I saw a new, adult patient recently who was interested in trying soft contact lenses for the first time. His prescription was spherical, mildly myopic, and non-presbyopic in both eyes. In my practice, I am fortunate to have access to fitting sets from all four major manufacturers, so for this patient the options seemed to be essentially endless.
With so many options, it can feel daunting to determine the “best” contact lens to initially choose for a patient.
Contact lens considerations
I often hear other doctors or student interns rationalize a lens choice because they personally prefer that lens brand. While personal experience is important, some patients prefer certain brands over others, and it may not always be the brand you like for your own eyes. In a perfect world, there would be large, randomized clinical trials that would compare all of the lens brands to one another and tell us which lens is the best choice for different kinds of patients.
Unfortunately, those types of clinical trials don’t really exist. We typically rely on reports comparing two to four lens brands/modalities to one another or studies that report on the performance of one brand. While this evidence is meaningful, it can still leave a clinician wondering how to make the best lens choice for the patient, especially when you consider that personal and lifestyle factors also play a major role in the success a patient has with a lens brand or modality.
Winning strategy for lens selection
We have to develop a strategy, therefore, to select contact lenses for our patients. While this process can sometimes feel somewhat non-scientific and random, you can practice a step-wise approach that lends reason and rationale to your lens selection.
Parameter availability
First, consider parameter availability. For patients with mild to moderate hyperopia, myopia, and/or astigmatism, most contact lens brands (regular replacement and daily disposable options) offer parameter ranges that can accommodate them. Some brands even have slightly extended ranges to serve those ametropic prescriptions with parameters just outside what we would consider mild-moderate (i.e., more than 6 diopters of myopia, 2.75 diopters of cylinder, etc.).
Be on the lookout for prescription types that are outside of these “normal” ranges early in the fitting process. While these types of prescriptions are almost never deal-breakers when it comes to soft contact lens wear, prescription features like high hyperopia, high astigmatism magnitudes, and astigmatic presbyopia might be the limiting factor when choosing a contact lens brand.
Replacement schedule
Once you’ve acknowledged parameter needs, determine the replacement schedule. Daily disposable options are the most convenient and healthy soft contact lens option. In recent years the parameter availability for daily disposable spherical, toric, and multifocal lenses has expanded greatly.
As well, there are generally more options in each correction category for daily disposables. This means that most prescriptions can be corrected with a daily disposable option.
“Choose a daily disposable option first whenever possible.”
Especially for new wearers who are unlikely to be familiar with monthly or biweekly replacement options, a daily disposable modality is the best way to initiate successful, comfortable, healthy soft contact lens wear.
If a daily disposable isn’t a realistic option for the patient, consider choosing a monthly contact lens or two-week replacement option in a silicone hydrogel material to maximize oxygen permeability.
Contact lens cost
Next, consider cost. In a perfect world, we wouldn’t have to consider cost restrictions when choosing a contact lens for a patient. In reality, cost is quite important to our patients. Discussing the price range of the lenses you are considering will give you a sense of what the patient’s cost comfort level is.
“Educating about things like rebates and insurance benefits will also help the patient better understand how affordable contact lens wear can be.”
Within each manufacturer’s lens portfolio, there is typically a range of lenses that may be considered entry level from a cost perspective and some that come with a more premium price tag. That variability is a good thing for our patients. It means, with a daily disposable contact lens for instance, the patient can trial a lower cost option for a few days and then compare it to a higher cost option. As the clinician, you can allow the lenses to do the work for you and let the patient decide if differences in wearing experience between the two lenses justify any price differences.
Final thoughts
Once you’ve implemented a step-wise approach, keep an open mind and pay attention to patient feedback. Learning about a patient’s experience with a lens type can help guide you in making better lens selection decisions for that patient and those in the future. Successful soft contact lens selection can sometimes feel like more of an art than a science, but if your lens selection strategy considers each patient’s unique features and needs, you will be successful in selecting the best option.
