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GP LENS APPLICATIONS, BENEFITS AND MATERIALS

GP LENS APPLICATIONS, BENEFITS AND MATERIALS. GP LENS APPLICATIONS, BENEFITS & MATERIALS. Applications Benefits Materials Comfort. GP APPLICATIONS. Current Status Why Not GPs? GP Applications/Candidates. GP APPLICATIONS. Current Status. GP APPLICATIONS: CURRENT STATUS.

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GP LENS APPLICATIONS, BENEFITS AND MATERIALS

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  1. GP LENS APPLICATIONS, BENEFITS AND MATERIALS

  2. GP LENS APPLICATIONS, BENEFITS & MATERIALS • Applications • Benefits • Materials • Comfort

  3. GP APPLICATIONS • Current Status • Why Not GPs? • GP Applications/Candidates

  4. GP APPLICATIONS • Current Status

  5. GP APPLICATIONS: CURRENT STATUS • Approximately 12% of all CL patients; 6% of new fits • Slight increase in 2007 • Higher % in Japan & Germany • 30 - 50% in specialty practices/medical settings

  6. GP APPLICATIONS: WHY NOT GPs • Gap Practitioner • Spectacle Promotion • Disposable Lenses • Negative Publicity • Technology • Ouch!!!

  7. GP APPLICATIONS/CANDIDATES • Astigmatism • Borderline Dry Eyes • Refits • Irregular Corneas • Presbyopia • Children • Orthokeratology/Myopia Control

  8. GP APPLICATIONS/CANDIDATES • Astigmatism: GPs provide smoother corneal contour = better VA • Borderline Dry Eyes: More wettable surface; less dryness-induced complications • Refits: Very low Dk GPs & soft lens due to poor vision/complications • Irregular Cornea/keratoconus: Smooths out some of irregularity = better VA

  9. GP APPLICATIONS/CANDIDATES • Presbyopia: Improved bifocal designs result in vision rivaling spectacles • Children: GPs provide good vision & slow down progression of myopia • Orthokeratology: GPs are able to reduce existing myopia in low myopia

  10. GP LENS APPLICATIONS, BENEFITS & MATERIALS • Applications • Benefits

  11. GP BENEFITS • Quality of Vision • Ocular Health • Surface Wettability • Durability/Stability • Reduction in Myopia Progression • Patient Retention • Profitability

  12. GP BENEFITS: QUALITY OF VISION • Result of better optical quality, surface wettability & astigmatic correction • Johnson/Schnider study: N = 20; wore GPs x 6 wks; soft x 6 wks All unadapted wearers; good candidates Vision better, staining less with GPs 8 preferred GPs; 15 would be satisfied with them

  13. GP BENEFITS: OCULAR HEALTH • Oxygen transmission 2 - 4x greater • Reduced GPC • Reduced Ocular Infection

  14. OCULAR HEALTH: Greater Oxygen Transmission • Dk = Oxygen Permeability (potential for O2 to pass through CL = diffusion x solubility) • Dk/L = Oxygen Transmission (actual oxygen transmission through lens = Dk/thickness x 10 Example: If Dk =30 & thickness = .15mm then Dk/L = 20 • EOP = Equivalent Oxygen Percentage (how much of 21% oxygen reaches cornea)

  15. OCULAR HEALTH: Holden-Mertz Criterion • Daily Wear: Dk/L = 24.1; EOP = 9.9% • Extended Wear: Dk/L = 34.3; EOP = 12% • Extended Wear (no residual swelling) = 87; EOP = 17.9% • New criterion (Sweeney, Bonanno et al): 125

  16. DK Revisited: Bennett-Gordon Study • Compared 3-4 commonly used soft & GP lenses in several categories including DW, EW, +3D & -3D powers • GPs meet Holden-Mertz in almost all categories • Soft EW/disposable only provide 1/3 to 1/2 oxygen in + powers

  17. Hay/Seal Acanthamoeba Study • Evaluated adherence to unworn CL materials/buttons • Castellanii & polyphaga; cysts & trophozoites • Significant adherence to hydrogel samples; higher adherence to high water/ionic • No adherence to GP buttons

  18. GP BENEFITS • Quality of Vision • Ocular Health • Surface Wettability

  19. GP BENEFITS • Quality of Vision • Ocular Health • Surface Wettability • Durability/Stability

  20. GP BENEFITS • Quality of Vision • Ocular Health • Surface Wettability • Durability/Stability • Reduction in Myopia

  21. GP BENEFITS: REDUCTION IN MYOPIA • Houston Myopia Study: after 3 years GP group increased approx. .50D total; spectacle group approx. 1.50D • Khoo (Singapore); after 3 years GP group increased .44D/yr; spectacle group .78D/yr; appeared to be both flattening & axial length suppression • CLAMP: Ohio State (Walline): 1.56DGP); 2.19D (soft): 3 years

  22. GP BENEFITS • Quality of Vision • Ocular Health • Surface Wettability • Durability/Stability • Reduction in Myopia • Patient Retention

  23. GP BENEFITS: PATIENT RETENTION • Only 1% of mail order are GPs • GPs are custom devices; hard to sell in pharmacies • Rarely price advertised • Can use service agreement • Few GP prescriptions given to patients; when prescribing, be sure to include: no substitutes, refills, exp. date

  24. GP BENEFITS • Quality of Vision • Ocular Health • Surface Wettability • Durability/Stability • Reduction in Myopia • Patient Retention • Profitability

  25. GP BENEFITS: PROFITABILITY • Ames Study: 38% of patients fit into GPs; 48% of profit • Ames/Gunning: Profit per replacement lens higher; 2X as many spectacle sales; 8x as many service agreements

  26. PROFITABILITY(DR. KEITH AMES)

  27. WHAT DO CONTACT LENS PRACTITIONERS THINK? • Email survey sent to all Cornea and Contact Lens Diplomates for their perceptions about GP versus soft lenses • Scale was 1 (definite disadvantage) to 5 (definite benefit)

  28. DIPLOMATE RESPONSES • High Astigmatism 4.34 3.07 • Post-Surgical 4.27 2.14 • Ease of Handling 3.94 3.27 • Deposit Resistance 4.00 2.80 • Durability 4.27 2.60 • Profitability 4.20 3.00 • Prof. Satisfaction 4.47 3.60

  29. DIPLOMATE RESPONSES GPs Soft Initial Comfort 2.07 4.47 Long-Term Comfort 3.94 4.14 Quality of Vision 4.80 3.74 Eye Health 4.40 3.34 Presbyopia 3.67 2.47 Myopia Control 3.87 1.47 Keratoconus 4.54 1.60

  30. GP LENS APPLICATIONS, BENEFITS, & MATERIALS • Applications • Benefits • Materials

  31. GP MATERIALS • Types of Lens Materials • Silicone/Acrylate • Fluoro-Silicone/Acrylate

  32. GP MATERIALS: Silicone/Acrylate • Copolymers with “silicon” for O2, methacrylate for stability, wetting agents (methacrylic acid, HEMA) & cross-linking agents for stability • First successful GP material (Polycon) • In higher DK materials, wettability/stability became problems

  33. GP Materials: Fluoro-Silicone/Acrylate • Combined fluorine with other ingredients of S/A to enhance mucin interaction with lens surface = wettability & stability; increase Dk • Materials can be divided by Dk: • Low Dk = 25 - 50 • High Dk = 51 - 100 • Hyper Dk = >100

  34. Low Dk GP Materials • Fluoroperm 30 (Paragon Vision Sciences) • Boston ES (Polymer Technology Corporation): Aerocor technology; can be made in ultrathin designs

  35. High Dk GP Lens Materials • Fluoroperm 60 & Paragon HDS (Paragon Vision Sciences) • Boston EO (Polymer Technology Corporation)

  36. Hyper Dk GP Materials • Menicon Z (Menicon); good wettability despite high Dk; ultrathin available; from Japan; approved for continuous wear • Boston XO & XO2 (Polymer Technology Corporation) • Paragon HDS100 • Optimum Extra (100) Contamac

  37. PLASMA TREATMENT • Most ECPs believe it is “coating”(i.e., car wax); actually utilizes electrical energy to change electrical structure of lens surface • Very popular as the treating of GP polymers with plasma is a very effective cleaning method to remove any remaining residues (i.e., oils, solvents, waxes) from the manufacturing process. • Significantly reduces surface wetting angle • Claims that it increases initial comfort • Most materials are now being promoted as plasma treated

  38. Plasma Treatment ???? • How long does it last? (hours? days? months?) • Can be damaged via abrasive cleaner use; polishing • There is typically an additional cost ($2 - 6/lens)

  39. Plasma Treatment: Is it Worth It? Results of a Recent Survey • GP Lens Institute Advisory Committee surveyed (25 responses) • What % of lenses Plasma Treated: 84% PT > 10% of lenses; 20% PT > 50% • 56% indicate initial wettability better; 28% same; 8% worse • 65% indicate better initial comfort; 31% the same; 4% worse

  40. How long does the treatment last? • 1 - 7 days: 13% • 1 - 2 weeks: 8% • 2 - 4 weeks: 4% • 1 - 3 months: 26% • 3 - 6 months: 31% • > 6 months: 18%

  41. GP MATERIALS • Materials • Material Selection

  42. Low Dk GP Selection • Myopes • Dry Eyes • Refits • Daily Wear

  43. High Dk GP Selection • Hyperopes • Flexible Wear (hyperopes) • Extended Wear (myopes) • More oxygen needed HYPER Dk: Extended Wear (Hyperopes)

  44. GP LENS MATERIALS

  45. OTHER FACTORS • Refractive Error • Corneal Topography • Refits • Occupation/hobbies

  46. GP LENS COMFORT • Presentation • Topical Anesthetic • Good Initial Vision • Lens Design

  47. GP LENS COMFORT • Presentation

  48. PRESENTATION • Perceptions about Adaptation • Concerns • Patient Apprehension • Practitioner Apprehension The New Practitioner • Inadequate Education • Takes too much time • Too uncomfortable

  49. PRESENTATION METHODS • Gauge patient’s reactions to ocular tests • High reactors = gradual adaptation • Offer realistic expectations • Don’t be tentative in GP description • Don’t use negative phrases: discomfort, pain, intolerance, failure; use “lens awareness,” “lid sensation” • “GP” (not “RGP”)

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