What kind of patient comes to your mind when you think of a neophyte or new contact lens wearer? It’s easy to assume that most new contact lens wearers are pre-teens or teenagers who are ready to ditch their glasses, but in reality, a new wearer could be of any age or refractive error type.
An emmetropic presbyope may pursue contact lens wear for the first time because they dislike being reliant on reading glasses. An adult with low levels of myopia might be interested in finally having clear distance vision without glasses for the first time. A new retiree might be considering contact lenses to wear during new hobbies and activities.
Different factors will motivate patients to pursue contact lens wear. As eyecare providers (ECPs), our job is to understand the nuance of the patient’s refractive and personal needs, and choose a lens that will allow them to have a great first experience with soft contact lenses.
But with so many options available to choose from, how can you effectively choose a lens for a person who has never used contact lenses before?
Choose a daily disposable modality
Daily disposable soft contact lenses are the safest replacement modality because they decrease the risk and severity of contact lens-related complications.3 This safety profile combined with the increased comfort and convenience patients experience with dailies have lead to a steady increase in daily disposable prescriptions.4
Between 2000 and 2023, prescribing of daily disposable lenses increased from an average of 17.1% to 46.7% across 20 countries, including America, Canada, Japan, and the UK.4 When choosing a lens for a neophyte, consider daily disposable options first. We often talk about how kids should be fitted in daily disposable modalities whenever possible, but it’s important to include adults in that discussion as well.
This is especially true for new wearers who are not accustomed to using a planned replacement (monthly or 2-week) modality, making the daily disposable conversation relatively easy. They are convenient and eliminate the hassle of buying solution, cleaning, and storing lenses.
In today’s market, there are daily options available for most refractive error types (sphere power, astigmatism, multifocals, etc.), and most manufacturers have product portfolios that include a premium daily, and a more economical, entry-level option.
For patients with a refractive error in “normal” ranges, there are typically multiple daily disposable options that could address their visual needs. We are even starting to see daily disposable options for patients with more “unique” prescriptions or those who may not have had a parameter option in the past.
For example, Johnson & Johnson is launching the Oasys MAX Multifocal for Astigmatism in 2025. This is the first daily disposable toric multifocal to hit the market and offers sphere, cylinder, and add powers that should allow ECPs to fit most astigmatic presbyopes.
Address all refractive needs
When choosing a lens and power profile for your new contact lens wearer, make sure you maximally correct each refractive error detail. As eyecare providers, we tend to under-prescribe astigmatic contact lens options.5
Patients with astigmatism
It can be tempting to fit a spherical lens on a patient that has only 0.75 or 1.00 diopter (D) of astigmatism, but it has been shown that even low astigmats prefer vision and comfort with toric correction when compared to spherical.6-8
Dropping that correction in the contact lens may result in unsatisfactory vision and/or visual comfort. For new wearers that are accustomed to having their astigmatism corrected with spectacles (even in small magnitudes), it’s important to acknowledge that they are used to having full toric correction and will expect that for visual satisfaction with a contact lens.
Choose a toric option whenever you see that the manifest refraction has 0.75D or more of cylinder.
Patients with presbyopia
Similar to astigmatic options, presbyopic contact lens modalities also tend to be under-prescribed.9-11 This is important to keep in mind, especially for adults who are interested in trying contact lenses for the first time.
Some adults don’t require contact lens wear until they start to reach pre-presbyopic or presbyopic ages. Often these adults have low hyperopic or myopic prescriptions. This means that they were able to get through most of their adult life with little to no blur at distance or near, and no need for glasses or contact lenses. As presbyopia approaches, however, they begin to experience blur that they can’t work through, and find themselves reliant on reading glasses.
This can be quite alarming after a lifetime of good vision. For these patients, even if they are in the emerging or early stages of presbyopia, consider choosing a multifocal design. Even if their distance prescription is minimal, prescribing a multifocal that allows them to see at all distances and be free of spectacles will address their major complaints.
For patients with higher refractive errors and/or astigmatism, also choose a multifocal option before resorting to over-contact lens reading glasses wear or monovision. Presbyopes pursue contact lens wear because they want to be spectacle-free and experience a visual environment as much like their pre-presbyopic days as possible.
While monovision might provide “good” in office vision at distance and near, it doesn’t provide a good range of vision and depth perception that a multifocal can. In fact, it’s been shown that contact lens wearers prefer multifocal contact lens correction to monovision, even when the objective visual acuity is similar between the two options.12,13
Be clear about handling and compliance
Once you’ve chosen a lens, evaluated it on the patient’s eye, and determined it to be a good option to trial, you need to teach the patient how to handle the lens. There are many different ways you can approach this depending on your practice modality. You may do application and removal training yourself, or hand that task off to a trusted staff member.
Regardless of how you approach handling training in your practice, ensure that the patient has a solid understanding of how to apply, remove, clean, and store the lenses (if applicable), and how to troubleshoot common situations that might arise.
Non-compliance can often occur because our patients aren’t well educated from the start, so take a little extra time to inform them about proper care and compliance in the beginning to avoid issues in the future.
Conclusion
A successful new contact lens wearer has the potential to be a patient in your practice for a long time to come. Be thoughtful about how you approach initial lens selection by choosing options that will provide good ocular health and maximize vision correction.
This strategy will ensure that your new contact lens-wearing patient is satisfied and eager to return each year to update their prescription and see what might be new and available to them.
