Published in Contact Lens

Finding Lens Selection Strategy for New Contact Lens Wearers

This is editorially independent content
4 min read
For patients new to contact lenses, it is up to optometrists to take accurate measurements, find the best fit and modality, and educate these patients on handling.
Finding Lens Selection Strategy for New Contact Lens Wearers
What kind of patient comes to 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 ready to ditch their glasses, but in reality, a new wearer could be of any age or refractive error type. With so many options available, how can you effectively choose a lens for someone who has never used contact lenses before?

Choose a daily disposable modality

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 also important to include adults in that discussion.
Dailies disposable soft contact lenses are the safest option for our patients, decreasing the risk of contact lens-related complications.1
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 typically pretty easy. They are convenient and eliminate the hassle of buying solution, cleaning, and storing lenses.
In today’s market, daily options are available for most refractive error types (sphere power, astigmatism, multifocals, etc.). 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.

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.2

Patients with astigmatism

It can be tempting to fit a spherical lens on a patient with only 0.75 or 1.00 diopter of astigmatism, but it has been shown that even low astigmats prefer vision and comfort with toric correction when compared to spherical.3-5

For new wearers, it’s important to remind patients that wearing glasses for a significant amount of time makes them accustomed to having their full astigmatic prescription corrected.

Dropping that correction in the contact lens may result in unsatisfactory vision and/or visual comfort. Choose a toric option whenever the manifest refraction has 0.75 diopters or more of cylinder.

Patients with presbyopia

Similar to astigmatic options, presbyopic contact lens modalities also tend to be under-prescribed.6-8 This is important to keep in mind, especially for adults interested in trying contact lenses for the first time.
In my practice, I’ve found that some adults don’t require contact lens wear until they reach pre-presbyopic or presbyopic ages. Often these adults have low hyperopic or myopic prescriptions. This means they could 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. Consider choosing a multifocal design for these patients, even in the emerging or early stages of presbyopia. Even if their distance prescription is minimal, prescribing a multifocal that allows them to see all distances and be free of spectacles will address their major complaints.

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 have to teach the patient how to handle the lens. You can approach this in many different ways, depending on your practice modality. You may do application and removal training or hand that task off to a trusted staff member.
Regardless of how you handle that in your practice, ensure that the patient has a solid understanding of how to handle, 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.
  1. Stapleton F, Bakkar M, Carnt N, et al. Clear - Contact Lens Complications. Cont Lens Anterior Eye 2021;44:330-67.
  2. Morgan PB, Efron N, Woods CA, International Contact Lens Prescribing Survey C. An International Survey of Toric Contact Lens Prescribing. Eye Contact Lens 2013;39:132-7.
  3. Berntsen DA, Cox SM, Bickle KM, et al. A Randomized Trial to Evaluate the Effect of Toric Versus Spherical Contact Lenses on Vision and Eyestrain. Eye Contact Lens 2019;45:28-33.
  4. Cox DJ, Banton T, Record S, et al. Does Correcting Astigmatism with Toric Lenses Improve Driving Performance? Optom Vis Sci 2015;92:404-11.
  5. Logan AM, Datta A, Skidmore K, et al. Randomized Clinical Trial of near Visual Performance with Digital Devices Using Spherical and Toric Contact Lenses. Optom Vis Sci 2020;97:518-25.
  6. Morgan P, Woods C, Tranoudis I. International Contact Lens Prescribingin 2016. Contact Lens Spectrum 2017;32:30-5.
  7. Morgan P, Woods C, Tranoudis I, et al. International Contact Lens Prescribing in 2017. Contact Lens Spectrum 2018;33:28-33.
  8. Morgan PB, Efron N, Woods CA, International Contact Lens Prescribing Survey C. An International Survey of Contact Lens Prescribing for Presbyopia. Clin Exp Optom 2011;94:87-92.
Erin Rueff, OD, PhD, FAAO
About Erin Rueff, OD, PhD, FAAO

Dr. Erin Rueff received her Doctor of Optometry degree from The Ohio State University (OSU) College of Optometry. Upon graduation, she completed the Cornea and Contact Lens Advanced Practice Fellowship at OSU. After fellowship, she continued at OSU as a clinical instructor and completed a PhD in Vision Science. In 2018, she joined the faculty at the Southern California College of Optometry at Marshall B. Ketchum University. Dr. Rueff’s research interests include contact lens discomfort and compliance. She enjoys teaching students in the clinic and classroom on contact lens and general optometry topics. Her clinical interests include multifocals, gas permeable and scleral contact lenses, keratoconus, and dry eye.

Erin Rueff, OD, PhD, FAAO
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