We all know about the benefits of hybrid contact lenses: for patients with corneal disease needing patient care, hybrid lenses offer incredible options. However, did you know hybrid lenses can be used for routine care and can tremendously help patients with astigmatism, and presbyopia, as well as patients who might not have had success with soft contact lenses? Hybrid lenses can even be used for specialty care outside corneal disease—giving these lenses even more use cases for the optometrist.
Furthermore, new developments in empirical lens fitting techniques make the
SynergEyes portfolio of hybrid lenses incredibly accessible for first-time fitters allowing you to focus on what matters most: your patients’ comfort, health, and sight. Plus, this technique does so while reducing your chair time, increasing efficiency, and generating new revenue for your practice.
We interviewed five clinicians who have been leveraging hybrid lenses in their practice for both routine and specialty care. In this article, these doctors share their insights into how they are using the SynergEyes portfolio of hybrid lenses in practice, providing their patients an excellent contact lens wearing solution, as well as building their practice and driving new streams of revenue.
Dr. Kasia Aleszczyk | SoLo Eye Care
Dr. Kasia Aleszczyk was born and raised in the Chicagoland area. Dr. Aleszczyk holds membership in the American Optometric Association, the Illinois Optometric Association, the Beta Sigma Kappa Honor Society, and the Tomb & Key Honor Fraternity. Kasia has clinical interests in specialty contact lenses including lenses for the treatment of keratoconus, post-operative LASIK ectasia and cornea transplant patients.
Dr. Melanie Frogozo | Alamo Eye Care
Dr. Melanie Frogozo is an optometrist who is a Diplomate in the Cornea, Contact Lens, and Refractive Technologies section of the American Academy of Optometry. Dr. Frogozo is residency trained in the treatment and management of anterior segment disease through medically necessary contact and prosthetic lenses. Originally from Houston, she completed college at the University of Texas at Austin and optometry school at the University of Houston.
Dr. Tiffany Andrzejewski | Chicago Cornea Consultants
Dr. Andrzejewski’s special areas of interest include the management of dry eyes, keratoconus, and other cornea and contact lens-related issues, as well as scleral contact lenses. She is highly trained in fitting specialty contact lenses for keratoconus, post-surgical corneas, and other corneal diseases, as well as multifocal, prosthetic contact lenses, and lenses for otherwise difficult to fit prescriptions.
Dr. Robert Steinmetz | SoLo Eye Care
Dr. Robert Steinmetz is the director and owner of SoLo Eye Care and Eyewear Gallery in the South Loop. Dr. Steinmetz is an Adjunct Clinical Preceptor at the Illinois College of Optometry and serves on the advisory board of three major pharmaceutical companies involved in the research and development of anti-allergenic and dry eye therapy. His clinical interests include anterior segment disease, hybrid and scleral contact lens technology, and corneal refractive therapy.
Dr. Ryan McKinnis | Cleveland Eye Clinic
Dr. McKinnis focuses a large portion of his career on advanced contact lenses for the most difficult patients and advanced ocular disease. He researches, publishes, lectures, and is a leader in keratoconus, scleral, gas-permeable, hybrid, and custom soft contact lenses. He is former governor of Zone 2 of the Ohio Optometric Association as well as a Fellow in the American Academy of Optometry and the Scleral Lens Education Society. Dr. McKinnis has achieved the title of Diplomate in Cornea, Contact Lens, and Refractive Technologies of the American Academy of Optometry. While not in the office you can often find Dr. McKinnis with his four children and his wife, Heather. He’s passionate about sports, loves to golf and creatively plans travel adventures for his wife and children as often as possible. He is also active in their local church and community when not chauffeuring the children!
What are hybrid contact lenses?
The
SynergEyes portfolio of hybrid contact lenses combine a rigid corneal contact lens (RGP) with a soft contact lens material bonded 360 degrees to the periphery of the lens, forming a HyperBond®. This design optimizes clear vision with the GP material and comfort with the soft “skirt.” There are hybrid designs for both patients with normal corneas and irregular corneas.
The gas permeable material used in these lenses is petrafocon A which has a high Dk value of 130, and the skirt is made out of a silicone hydrogel material (hem-larafilcon A) which has a Dk of 84 and a 27% water content.1
Most designs of these lenses are available with the ability to correct +20.00 to -20.00 Diopters (D) of myopia and hyperopia, astigmatism up to 6.00 D, and add powers between +1.00 and +4.00 D.2
SynergEyes Duette and UltraHealth lens designs are now available with Tangible™ Hydra-PEG: a coating that is bonded to the contact lens to increase comfort and wettability. This coating maintains its presence for the entire duration of the 6-month life of the hybrid lens.
A closer look at SynergEyes hybrid contact lens options:
- Duette
- Single vision lenses for normal shaped corneas
- Corrects hyperopia, myopia, and astigmatism
- Duette Progressive
- Multifocal lenses
- Options for center distance and center near design
- Adds up to 5 Diopters (CD only)
- UltraHealth
- Advanced hybrid technology for keratoconus
- Reverse geometry design allows for flatter base curves and less peripheral tightness when fitting steeper corneas.1
- UltraHealth FC
- Designed for flatter post-refractive surgery patients (post-RK, post-LASIK) by using a refined reverse geometry design.
Here's a great overview of SynergEyes lenses
How can SynergEyes hybrid contact lenses help grow your practice?
- Fitting patients in SynergEyes hybrid lenses can help increase profitability since these lenses are only available to independent ECPs which means patients must obtain materials through you and are unable to purchase from big box retailers or online.
- The specialization factor of hybrid lenses is something patients like to talk to their friends about and will garner more word-of-mouth referrals than soft lenses.
- Continuum of care. SynergEyes hybrid lenses are designed to offer a continuum of care, meaning these lenses can grow with your patients and evolve with them as their needs change. The Duette Progressive lens is available in both Center Distance and Center Near designs, so if a patient is successful wearing Duette Progressive lenses as an early presbyope, you know that there is a Duette Progressive lens option ready for them as their near vision needs change with age and advancement of presbyopia.
- Patient retention is stronger when you are viewed as providing a unique and special product.
If you are wondering if you have enough patients to start using hybrid lenses, you don’t have to look far!
Patients in your practice who may benefit from a hybrid contact lens
- Patients who are unhappy with the quality of their vision in soft contact lenses.
- Patients with subtle irregular astigmatism: dry eye, epithelial basement membrane dystrophy, post-LASIK.
- Taking a topography on patients whose complaint is “my vision is just not sharp enough” can reveal these subtleties, and you can be their hero!
- Patients who have failed many soft multifocal/progressive contact lens designs.
- Patients with astigmatism whose soft lenses “move around too much” (Note: in a recent survey of toric lens wearers, nearly 76% of respondents reported multiple issues involving dryness and toric rotation with their soft toric lenses).4
- People with keratoconus or other irregular corneas
SynergEyes hybrid lenses for normal corneas
As discussed, hybrid lenses can tremendously benefit patients with normal corneas. These patients can present in your practice as those “routine” contact lens wearers. Many of these patients’ lives can be enhanced with the improved optics, stability, and comfort of a hybrid contact lens.
A quick way to identify candidates is to simply ask current soft contact lens wearers about the quality of vision in their lenses. When you are hearing less than stellar reviews about vision and lens stability with their current soft contact lenses, this is a perfect opportunity to introduce hybrid lens technology. This, combined with their wide range of parameters, help make hybrid contact lenses a perfect go-to option for these patients.
Even if you don’t think your patient would choose a more advanced lens, informing them of their options solidifies that you are an expert in your field and offering the best possible products to them. In a recent survey of toric lens wearers, nearly 75% of respondents suggested that they would be willing to pay an additional $50 or more per year for a contact lens that eliminated the issues they currently experience with their lenses.4 You may be surprised at how many patients value lenses that can offer the best technology, regardless of price, because they want the best vision possible.
Drs. Steinmetz and Aleszczyk routinely offer
SynergEyes hybrid contact lenses to astigmats and presbyopes—two of the most common patients you are likely to see in your practice!
Duette : for patients with astigmatism
Dr. Steinmetz has found success fitting hybrid lenses for his normal cornea patients who have astigmatism and specifically targets athletes. Whether athletes in high school, college, or on professional sports teams, if patients have astigmatism and their soft toric contact lenses aren’t providing the most clear and stable vision, chances are, vision can be a major problem while trying to track a ball or focus on a moving target.
Duette lenses
Dr. Steinmetz prescribes these patients Duette hybrid contact lenses and explains how both improved optics and stability can help take their athletic performance to the next level. When it comes to choosing between hybrid lenses and RGPs, the stability of hybrid lenses is much better than with RGP lenses, especially for those who need front surface toricity with prism ballast, making it an easy choice for these patient types.
“When you take a look at an example of a high-end athlete, high-velocity ball sports require vision better than 20/20,” says Dr. Steinmetz. “The best way for me to give my patients 20/15 or even 20/12 vision is going to be with a hybrid lens—because with SynergEyes lenses, athletes don’t have to worry about blurred vision, which could be the difference between winning and losing a game.”
Dr. Aleszczyk routinely offers Duette hybrid lenses when she finds herself in the office faced with a patient who has high astigmatism or high myopia and is just not getting the visual clarity they desire. These patients typically have never heard of hybrid lenses and are not aware other options exist. They think they are limited to the vision they are currently getting out of their soft lenses.
After educating these patients on the optics of hybrid lenses and how they can improve vision, not only are these patients eager to try hybrid lenses, they are thankful to you for introducing them to technology they have never heard of.
Dr. Melanie Frogozo suggests considering hybrid lenses for patients with astigmatism, especially oblique astigmatism which can be so difficult to correct with soft contact lenses due to rotation.
Patient case: Dr. Aleszczyk
Dr. Aleszczyk remembers a 30-year-old highly myopic (-12.00 D) patient who scheduled an appointment with her because the patient knew she fit hybrid lenses. The patient had been wearing soft contact lenses but was unhappy with the quality of her vision. Dr. Aleszczyk fit her with Duette lenses because of Duette’s extensive parameter options. Fitting this patient in a Duette lens was life changing. It’s important not to underestimate how improving a patient's vision, even “just a little bit” can make a difference in their lives. This patient instantly became a patient for life, and an advocate for the practice.
Some patients may be much more sensitive to the rotation of soft toric lenses than others. This may be because the prism ballast of a soft toric lens is ruled by gravity. When a patient is not sitting upright and is, for example, laying on their side to watch TV, the lens will rotate and vision will be out of focus. Hybrid lenses through the GP component and tear lens, make this rotation inconsequential. This is a perfect example as to why you should take the time to discuss lens performance and satisfaction with your contact lens wearers, especially those with astigmatism! They might be happy with their vision only when staring straight ahead, but might report total lens failure upon head movements or while doing other hobbies or playing sports.
Duette Progressive: for patients with presbyopia
With his
presbyopic patients, Dr. Steinmetz finds that the confidence that comes from not having to pull out reading glasses at a dinner table is enough of a motivation to move into hybrid lenses.
He also notes good patient retention in the practice since these patients can age with their lenses due to the continuum of care Duette lenses can provide. He will first fit an emerging presbyope with a Duette Progressive with a low ADD power and graduate them to higher ADD powers as they age, all while keeping the exact same lens design. This makes the fitting process an absolute dream and increases efficiency in the exam lane: “I can’t tell you how great it is to be able to fit a lens once, and simply change the parameters I need as the patient’s needs evolve without having to re-fit!”
There is your routine presbyope, and then there is your presbyope with astigmatism. These patients have often been left frustrated by limited soft contact lens options that offer little in terms of clear quality vision at all distances. Dr. Frogozo leverages the Duette Progressive lenses for these patients. These lenses are highly customizable with varying optical zone sizes and ADD powers giving optometrists an incredible arsenal of options to offer these patients, not to mention they can be ordered empirically.
Patient Case: Dr. Steinmetz
A 49-year-old single female physician who presented to my office with mild hyperopia and significant corneal astigmatism of 1.75 diopters. Her health history is unremarkable, aside from a history of surgical cosmetic procedures. Her ocular health is normal and she presents with no signs or symptoms of dryness.
Her habitual single vision glasses are two years old and used for reading, viewing electronic medical records at work and performing minor in-office procedures. Her chief complaint at the time of her visit was the inability to read small print without glasses and that they made her “look old." She has attempted soft monovision contact lenses in the past but never was able to adapt to the optics and felt “imbalanced.” She would love a contact lens she could wear all day and would even be happier if she could wear them socially.
Duette Progressive
She was a perfect candidate for Duette Progressive lenses. I called the SynergEyes Technical Consultation team and empirically fit her in a Duette Progressive lens with Tangible Hydra-PEG with a low +1.00 ADD power in a flat skirt. Her corneal cylinder nearly matched her refraction. She returned for her fitting and was very pleased with the comfort and acuity at all distances. At her two week follow up, she loved the overall experience, but wanted a little bit more reading power when holding her phone and dining in dim light. She was plano at distance but loved an additional over refraction of +0.50 at near OU. I was satisfied with her fit but wanted a slightly better centration. I steepened the skirt to medium and ordered the new lenses in a +1.75 ADD power. The results were remarkable. She was able to wear the lenses full time for 15 hours a day. She explained that she is even able to remove sutures in-office without her reading glasses. She has since referred several of her colleagues and friends to see if they are candidates for this technology.
UltraHealth: for patients with irregular corneas
When considering treatment options for patients with irregular corneas, most ODs might be more familiar with the benefits of hybrid lenses or RGPs. However, why consider hybrid lenses over RGPs as your first choice? For these patients, UltraHealth is a great option.
UltraHealth lenses (Photo Credit: Dr. Ryan McKinnis)
Patients who have keratoconus, corneal transplants, corneal scarring and more, can all benefit from the enhanced optics of a rigid lens. Those with highly altered corneal shapes can experience an instability in their RGP lenses or decrease in comfort, both of which can be improved with a hybrid lens.
SynergEyes recommends using the UltraHealth hybrid lens design for patients with mild to moderate keratoconus, while their SynergEyes VS lens, a scleral lens, may be preferable for more advanced cases.
When considering which lens to fit, hybrid lenses have advantages over scleral lenses. One is the ease of insertion and removal, which is closer to that of a soft lens. Those with glaucoma filtering blebs may benefit from the hybrid lens as a way to avoid compression by a scleral lens. If worried about corneal edema when fitting a corneal transplant, hybrid lenses provide increased oxygen due to the thin profile of the RGP lens and greater tear exchange.
Dr. McKinnis finds success with hybrid lenses because the weight of the lens is distributed more evenly across the lens and avoids compression over the apex of the keratoconic cornea, as compared to RGP lenses. He finds them easier to fit than many other kinds of lenses and orders them empirically using his patients’ topographies and prescription.
Dr. Tiffany Andrzejewski uses hybrid lenses for irregular corneas to bridge the gap between a patient who has previously worn soft contact lenses but needs the GP optics. The handling of the hybrid lens feels less foreign to patients since application and removal is similar and the fit is more simplified.
She uses topography images to evaluate the elevation data of the cornea. Those with central corneal steepening are great candidates for hybrid lenses because the lens will have a good centration.
Patient case: Dr. Andrzejewski
Dr. Andrzejewski describes a young Hispanic male patient with moderate keratoconus who was referred after corneal crosslinking surgery. During his initial consultation, Dr. Andrzejewski diagnosed him with floppy eyelid syndrome and bilateral pinguecula. She decided that a hybrid lens would be preferable to an RGP lens because of improved stability under the loose lids, and an easier fit than a scleral lens by avoiding having to vault over the pinguecula. The patient has successfully worn hybrid lenses for a year.
Hybrid Lenses for Myopia Control
Hybrid lenses are used in cases outside of the regular and irregular cornea, but have also become more commonly used in myopia control. While this is an off-label use, doctors like Dr. Frogozo, have been leveraging the Duette Progressive for myopia control providing yet another use case for hybrid lenses and practice revenue stream.
Myopia control has become a focus for a lot of doctors. Not only is myopia control an important public health issue, but the pediatric population can be one of a practice’s greatest drivers of growth as parents are likely to refer other parents to doctors who specialize in contact lenses for young kids.
According to studies, lenses that are used for myopia control should have the design of center-distance optics with a stronger ADD power of about +2.50 or more. The most recent progressive study showed greater myopia control effects with higher ADD powers (+2.50) compared to medium ADD powers (+1.50).3 The Duette Progressive Center Distance is available up to +5.00 ADD power which is higher than a soft progressive lens and could have a better myopia control effect.
Dr. Melanie Frogozo has found success using Duette Progressive hybrid lenses for myopia control due to:
- The optics of the central GP lens allows for more accurate correction of both myopia and astigmatism, especially oblique astigmatism.
- Hybrid lenses allow for the fit of the skirt and base curve to optimize centration of the optics of the eye. You are unable to change base curve in a soft lens
- You can customize for higher ADD powers
- You can customize the distance and near zones by modifying center distance zone size based on pupil size to ensure that the near zone is within the visual axis in order to control for myopia
How to start fitting SynergEyes hybrid contact lenses in your practice
Fitting hybrid lenses does not have to be intimidating. There are a few main things you need in order to get started:
- Your patient’s prescription
- Your patient’s keratometry (K) readings or topography
- Horizontal Visible Iris Diameter (HVID)
- Pupil size in photopic light (for fitting the Duette Progressive Center Distance design)
Is that it?
Yes, that’s it!
You can now fit Duette and UltraHealth lenses empirically. You simply need to call in with the information above and you are good to go!
What is empirical fitting and why is it a major advantage?
Being able to fit empirically can have tremendous benefits. Both SynergEyes Duette and UltraHealth lenses can be fit empirically.
- Not only can it allow you to save precious chair time, but it gives those practitioners who might not have a lot of experience fitting hybrid lenses the opportunity to do so.
- At a time when hygiene is more important than ever, limiting patient encounters, especially those that involve a lot of contact is paramount.
- Another major benefit is you do not need to invest in a fit set! This saves your practice money, and space!
Dr. Aleszczyk and Dr. Frogozo both use empirical fitting exclusively in their office for patients with normal corneas. Dr. Aleszcyzk found that her lens designs ended up with the same parameters as her design with an in-office fitting set. She confirms that more often than not, the lenses fit well on the first order with no need for changes.
If you are feeling motivated, you can certainly still obtain a fitting set. The “WOW” factor of trialing these lenses on patients in the office is second to none and can really be helpful for those patients who are on the fence about moving to a specialty lens. Giving patients the opportunity to experience the comfort and quality of vision offered by the lens can make a huge difference.
How to introduce hybrid lenses to your patients
Patients appreciate being given the option of advanced technology. You would be surprised at how many routine patients might elect for a more advanced lens design because they want to have the highest quality vision possible.
When it comes to navigating the cost of hybrid lenses, the benefits of clear, consistent, and comfortable vision oftentimes is enough. It is also important to explain to patients that hybrid lenses last longer than soft contact lenses and overall, the price point for an annual supply can be similar to a year supply of daily lenses.
As for explaining hybrid lenses to patients who might already be familiar with soft lenses and rigid gas permeable lenses, it is easiest to talk about hybrids the way they are usually taught! Hybrid lenses are taught as “the optics of a rigid lens, with the comfort of a soft lens”, and that’s exactly the way you can explain them to patients!
You can add in a small discussion about how the tear film is able to “fill in all the gaps” to create a more perfect optical surface to see with. Dr. Steinmetz explains the lens as “floating” on the tear layer. These explanations help patients understand the technology and why it is special.
Dr. Steinmetz introduces these lenses to his patients by allowing them to hold the hybrid lens in the office on their first appointment. This helps them to understand why the lens is special and takes away the apprehension of wearing a “hard” lens.
Dr. Andrzejewski explains hybrid lenses as an option for better customization to the shape of the patient’s eye compared to a soft “off the shelf” product.
How to ensure success when fitting hybrid contact lenses
Provide Instructions Before The Dispensing Appointment
Have the patient watch insertion and removal videos prior to their dispensing appointment. SynergEyes provides these videos online (
Duette and
UltraHealth) as well as brochures that you can give to the patient at their first appointment to help them find the videos and educate them on their new lenses. Patient education prior to the appointment saves a lot of time on the day of dispensing.
Provide Exact Lens Care Instructions
To avoid any confusion, type up the exact care regimen you’d like your patients to use with their lenses, put your personal office branding at the top, and voila! Patients feel that they are receiving a high-quality, personalized product and service. Dr. Frogozo’s patients leave the dispensing appointment with a “goodie pack” of solutions and instructions.
Tips To Grow Your Practice With Hybrid Lenses
- Fit yourself and your staff with hybrid lenses. The more experience and comfort your office has with the technology, the easier you can explain it to your patients. This especially helps with teaching insertion and removal.
- Once you decide to incorporate this technology, get the word out! Send it out in your office’s email marketing letter, put a post or blog about it on your website and social media channels.
- When you have a happy hybrid patient, take a photo and ask if you can share their story on your social media. Patients and referring Doctors love to see examples of happy patients.
- Let current patients know. If they are in your chair with complaints about their lenses, explain the hybrid technology. Many just want the best that’s out there and are willing to make the investment.
Dr. Steinmetz recommends adding hybrid lenses as one way to differentiate yourself from other practitioners. He has found that the optics of the Duette and Duette Progressive lenses provide his patients the best acuity of any lens on the marketplace.
Dr. Aleszczyk, who has fit hybrid lenses for years, thinks of them as a “no-brainer” tool to add to your office, especially with the success of empirical fitting with SynergEyes, which allows you to order lenses without having to use trial lenses in the office.
Dr. McKinnis finds that the unique simplicity of empirical fitting means hybrid lenses are a favored option in his clinic for reduced chair time and improved patient satisfaction, particularly for his many patients with high astigmatism, presbyopia, and irregular corneas.
Why hybrid lenses will be a great addition to your practice
Whether you’re treating patients with regular or irregular corneas, hybrid contact lenses are a great option for those who want to achieve sharper vision. Not only can hybrid lenses allow you to keep your corneal disease patients returning to your practice, but they have a strong place in routine care as well!
Every practice sees patients with
astigmatism and presbyopia, along with soft contact lens wearers who are unhappy with the quality and stability of their vision. You do not need to be a “specialty” practice to use hybrid lenses, or need a lot of experience or be an “expert” at fitting them to get started—hybrid lenses can be fit empirically, making it easy to get started without a lot of experience or investment.
Hybrid contact lenses can provide your patients GP quality vision with the comfort of a soft lens, and they can elevate the care you provide to patients, enhancing their experience while differentiating your practice and growing profits through patient retention and word of mouth referrals.
References
- Watanabe, RK. “Contact Lens Design & Materials: Hybrids – Then And Now”. Contact Lens Spectrum. November 1, 2017. https://www.clspectrum.com/supplements/2017/november-2017/contact-lens-spectrum-special-edition-2017-your-g/contact-lens-design-amp;-materials
- “Patient Instruction Booklet For The: Duette®SiH Hybrid Contact Lens. www.synergeyes.com.
- “Multifocal contact lenses slow myopia progression in children”. National Institute of Health News Release. August 11, 2020. https://www.nih.gov/news-events/news-releases/multifocal-contact-lenses-slow-myopia-progression-children
- “Toric Wearer Survey 2020.” AYTM Online Survey (prepared by SynergEyes), November 5, 2020.
