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S P E C I A L E D I T I O N 2 0 1 5 • O P T O M E T R I C M A N A G E M E N T . C O M ric Association (AOA) Contact Lens Section and Johnson & Johnson Vision Care, Inc. is a guide to Healthy Vision and Contact Lenses, available on the AOA website. Tis guide helps doctors and staf members walk the patient through the important steps of informed choice, and helpful Do's and Don'ts of contact lens wear — for all types of wear, not just extended wear. OM HEATHER WEBSTER, O.D., is in private practice at InVision Eye Care Cen- ter in Columbia, Mo. She received compen- sation from Johnson & Johnson Vision Care, Inc., for her time in writing this article. Visit tinyurl.com/ OMcomment to comment on this article. REFERENCES 1. Efron N, M. P. (2012). International Survey of Contact Lens Prescribing for Extended Wear. Optom Vis Sci, 122-129. 2. Chalmers R, K. L. (2010). Risk Factors for Contact Lens Complicaitons in US Clinical Practices. Optom Vis Sci, 725-735. 3. Chalmers R, W. H. (2011). Age and other risk factors for cor- neal infltrates and infammatory events in young soft contact lens wearers from the Contact Lens Assessment in Youth (CLAY) study. Cornea, 6690-6695. 4. Chalmers R, K. L. (2012). Multicenter Case-Control Study of the role of Lens Materials and Care Products on the Development of Corneal Infltrates. Optom Vis Sci, 316-325. FE ATURE THE EMME TROPIC E XPERIENCE 33 Overnight Wear As we all know, overnight wear of contact lenses is not without risk. In consulting with Dr. Robin Chalmers, a leader of several important multi-site clinical in- vestigations regarding risks and management of contact lens- related complications, she shows us that while we can't eliminate the risks, we can do a lot to bet- ter manage them. (See "Tips for Optimizing the Overnight Wear Experience," below.) A 2010 retrospective review of risk factors for contact lens complications found that being under age 25 put the patient at a 2.6 times higher risk for CIEs compared to patients over that age. In addition, having a high prescription (over plus or minus 5 diopters) put the patient at a 1.5 times higher risk for presenting with any kind of an adverse event, and a 1.9X risk for infectious com- plications such as conjunctivitis. 2 The high refractive error doesn't cause the event, but "It just makes the patient more dependent on their contact lenses, so they might tough it out and allow it to get worse before they take their lenses out and go seek care," says Dr. Chalmers. A second study arising out of the Contact Lenses Assessment in Youth (CLAY) study 3 reinforced the risk of younger age (peak risk be- tween 15 and 25 years), and also showed increase risks for CIEs with the use of multipurpose solutions (2.86X), silicone hydrogel materials (1.85X) and extended wear (2.37X). Limiting the use of solutions by selecting a lens replacement fre- quency that allows the patient to throw every lens away immediately on removal is key. The third piece of evidence comes from a retrospective, multicenter case-control study at fve academic eye care centers in- volving more than 50 soft contact lens brands and more than 10 lens care products. 4 This study again confrmed the risk of younger age, with each year older resulting in a 5% decreased risk of CIE (0.95X risk), and described the CIE risk of re- using lenses (4X). These important studies don't tell us NOT to prescribe extended wear, but help us tell our pa- tients WHY we make decisions and recommendations. Tips for Optimizing the Overnight Wear Experience Avoid higher-risk patients (non-modifable factors) • Lid or ocular surface disease • Younger patients (15-25) • High prescriptions (over +/- 5D) Educate (modifable factors) • Put everything in writing - Healthy Vision and Contact Lenses guide from the AOA • Reinforce at EVERY follow-up visit - Ask them to say AND do • Avoid lens reuse & storage in cases - Six night and 30 night options available • Make sure patients know to seek care IMMEDIATELY in the event of a problem - Red or painful eye - Changes in vision Spotlight on Science *ACUVUE OASYS ® Brand Contact Lenses are indicated for vision correction for daily wear (worn while awake) or extended wear (worn while awake and asleep for up to 6 nights/7 days). Relevant Warnings: Patients should be cautioned that proper use and care of contact lenses are essential for the safe use of these products. Serious eye problems, including corneal ulcers, can develop rapidly and in rare cases lead to loss of vision. The risk of serious problems is greater for extended wear vs. daily wear and smoking increases this risk. Patients should be instructed not to expose contact lenses to water while wearing them, due to the risk of infection, and to discard and replace them if they are submersed in water during wear. Side Effects: Potential side effects include infltrative keratitis; other less serious side effects include irritation, dryness, itching, or discomfort. Relevant Precautions: Patients should be instructed to immediately remove their lenses and promptly contact their eye care professional if they experience any problems. Contraindications: Lenses should not be prescribed for routine vision correction if patients have any eye infection, eye disease, infammation, systemic disease that may be affected by or impact lens wear, severe dry eye, certain allergic conditions, use certain medications (ex. some eye medications), experience eye discomfort, excessive tearing, redness, reduced corneal sensitivity or other eye problems. Additional Information: It is recommended that the contact lens wearer frst be evaluated on a daily wear schedule. If successful, then a gradual introduction of extended wear can be followed. Consult the package insert for complete information, or contact VISTAKON ® Division of Johnson & Johnson Vision Care, Inc., by calling 1-800-843-2020 or by visiting www.acuvueprofessional.com. See page 4 for more important prescribing information.