lens he has been able to successfully fit for low-add patients. "The reason is that we have been taught there's a tradeoff between distance and near vision, but we are not seeing that here. We are obtaining good up-close vision without compromise. And people who require +2.00 to +2.50 adds are doing remarkably well with these too."

Harmony Grinstead, OD, who practices in Laurel, Maryland, said she is considering prescribing the water gradient DDMF, and the findings here impressed her. "The most important thing for me is that patients did not have to keep coming back to get the right fit," she said. "This is not just important to me, but also to my patients.... Also, even a 50% improvement [over habitual lenses] would have been good, and this was lots higher."

Dr Manchea is an employee of Alcon Labs, Inc. Dr Reindel and Dr Saxon are employed by Bausch & Lomb. Dr Bennett is a consult for the Contact Lens Manufacturers Association. Dr Brujic consults for multiple lens manufacturers, including Bausch & Lomb. Dr Grinstead and Dr Lenfesty have disclosed no relevant financial relationships.

Optometry's Meeting by the American Optometric Association (AOA): Abstracts 22 and 26. Presented June 25, 2017.

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