The international eye-care profession is busy these days, adjusting to notable new challenges pertaining to contact lens options in patient care. At the top of the list and eliciting both the excitement and the caution of all concerned, are silicone hydrogel contact lenses for 30-day continuous wear.

Contact lenses form an essential part of a sound eye-care practice. Surveys of practitioners who actively promote contact lenses have verified this effect, stating greater patient loyalty, increased referrals per patient and a higher per capita annual return than spectacle wearing patients only ^1,2.

To a practitioner gauging a potential continuous wear patient in office, a fundamental question arises: 'why silicone hydrogels?'

Towards the end of the nineties, contact lenses took an unfortunate backbench to costly surgical alternatives such as LASIK. However with time, the technology pendulum has wisely swung back in the contact lens direction. Incredible advances have emerged in biomaterial engineering and surface chemistry, allowing scientists to generate a new breed of silicone hydrogel contact lenses. The timing of arrival of these could not be better. As usual with history repeating itself, the public has already grown weary of sensational press reports of adverse outcomes with refractive surgery, and is again showing a healthy interest in contact lenses ³.

Practitioners who market avant-garde technology appeal to the public, by making the following simple, subliminal statement: we are enthusiastic about our line of work and are proudly offering the latest advances in the field. The savvy consumer will quickly appreciate the value and convenience of continuous lens wear.

The role of silicone hydrogel lenses in daily wear should not be undervalued. They have been used in instances of dry eyes, chronic hypoxic stress and as therapeutic bandage lenses. Due to the ease of insertion and removal brought about by the rigidity of the silicone material, some unsuccessful continuous wear patients have even selected to use these lenses in daily wear frequent replacement plans. Indeed, the lenses are so physiologically superior to previous hydrogels, that one could find it difficult not to recommend them as the lens of first choice to all patients.

   

Education and commitment are essential attributes to promoting continuous silicone hydrogel lens wear in practice. The knowledge required to maintain good practice standards and to manage problems potentially associated with silicone hydrogels is easily obtainable. Practitioners need to yield to the advice of researchers in the field, as they have the net advantage of years of preliminary exposure to the new materials and to observation of the lens performance in stringent clinical trials.

Information collected in trials, researcher impression and deductions, discussions on every aspect of silicone hydrogel lens selection, fitting, aftercare, and long-term effects are continually being published and updated at international conferences. Local contact lens associations, colleges and other licensing bodies also offer continuing education seminars, workshops and lectures. Most conference organizations also publish a compendium of presentations, abstract books, journals, cd/dvd-rom, websites, newsletters etc…

For a more comprehensive approach, various clinical books are now available which give step-by-step instructions and information on silicone hydrogel contact lenses. One such book edited by Vision Cooperative Research Centre (VisionCRC)'s Debbie Sweeney and entitled "Silicone hydrogels: the rebirth of extended wear ⁵" explores every facet of this new modality from its history and origin through its biochemistry, surface qualities, advantages, possible adverse events, practice management and emergency contingencies. Current educational textbooks edited for students in the fields of vision and contact lenses also dedicate entire chapters to extended wear and in particular, to continuous silicone hydrogel lens wear.

Another sensible and comfortable method of keeping abreast of the silicone hydrogel topic, is by simply browsing this very website. All recent data are made available soon after publication in a methodical and unbiased manner. Furthermore, it provides an excellent supplementary list of reference papers and access to a panel of experts, which can assist practitioners in times of doubt or unease about various lens-related issues.

Slit lamp examination of Silicone Hydrogel wearer

In a clinic, no additional equipment is required in a standard consulting room when incorporating silicone hydrogel contact lenses. The traditional bio-microscope and keratometer do just fine. On the other hand, it is crucial for clinicians to be able to differentiate changes taking place in the anterior eye. The easiest approach for this is to refer to grading scales. Grading scales are self-explanatory, easy to use and readily available either through their authors or sponsors. At this time, 2 different scales are in circulation and widely available to eye-care providers. For efficiency and consistency, practitioners are better off familiarizing themselves with one grading scale, and frequently assessing their own repeatability in grading the various symptoms.

The "Guide to Corneal and Infiltrative Conditions⁶" published by the Vision Cooperative Research Centre (VisionCRC)/ LV Prasad Eye Institute is also easy to understand and is excellent for gauging conditions related to continuous wear, such as CLPU, CLARE, SEALS, microbial keratitis etc… The guide can be downloaded as a PDF from this website or obtained through direct correspondence with the Vision Cooperative Research Centre (VisionCRC).

As with most matters relevant to new technology, and regardless of how good a clinician is, one of the most unpredictable and potentially legally harmful aspects of clinical practice is human error. A simple act of forgetfulness, such as not checking a message bank or turning on an answering machine can have disastrous repercussions. Clinicians can use this opportune time when introducing new technology to their staff and patients to review all systems in place, test staff knowledge and skills and tighten the monitoring of patient care and compliance. The most important items worth noting are: ^4,5

• Practitioners need to ensure careful and optimal patient selection in fitting silicone hydrogel lenses for extended wear. Clearly patients with chronic ocular disease or difficulty accessing emergency care are not suited to extended wear of any kind. However, many other subtle difficulties such as environmental/occupational hazards exist, which will easily be brought out through a careful case history.
  
• Continuous wear patients should be able to consult an eye-care practitioner at all times. Mobile/cell phones or pagers are far more effective in this regard than message banks or answering machines, where there can be a considerable delay in accessing messages or worse, messages can accidentally be lost or erased.
  
• Eye-care professionals are ultimately responsible for the actions of their employees. Practice personnel need to be well versed in the triage of incoming patients and telephone calls, need to be familiar with key symptoms of acute adverse events and must know how to act when faced with such events.
  
• Patient aftercare visits should be set for regular intervals, monitored, enforced as much as possible within guidelines, and mainly must be well documented. Patient compliance needs to be re-assessed and re-emphasized at each visit
  
• All records must be kept in good order and frequently audited for obvious inaccuracies or updating. Documentation of the various types suggested in the current literature is highly recommended ^4,5.

Once practitioners have incorporated silicone hydrogel continuous contact lens wear into their practice, the last thing to do then is to get proactive in expanding and promoting this. A few suggestions based on recent surveys are offered below, which can be tailored to any practice, without the need for expensive advertisements:

• Regular staff meetings can be used to keep staff members in the loop, ensure good communication, enhance teamwork and get employees committed to the concept of silicone hydrogel continuous wear.
  
• Patient questionnaires are a good way to get feedback from new silicone hydrogel lens wearers. Systems need to be put in place to address concerns and very importantly, to let patients know how these concerns have been dealt with.
  
• Practice newsletters highlighting silicone hydrogel contact lenses and their benefits can be strategically placed in waiting areas and/or sent out with recall notices.
  
• Dispensing and consulting room walls may be used to feature silicone hydrogel contact lenses, 30-day continuous wear, and a clinician's own expertise and specialty in this field.
  
• Recompense by way of discounts or other special offers to patients for word of mouth referrals seems to have become a popular trend with some practitioners. However, it is up to individuals to decide whether this option is suited to their practice.