1. Contact Lens Options for the Non-Traditional Patient
Shane R. Kannarr, O.D.

2. Non-Traditional Patients for Contacts

3. Dry Eye Sufferer
Astigmatic
Presbyope
Young Myope
Non-Compliant Patients

4. Benefits of Fitting the Patients

5. Patient Satisfaction
Loyalty
Practice Builders
34 Million current wearers
12 million new fits
11 million drop outs
PROFITABILITY

6. Contact Lens Fits by Type
Segment Trend
Total Lenses +7%
SVS +4%
Toric +11%
Multifocal +25%
Colors +6%
Specialty lenses are driving the category growth
Higher margin --> higher profits
Source: HPR 1H 2003

7. Comfort and Vision are Top Benefits for both Current Contact Lens Wearers and Considerers
(% Absolutely Critical — Top Box)
Key Communication Points:
> Comfort is THE unmet need . . .
> CL comfort has increased significantly in last 2 decades but still enormous opportunity for manufacturers and eye care practitioners to increase patient satisfaction
Source: Vistakon Attitude and Usage Study of Vision Corrected Consumers 2002

8. Dry Eye

9. Today’s Choices… ACUVUE® ADVANCE™ with HYDRACLEAR™
Key Communication Points:
> Todays current CL choices force a compromise:
- comfort, handling & vision excellence of traditional hydrogel but with limitations in maximum O2 supplied
- or increased oxygen of high silicone lenses with stiffer, less comfortable materials & designs
> VISTAKON combined the best of both AND
- incorporated HYDRACLEAR for silky smooth comfort that LASTS
Creating a new generation of contact lenses, revolutionary technology that provides exceptional long lasting comfort
ACUVUE® ADVANCE™ with HYDRACLEAR™
Revolutionary Technology Exceptional Long Lasting Comfort

10. ACUVUE® ADVANCE™ with HYDRACLEAR™
A new generation in DAILY WEAR
The outstanding initial comfort of a hydrogel lens
Exceptional end of day comfort that outlasts the competition
Uncompromized visual acuity of theACUVUE® Brand
Oxygen delivery and lens properties that help keep eyes as white as with no lenses

11. Acuvue Advance Silicon Lens Hydrogel Comfort High Dk/t=83 Daily Wear
2 Week Replacement
Same Design as Acuvue 2

12. 30 Day Lenses Not Just for Extended Wear
Consider Low Water Contact Lenses
Look at Systemic Medications
(BCP and Antihistamine)
Limit Wear Time
Use Artificial Tears
Consider Plugs

13. Astigmatics… Not Just for RGP’s Anymore

14. Expectations

15. Residual Astigmatism (RA)
RA=Refractive Cylinder-Corneal Cylinder
Example on Next Slide
>1D consider RGP

16. Example: Refraction -3.00 - 2.00 x 180
K Readings x 180 / x 090
For Our Purposes:
2 – 1.25 = .75
(RGP probably not needed.)

17. “LARS RULE” Left Rotation Add Right Rotation Subtract
From your vantage point
Each clock hour = 30 degrees

18. Example Trial Lens: -3.00-1.25x090----OD rotates 20 degrees left
x OS rotates 20 degrees right
NEW TRIALS
OD x110
OS x070

19. Fuzzy Math…..

20. Soft Contact Lens Options

21. A. Less than -3.00 D of Cylinder
Acuvue Advance and Purevision
are nice compliments.

22. Both are -0.75 to -2.25 Cyl in -0.50 Increments.
Both are Axis 0 to 180 in 10 Degrees Increments.
Good Stability.
2 Week to 1 Month Replacement.
Avg. Sale Price/Box $42-45

23. Profit / Patient / Year =$93.00/$186
Let Patients See the Improved Vision for Themselves.
Up to D of Cyl use Spherical Equivalent for Remainder.
(example on next slide)
Other Options:
Frequency 55 Toric/Vertex Toric

24. Example
Refraction: x 090
Closest Lens: x 090
Uncorrected Astigmatism (UA)
-3.25 – 2.25 = 1.00D
Spherical Equivalent of UA
-1.00 / 2 = -0.50
Add to Sphere of Refraction
-2.00 – 0.50 = -2.50
New Contact Script = x090

25. Greater than
-3.50D of Cylinder

26. UCL, Sunsoft Toric, and Preference Work Well Together
Parameters Sphere:+20.00/20.00
Cylinder:7D
Axis is in 5 Degrees Steps
Educate Patient about Possible Fluctuations in Vision
Order with warranty

27. **********IMPORTANT**********
Charge for your TIME
Can not use standard multiplier
Patient Satisfaction=Practice Builder

28. C. Rigid Lens Options

29. Correction on the front of the lens Back Surface Toric:
Front Surface Toric:
Correction on the front of the lens
Low Residual Astigmatism
Back Surface Toric:
Back of lens shaped to match cornea
High Residual Astigmatism
Excellent Vision
Comfort is the Issue

30. Presbyope

31. No One likes Growing OLD

32. A. Monovision

33. Start the Patient Early in Presbyopia
Educate the Adaptation Time
Start with the Non-Dominate Eye as Near (may switch)
Return the Patient in 7-14 Days
Manage Expectations

34. Cost Effective for the Patient (any single vision lens will work)
NO Contact Lens Salute
Cost Effective for the Patient
(any single vision lens will work)
No Intermediate as Presbyopia Progresses
Trouble in Low Light Conditions
Trouble over 2.00 D of add

35. KEY POINTS Will require chair time Inexpensive to patient
Easier to start early in presbyopia
Patients are happy that lens cost doesn’t increase
Works for the majority of the patient
Decrease Depth perception
(consider 3rd lens)

36. B. Soft Contact Bifocals

37. Usually Provides All Ranges of Vision
Comfort Over Rigid Lens
Maintain Stereo Vision
Works at All Add Powers
Can be Costly
Some Report Constant Blur

38. Let Lens Settle Before Rechecking Manage Expectations
Halos at Night
Let Lens Settle Before Rechecking
10-15 minutes is good
Manage Expectations
Return to Check After Wearing
Use Trial Lenses

39. ** Great Options **

40. Multifocal Market by Brand
Multifocal Shares Brand Share
Share vs YAgo
Acuvue Bifocal (21.1)
SofLens Multi-Focal
Focus Progressives 12.1 (13.8)
Frequency 55 Multifocal
Dailies Progressives 1.9 (0.2)
In only 9 months, SofLens Multi-Focal is the fastest growing product in the category.
Source: HPR Q2:2003

41. Soflens 66 Multifocal Base Curve 8.8 / 8/5 Powers:
Add: Low (< +1.75)
High (> +1.75)
Design:
Watch Pupil Size in High Adds

42. Consider Modified Monovision
Cost / Box:$31.25
Avg. Price / Box: $60.00
Profit / Patient / Year:$119.00

43. Exceptional Visual Acuity
Natra-SightTM Optics
Broad near to distance power transition to provide crisp, clear, natural vision
Aspheric center-near with broad add profile across optic zone
Equalized Mass Distribution
Facilitates lens centration essential for effective functioning of the aspheric optics

44. Natra-SightTM Optics Not all aspherics are the same
Power Profiles
SLMF Low
ADD
SLMF High
ADD
Power Profiles: Low vs. High
The difference between SofLens Multi-Focal’s low and high ADD lenses is quite apparent in these 3-D power profiles.
The power of the low ADD increases gradually as one moves from the lens periphery to the center.
The high ADD is distinctly different from the low ADD design as while it also affects a gradual power increase from periphery to center, there is a distinct central zone, or plateau, of greater plus power. It is this distinct near zone that boosts the near ADD power.
Some older, or more mature presbyopes who require higher ADD power will benefit from this design.
Fitting older patients with modified monovision, using two low ADD lenses, or a combination of a high ADD and a low ADD may be as, or even more effective in providing the older presbyope with functional vision.
One should note the visual performance of the high ADD lens is more dependent on pupil size than the low ADD design. As such, the high ADD lens may compromise the quality of distance vision in some individuals, especially if their pupils are small.
Ciba Progressives
Single Steep Add

45. Basic Fitting Tips Know the Distance/Near Demands Control Expectations
Add power <= +1.75/Start with low add
Add power > +1.75/Start with high add
Always use 8.5 BC with high add
Aspheric Design offsets low amounts of Astigmatism

46. Rule of Thumbs for Add Powers
< 47 Low Add in Both eye
> 47 Low Add in Dominate eye
High Add in non Dominate eye
Be a little Creative
Tailor your fit to your patients needs

47. Fits for “Normal Demands/Distance Demands”
Find Prescription
Fit on Rx OU/Low Add OU
Let Settle Minutes Before Checking
Aim for 20/25 at Distance/20/40+ at Near
RTC 1 week (Patient to bring list of were lenses do and do not meet expectations)

48. Difficulties with Distance
Difficulties with Near
Dominate Eye Remains the Same
Non Dominate Eye
Distance is Rx + ½ of Add
Low Add
Difficulties with Distance
Check Over Refraction with Trial Lenses
Look at Base Curve

49. Example Refraction -3.00D—OU +2.00 Add—OU OD is Dominate
Initial Fit /Low Add OU
1st F/U /Low OD
-2.00/Low OS

50. Excessive Near Demands
Refraction
Week 1 Fit on Refraction OU/Advise Readers
Week 2 Dominate On Rx / Low Add Non-Dominate On Rx / High Add
Week 3 Add + to Non-Dominate with Trial
Lenses until Near is Adequate

51. Example Refraction -3.00 OU +2.00 Add OD Dominate
Week /Low OU/Readers
Week 2 OD -3.00/Low OS -3.00/High
Week 3 OR OS
OD /Low
OS /High
Think before you use High Adds OU

52. FREQUENCY® 55 MULTIFOCAL LENS DESIGN

53. FREQUENCY® 55 MULTIFOCAL PARAMETERS
BC/Diam.: 8.7/14.4 mm
Sphere power: to -6.00D
Add:+1.00 (NEW) +1.50, +2.00, D
Optical Design
D lens for dominant eye
N lens for non dominant eye
Handling tint: light blue edge-to-edge
Packaging: blisters in 6-packs, single blister trials
Modality: recommended for monthly replacement

54. Determine Spectacle Rx and Best Vision Sphere.
FITTING PHILOSOPHY
Determine Spectacle Rx and Best Vision Sphere. ▼
Determine Contact lens power adjusting for vertex distance, if required.
Determine the dominant eye. Consider fogging with a lens test to determine dominancy.
Place the “D lens” on the dominant eye and the “N lens” on the non-dominant eye. Wait 10 minutes for the lenses to equilibrate.
Under normal illumination conditions, evaluate visual acuities for distance and near, first monocularly then binocularly

55. FITTING PHILOSOPHY Acuity expectations: “D lens” – Distance 20/20
Near 20/40 or better
“N lens” – Near 20/20
Distance 20/40 or better
Binocularly – Distance 20/20
Near /20

56. Acuvue Bifocal Ciba Progressive
* Other Options *
Acuvue Bifocal
Ciba Progressive

57. C. Rigid Bifocals

58. Simultaneous Vision
Concentric Design
Translating Designs
Is Great Vision Trade-Off for Initial Discomfort?
Educate the Patient about Adaptation (It will get better!)
Lots of Hand-Holding in the Initial Phases

59. In All Options, Charge Adequately for Your Time.

60. Non-Compliant Patients

61. Significant Neo or Corneal Edema
Again Look at 30 Day Lenses
DK / L Comparison
“Poor Man’s LASIK”
LASIK

62. Rapidly Progressing Myope

63. Young Child or Above
Changing More Than D / Year
Fit a Half of a Diopter Flat
Return to Check at 6 Months /
Watch Cornea and Comfort
Inform Patient of Proper Expectations
Patience, Patience, Patience!