Are Silicone Hydrogel Contact Lenses More Comfortable Than Hydrogel Contact Lenses?

Abstract

OBJECTIVES:: Discontinuation or "dropout" from contact lens (CL) wear continues to afflict the CL industry. This study was conducted to determine whether the advent of new CL materials and designs has impacted the dropout rate and the reasons for discontinuation. METHODS:: Current and lapsed CL wearers residing in Canada were recruited using Facebook to take part in an on line survey investigating CL wearing experiences during 2008 to 2010 and to establish the percentage of participants who temporarily and permanently discontinued CL wear during the period surveyed. RESULTS:: Four thousand two hundred seven eligible surveys were received (64% female; median age 27 years). Forty percent had lapsed from lens wear for at least 4 months; however, 62% of the lapsed wearers (LWs) resumed wear. There were no differences between LWs and nonlapsed wearers (NLWs) with respect to gender; however, LWs were older, started lens wear when older, and had not worn lenses for as long as NLWs (all P<0.001). More NLWs than LWs wore silicone hydrogel CLs (49% vs. 38%, P<0.001) and more LWs than NLWs wore daily disposable lenses and hydrogel CLs (24% vs. 19% and 22% vs. 18%, respectively, P≤0.001). Primary reasons for discontinuation were discomfort (24%), dryness (20%), red eyes (7%), and expense (7%). Compliance with lens replacement was no different between LWs and NLWs (48% vs. 45%). CONCLUSIONS:: About 23% of those surveyed had discontinued CL wear permanently. The primary reasons for dropping out continue to be discomfort and dryness. Dropout rates were lower in silicone hydrogel wearers.

Full text

ARTICLE
The Impact of Contemporary Contact Lenses on Contact
Lens Discontinuation
Kathy Dumbleton, M.Sc., Craig A. Woods, Ph.D., Lyndon W. Jones, Ph.D., and Desmond Fonn, M.Optom.
Objectives: Discontinuation or “dropout”from contact lens (CL) wear
continues to afflict the CL industry. This study was conducted to determine
whether the advent of new CL materials and designs has impacted the
dropout rate and the reasons for discontinuation.
Methods: Current and lapsed CL wearers residing in Canada were recruited
using Facebook to take part in an on line survey investigating CL wearing
experiences during 2008 to 2010 and to establish the percentage of
participants who temporarily and permanently discontinued CL wear
during the period surveyed.
Results: Four thousand two hundred seven eligible surveys were received
(64% female; median age 27 years). Forty percent had lapsed from lens
wear for at least 4 months; however, 62% of the lapsed wearers (LWs)
resumed wear. There were no differences between LWs and nonlapsed
wearers (NLWs) with respect to gender; however, LWs were older, started
lens wear when older, and had not worn lenses for as long as NLWs (all
P,0.001). More NLWs than LWs wore silicone hydrogel CLs (49% vs.
38%, P,0.001) and more LWs than NLWs wore daily disposable lenses
and hydrogel CLs (24% vs. 19% and 22% vs. 18%, respectively, P#0.001).
Primary reasons for discontinuation were discomfort (24%), dryness (20%),
red eyes (7%), and expense (7%). Compliance with lens replacement was
no different between LWs and NLWs (48% vs. 45%).
Conclusions: About 23% of those surveyed had discontinued CL wear
permanently. The primary reasons for dropping out continue to be
discomfort and dryness. Dropout rates were lower in silicone hydrogel
wearers.
Key Words: Silicone hydrogel—Daily disposable—Contact lenses—
Discontinuation—Dropout—Lapsed—Compliance.
(Eye & Contact Lens 2013;39: 93–99)
Discontinuation or “dropout”from contact lens wear continues
to impact the contact lens industry. In two separate studies
conducted in Canada in the 1990s, between 34% and 51% of
wearers reported discontinuing from contact lens wear for some
period of time.
1,2
The most common reasons reported for discon-
tinuing wear were discomfort, dryness, and the onset of visual
problems associated with presbyopia.
1–6
However, since these
studies were conducted, many new lens materials, modalities,
and designs have been introduced to the market. Arguably, the
most radical changes have been the introduction of daily dispos-
able (DD) contact lenses and silicone hydrogel (SiHy) materials.
7,8
SiHy lenses have eliminated many of the hypoxia-related
problems associated with conventional hydrogel lenses,
9–13
and
improved comfort with these materials has also been reported in
several studies.
14–18
These lenses may also be prescribed for
extended and continuous wear,
19–21
which offers an extremely con-
venient modality for patients who either prefer a permanent cor-
rection of their ametropia or not to have to clean and disinfect their
lenses on a daily basis; however, extended wear shows a higher
incidence of microbial keratitis compared with daily wear regard-
less of lens design or material.
22,23
In a similar way, DD lenses also
offer many lifestyle advantages and the ultimate in convenience for
contact lens wearers; in addition, these lenses have been shown to
be beneficial for patients who suffer from seasonal allergies
24,25
and
other complications which can result from reusable contact lens
wear including contact lens papillary conjunctivitis.
26
In general,
very few complications have been reported to occur in DD lens
wearers when compared with spectacle wearers
27
; however, serious
complications including microbial keratitis can still occur with this
modality, particularly if patients are not compliant with their
replacement.
22
Recently, enhancements have been made to some
DD lenses, which have been shown to result in improvements in
comfort.
28,29
It is not known whether these innovations in lens
materials and modalities have impacted the dropout rate from con-
tact lens wear or the reasons for discontinuation.
This study was designed to investigate the current rates and
reasons for discontinuation from contact lens wear. The specific
objectives of the study were to establish the percentage of study
participants who had temporarily and permanently discontinued
contact lens wear during the qualifying period of two years (2008
to 2010), to investigate the causes of discontinuation, and to
determine whether there was a difference in the rate of discontin-
uation based on lens materials or designs and compliance with
recommended intervals for lens replacement. It was decided that
the study should be conducted in Canada to allow comparison with
the results from the two previously reported Canadian studies.
1,2
Because it is possible that people who “dropout”may actually
successfully return to lens wear, the terms “lapse”and/or “lapsed
wearer”are used rather than “dropouts”. The reasons for resuming
lens wear were also evaluated for the lapsed wearers.
MATERIALS AND METHODS
Study Design
Ethical approval was obtained through the Office of Research
Ethics at the University of Waterloo before commencement of this
From the Centre for Contact Lens Research (K.D., L.W.J., D.F.),
University of Waterloo, Waterloo, Canada; and the School of Medicine
(C.A.W.), Deakin University, Warun Ponds, Victoria, Australia.
This study was funded by Alcon.
Address correspondence and reprint requests to Kathy Dumbleton, M.Sc.,
Centre for Contact Lens Research, University of Waterloo, Waterloo,
Canada N2L3G1; e-mail: kdumble@uwaterloo.ca
Accepted August 29, 2012.
DOI: 10.1097/ICL.0b013e318271caf4.
Eye & Contact Lens Volume 39, Number 1, January 2013 93
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study, which was conducted following the tenets of the Declaration
of Helsinki. The study comprised an online survey. Current and
lapsed contact lens wearers residing in Canada were recruited to
take part in the survey via the social media website of Facebook
(www.Facebook.com). The target sample size was 4500. Previous
studies on contact lens discontinuation have been smaller (approx-
imately, 1500 in the most recent Canadian study
2
); however,
because the current study was conducted online, a larger sample
size was possible.
Before completion of the survey, prospective participants were
invited to read an online information letter and were required to
indicate their consent to participate by clicking on a radio button,
which took those prospective participants to the first page of the
survey. On this page, a series of preliminary questions were asked
to confirm eligibility. Only Canadian residents who were at least
17 years old, who had purchased contact lenses in Canada between
2008 and 2010, and who had worn contact lenses for at least six
consecutive months during this period were eligible to participate.
To be considered as a lapsed wearer, participants were additionally
required to have discontinued contact lens wear for a period of at
least four consecutive months during the same period. Multiple
entries from identical internet protocol addresses were not permit-
ted. Ineligible participants were advised that they did not meet the
criteria for the study and were not able to continue with the survey.
The first phase of enrollment involved general advertising on
Facebook for both current and lapsed wearers (17 years or older).
Age monitoring throughout the study revealed a high initial response
rate from patients younger than 30 years. A recruitment strategy
targeting account holders older than 30 years was implemented after
two thirds of the study participants had been recruited.
Lapsed and nonlapsed wearers completed different versions of
the survey. In addition to collecting general demographics and
responses relating to contact lens wear, which were asked for all
wearers, lapsed wearers were asked several additional questions.
These were: The main reasons for stopping lens wear; whether they
resumed wear again during the period of time evaluated; and if so,
the primary reason for resuming lens wear.
The questions relating to contact lenses worn were asked in
a sequence, which was designed to aid selection of the lens type worn.
Participants were asked first if they wore rigid gas permeable (RGP)
lenses or soft lenses. Those responding for soft lenses were then asked
if they wore DD lenses (“lenses disposed of at the end of each day”),
all were asked if they were wearing toric lenses (“designed to correct
astigmatism”), and were asked if they were wearing multifocal or
bifocal lenses (“designed to correct presbyopia”). After responding
to these questions, participants were asked to select their contact lens
brand (“with the exception of RGP wearers”) from a linked page with
photographic aids and names of the possible products used, that is,
participants selecting DD lenses were only directed to a linked page
with images of DD lenses, those selecting multifocal or bifocal were
only directed to a linked page with images of these lenses, etc. Par-
ticipants who did not make a selection from the product photographs
were asked to manually enter the name of the brand of their lenses.
Participants selecting reusable soft lenses were also asked to
select their contact lens care products from a linked page with
images with photographic aids and names of contact lens products
available in Canada at the time the study was conducted. Once
again, participants who did not make a selection from the product
photographs were asked to manually enter the name of the brand of
their care products. All reusable soft lens wearers were also asked
whether and how often they rubbed and rinsed their lenses before
storage and whether and how frequently they “topped up”their
contact lens case (i.e., added new lens care solution on top of the
previous day’s solution, in the lens case). Upon completion of the
survey, participants were given the opportunity to receive a $10
gift card by mail if they chose to provide their name and address.
Data Analysis
Where relevant, data analyses were conducted using Statistica
9.0 (StatSoft Inc., Tulsa, OK). Data are presented in tables and
charts as frequency distributions. A significant level of a=0.05 was
used for all analyses with x
2
square tests used to compare differ-
ences in counts and two-sided difference between two proportion
tests when comparing proportional differences between the groups
investigated. Student ttests were used to compare differences
between the two study populations.
For the purposes of analysis, lapsed wearers included those who
were permanently lapsed and those who may have resumed wear
during the period evaluated. In these cases, the responses used were
those for lenses worn when these participants first lapsed from lens
wear.
RESULTS
Study Participants
In total, 4851 participants completed the online survey. Of these,
4207 surveys were eligible for analysis. The remaining 644 were
excluded for the following reasons:
•Five hundred thirteen dubious repeats (duplicate address, names,
etc.);
•One hundred forty-two questionable RGP respondents (lenses
replaced at intervals of less than three months);
•Two respondents who were too young to participate (under
17 years) and;
•Two respondents who were ineligible with respect to country of
residence (Russia and Lithuania).
Completed surveys were received from every province and
territory in Canada, with the highest number of responses coming
from Ontario (69%) followed by British Columbia (13%).
Sixty-four percent of participants were female. The mean age was
30 years (median 27 years, ranging from 17 to 77 years). Sixty
percent (2512) of the participants were identified as current lens
wearers and 40% (1695) were identified as lapsed wearers. Almost
two thirds of these (1049) did resume wear again during this period,
but approximately one third of these (333) later stopped once again.
This resulted in a final rate for lapsed wearers of 23% (979). Figure 1
shows the distribution of participants, and Table 1 summarizes the
participant demographics. There were no differences between lapsed
and nonlapsed wearers with respect to gender; however, lapsed
wearers were older, had started lens wear when older, and had not
worn lenses for as long as nonlapsed wearers (all, P,0.001).
Reasons for Lapsing From and Resuming
Lens Wear
Twenty-seven percent of lapsed wearers reported wearing their
lenses for only six months before stopping lens wear; 38% reported
wearing their lenses for more than six months up to 12 months, and
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94 Eye & Contact Lens Volume 39, Number 1, January 2013
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35% reported wearing their lenses for more than one year. For
those wearing lenses for longer than a year before discontinuing,
the mean length of wear was 5.966.4 years (median three years,
range: 1–35 years).
The main reasons for stopping lens wear (only one response per
participant) are shown in Figure 2 and Table 2. The reason most
frequently given was discomfort (24%) followed by dryness
(20%). Responses have been separated by age into participants
aged forty and younger and participants aged 41 and older. The
distribution of responses is similar, except that a higher proportion
of the older participants cited poor distance and near vision, or just
poor near vision than the younger participants. A higher proportion
of the younger participants cited discomfort, running out of lenses,
lenses being too expensive, and becoming pregnant.
Sixty-two percent of the lapsed wearers (n=1049) resumed lens
wear after the first period of stopping wear. The most common
reason for resuming wear was preferring their appearance in con-
tact lenses (32%) followed by preferring the convenience of con-
tact lenses (21%). Fourteen percent of those resuming wear said
that it was because their eye care practitioner (ECP) had recom-
mended a different contact lens type. Thirty-two percent of those
who resumed lens wear discontinued again during the period eval-
uated (n=333) with the primary reasons given once again being
dryness and discomfort.
Contact Lenses
Forty-five percent of lenses worn were reported to be SiHy
lenses, 21% of lenses worn were DD, 20% hydrogel (not DD), and
5% RGP. The remaining 10% of lenses worn were classified as
“unknown soft”; these included the following: surveys in which the
participants had selected “soft”as the lens type but had not selected
a picture from those provided; and the lens name that they entered
could not be definitively identified as a SiHy, DD, or hydrogel lens.
The distribution of lens type worn by group is presented in
Table 3. A higher proportion of nonlapsed than lapsed wearers
reported wearing SiHy lenses (49% vs. 38%, P,0.001) and a high-
er proportion of lapsed than nonlapsed wearers reported wearing
DD lenses (24% vs. 19%, P,0.001) and hydrogel lenses (22% vs.
18%, P=0.001).
Twenty-four percent of participants reported wearing toric
lenses, and there was no difference between the lapsed and
nonlapsed groups (25% vs. 23%, P=0.461). Twelve percent of
participants older than 40 years said that they were wearing bifocal
or multifocal lenses, and there was no difference between the
lapsed and nonlapsed groups (11% vs. 13%, P=0.278). Thirteen
percent of participants older than 40 years said that they were
wearing monovision lenses, but once again there was no differ-
ence between the lapsed versus nonlapsed groups (12% vs. 14%,
P= 0.352).
Thirty-eight percent of participants reported purchasing their
lenses from an optometrist, 43% from an optician or optical store,
and 14% over the Internet. Five percent responded “other”.This
purchase pattern was similar for all lens types with the exception
of RGP lens wearers where the vast majority purchased lenses from
their optometrist. A significantly higher proportion of lapsed wearers
purchased their lenses from an optician, compared with nonlapsed
wearers (48% vs. 39%, P,0.001), and a significantly higher pro-
portion of nonlapsed wearers reported purchasing their lenses from
the Internet, compared with lapsed wearers (16% vs. 12%, P,0.001).
Wearing Schedules
Overall, 85% of participants reported wearing lenses for daily
wear only; 9% reported occasional overnight wear (wearing lenses
during sleep for two to three nights a month); 3% reported frequent
overnight wear (two to three nights a week); and 3% reported
wearing lenses almost every night. Significantly, more lapsed
wearers reported any overnight wear compared with nonlapsed
wearers (16% vs. 13%, P=0.024); however, there was no significant
difference between lapsed and nonlapsed wearers with respect to the
average number of nights per month that they reported wearing
lenses during sleep (5 nights, P=0.493). The average wearing time
reported was 12.363.1 hours per day (median 13 hours) and
5.661.6 days per week (median six days). Lapsed wearers reported
significantly shorter wearing times (12.063.0 vs. 12.463.1 hours)
and fewer days per week (5.361.7 vs. 5.861.6 days) of wear than
nonlapsed wearers (both P,0.001).
Fifty-three percent of participants reported that they wished that
they could wear their lenses longer each day. When asked why
they could not, 45% of participants responded that it was because
their eyes became dry; 43% participants responded that it was
because the lenses became uncomfortable; 8% participants
responded that it was because their eyes became red; and 4%
participants responded that it was because their vision was no
longer acceptable. A higher proportion of lapsed than nonlapsed
wearers reported that it was because the lenses became uncomfort-
able (49% vs. 38%, P,0.001) and a higher proportion of non-
lapsed than lapsed wearers reported that it was because their
eyes became dry (50% vs. 37%, P,0.001).
Care Systems
Fifty-eight (2%) of the participants wearing reusable soft lenses
did not select a picture from the contact lens care systems displayed
TABLE 1. Survey Participants’ Demographics
All
participants Nonlapsed Lapsed P
% Female 64.4 64 65 0.555
Current age (yrs) 29.6610.2 28.769.8 30.9610.6 ,0.001
Median age (yrs) 27 26 28 —
Age range (yrs) 17–77 17–77 17–72 —
Age started wearing (yrs) 20.467.5 19.166.3 22.468.7 ,0.001
Median age started wearing 18 18 20 —
Years of wear* 8.967.6 9.567.7 5.966.4 ,0.001
*
Only includes lapsed wearers with wearing experience of .1
year.
FIG. 1. Distribution of survey participants.
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2013 Lippincott Williams & Wilkins 95
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or give a care system name. Of those selecting a picture or giving
a name, 85% reported using a brand name multipurpose solution
(MPS), 2% reported using a private label MPS, and 13% reported
using a hydrogen peroxide system. There was no difference in the
proportion of lapsed versus nonlapsed wearers using a hydrogen
peroxide care system (P=0.110) or using a brand name or private
label MPS care system (P=0.646). Overall, 57% of participants
using a care system reported rubbing and rinsing their lenses with
solution before storage every night. Significantly, more lapsed
wearers reported rubbing and rinsing their lenses every night com-
pared with nonlapsed wearers (64% vs. 53%, P,0.001). Overall,
41% of participants using a care system reported topping up their
solution in their lens case occasionally, frequently, or almost every
night instead of replacing the solution each day. A significantly
higher proportion of nonlapsed wearers than lapsed wearers
reported “never”topping up their solution (61% vs. 56%, P=0.010).
Replacement Frequency
A replacement frequency (RF) of more than one day was
considered to be noncompliant with the manufacturer-recommended
replacement frequency (MRRF) for DD wearers; a RF of 17 days
(i.e., less frequently than twice a month) was considered to be
noncompliant for lenses with a MRRF of two weeks; and a RF of
more than 34 days was considered to be noncompliant for lenses
with a MRRF of one month. Compliance rates were highest with DD
lenses and lowest with two week replacement lenses (P#0.007);
overall, 46% of the participants were compliant with the MRRF.
Compliance with the MRRF was 45% in nonlapsed wearers and
48% in lapsed wearers (P=0.053). Compliance with the MRRF
was higher for SiHy lens wearers than for hydrogel lens wearers
(45% vs. 38%, P=0.002).
Forty-eight percent of RGP wearers reported replacing their lenses
at intervals of 12 months or less, whereas the remainder reported
replacing their lenses at intervals of greater than one year. There was
no option for recording the exact length of time before replacement
when it was greater than one year, and it is not therefore possible to
determine compliance with replacement for RGP wearers.
DISCUSSION
To our knowledge, this is the largest survey conducted to
investigate discontinuation of contact lens wear since the intro-
duction of SiHy and DD lenses to the market. Forty percent of
participants were identified as lapsed wearers and had discontinued
contact lens wear for a period of at least 4 months during the period
surveyed (2008 to 2010). Almost two thirds of these participants
did resume wear again during that same period, but approximately
one third of those resuming wear later stopped once again. The
rates for temporary and permanent lapses from lens wear in the
current study are somewhat higher about 40% and 23%, respec-
tively, than those of 34% and 12%, respectively, which were
reported in the 1999 study.
2
In another previous study, specifically
FIG. 2. Reasons for lapsing from lens
wear.
TABLE 3. Distribution of Lens Types and Materials Worn
All participants Nonlapsed Lapsed P
Silicone hydrogel 45 49 38 ,0.001
Hydrogel 20 18 22 0.001
Daily disposables 21 19 24 ,0.001
RGPs 5 5 5 NS
Unknown soft 10 9 12 NS
RGP, rigid gas permeable; NS, not significant.
TABLE 2. Reasons for Lapsing From Lens Wear (Percent)
Reason for discontinuation
Percent of
lapsed wearers
I experienced discomfort with the lenses 24.4
I experienced dryness with the lenses 19.9
I experienced red eyes when wearing my lenses 6.8
I found that it was too expensive to maintain the lenses 6.8
I disliked or found handling the lenses too much bother 6.3
I ran out of lenses and did not buy any more 5.8
I found caring for the lenses too much bother 5.7
I experienced an eye infection which may have been
related to my contact lenses
4.7
I had poor vision with my lenses (distance and near) 3.7
I had seasonal allergies and could not tolerate the
lenses as well
3.6
I had poor near vision with my lenses 2.6
I became pregnant and could not tolerate the lenses
as well
2.6
My eye care practitioner recommended that I discontinue
lens wear
2.5
I had laser eye surgery to correct my vision 1
Other (only select this if your reason does not fit into
one of the above)
3.6
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investigating success in refitting lapsed contact lens wearers, the
short-term success rate was reported to be 77%
6
; however, in that
study, lapsed wearers were recruited specifically to determine their
success with being refitted compared with the current study in
which participants simply reported whether they had resumed wear
during the period investigated.
Almost two thirds of participants were female, and the median
age of participants was 27 years. There were no differences
between lapsed and nonlapsed wearers with respect to gender;
however, lapsed wearers were older, had started wearing contact
lenses at an older age, and had not worn lenses for as long as
nonlapsed wearers. These differences, although some are only
small, are consistent with those of Richdale et al.
3
The somewhat
younger demographic of participants in this survey is not surprising
because a social networking website was used for recruitment, and
participation in the study required completion of an online survey.
The distribution of participant age seemed to be somewhat biased
toward younger wearers when compared with data collected in
Canada over a similar period as part of the international prescribing
survey
30
; however, it should be noted that the current study
included contact lens wearers who had obtained their lenses from
a variety of sources and not just their ECP. Although the majority
of participants purchased their lenses from an optometrist, optician,
or from an optical store, 14% reported purchasing their lenses from
the Internet. This is lower than that reported in a study involving
college students where the rate reported was 22.5%.
31
It is inter-
esting that more than half of the lapsed wearers reported only
wearing lenses for 6 to 12 months before discontinuing from lens
wear. Further study of this finding may provide additional insight
into the reasons for discontinuing from lens wear but was beyond
the scope of this study.
The reasons given by the lapsed wearers for discontinuing wear
seem to be very similar in this study population to those previously
reported.
1–6
Discomfort and dryness were the most frequent rea-
sons, followed by red eyes, visual problems, and expense. The
distribution of responses was somewhat different, however,
between presbyopic participants and those who were approaching
presbyopia (older than 40 years), compared with prepresbyopic or
younger participants. A higher proportion of participants in the
older group reported poor vision (either distance and near or near
only), whereas a higher proportion of those in the younger group
reported prohibitive expense, running out of lenses, or pregnancy
as reasons for discontinuing lens wear. These results are not sur-
prising given the demographics of both groups of wearers.
The reported wearing time for lapsed wearers of daily wear lenses
was significantly shorter each day, and these participants reported
wearing lenses for fewer days each week, compared with nonlapsed
wearers. This finding is perhaps not surprising because the main
reason for discontinuing lens wear has been reported to be
discomfort, which would probably lead to shorter wearing times.
Over half of the participants reported that they wished they could
wear their lenses longer each day. The most commonly reported
reasons given for not being able to wear lenses longer were “dryness”
in the nonlapsed wearers and “because the lenses become uncomfort-
able”in the lapsed wearers. This result seems to indicate that the
lapsed wearers’symptoms were more extreme than those of the
nonlapsed wearers and may have ultimately led to discontinuation
from lens wear. Lapsed wearers wishing to wear their lenses longer
also reported shorter daily wearing times than nonlapsed wearers.
When a study of this nature is conducted via the Internet,
participants’recall of the type of contact lenses they wear, and
brand names, may not be accurate. This study incorporated photo-
graphs of contact lens packaging because photographic aids have
been shown to significantly improve lens wearers’ability to recall
their lens brands.
32
Overall, 95% of participants were wearing soft
lenses and 5% were wearing RGP lenses. The proportion of par-
ticipants wearing RGP lenses was somewhat higher than reported
for Canada in 2010 in the international prescribing survey by Mor-
gan et al.
30
; however, our study included all wearers rather than
only patients being fitted or refitted, and this could explain the
higher proportion. Almost half the participants were wearing SiHy
lenses and 21% were wearing DD lenses; these proportions were
slightly lower and higher, respectively, when compared with the
data from Morgan et al
30
for Canada from 2010. The differences
could possibly be attributed to the method of data collection, that
is, an online survey completed by wearers versus a fitting survey
completed by ECPs. It is also possible that some SiHy wearers did
not recognize their packages, and some reusable lens wearers
selected a DD package with a similar name to their actual lens type.
One of the specific objectives of this study was to determine
whether there was a difference in the rate of discontinuation from
lens wear based on lens materials worn, lens replacement schedules,
and compliance with recommended intervals for lens replacement.
The study showed that a higher proportion of nonlapsed lens
wearers were wearing SiHy lenses when compared with lapsed
wearers. Although it is recognized that this finding could be
attributed to a number of factors, one that should certainly be
considered is that fewer SiHy wearers lapse from lens wear because
of greater comfort afforded by these lens materials, which has been
reported.
14–18,33
If the overall comfort and end of day comfort with
SiHy lenses is superior to the comfort achieved with conventional
materials, this could well contribute to their overall success with
contact lens wear. There have also been significant innovations in
lens design and parameter availability in recent years, and many of
these features are available in current SiHy lenses.
34–37
Optimal
correction of vision for astigmats
38
and presbyopes
37
should also
result in lower rates of discontinuation from lens wear.
A perhaps surprising finding was that a higher proportion of
lapsed wearers were wearing DD lenses. Despite improvements in
comfort reported with some DD lenses,
28,29
DDs are not prescribed
by North American ECPs as frequently as they are in many other
countries.
30
This may be because they are regarded as the lens of
choice for either part-time wearers or patients already experiencing
problems with their lenses. These individuals may be more likely
to lapse from lens wear. It is also possible that when prospective
wearers do not seek contact lens care and advice from an ECP and
simply order lenses over the Internet without a prescription, the
lenses they choose are more likely to be DDs. Without the appro-
priate lens fitting and instruction on lens wear and care, these
wearers are more likely to be unsuccessful. Noncompliance with
lens replacement for this modality may also play a role in success
with this modality; with increased emphasis on the importance of
compliance with lens replacement, a higher success rate may be
found in DD lens wearers. At the time that this study was con-
ducted, SiHy DD lenses were not in widespread use in Canada. It
was therefore not possible to evaluate the combined role of a DD
modality with SiHy materials. Further study of this group of lens
wearers is required to better understand this finding.
Eye & Contact Lens Volume 39, Number 1, January 2013 Contact Lens Discontinuation
2013 Lippincott Williams & Wilkins 97
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A high proportion of participants wearing all types of soft lenses
did not comply with the MRRF. In the current study, it was not
possible to determine compliance with the ECPs recommendations
for lens replacement because only the wearers’report of replacement
interval and the known MRRF for the lens types that were worn
were available. Consistent with previous studies, the compliance rate
was highest for DD wearers and lowest for two-week replacement
wearers.
39–41
Although it has been suggested that contact lens wear-
ers who are not compliant with their contact lens wear and care may
be more likely to lapse from lens wear, no difference was found in
this study in the compliance rate for lens replacement between lapsed
and nonlapsed wearers. This suggests that noncompliance with lens
replacement is not a major factor driving dropout from lens wear.
In agreement with the work of Yeung et al,
42
compliance with
the MRRF was higher for wearers of SiHy lenses when compared
with wearers of hydrogel lenses. There are several possible reasons
for this difference. It may be that lens replacement with SiHy
lenses is driven by a deterioration in subjective vision and com-
fort.
43
The differences in surface deposition with SiHy lenses when
compared with hydrogel materials should also be considered as
a possible reason for replacing SiHy lenses sooner than hydrogel
lenses.
44–49
A prospective study investigating subjective and objec-
tive lens performance with contemporary lens materials would
however be required to further investigate this finding.
The distribution of care systems used suggest relatively low use of
private label care systems (2%); however, it is possible that the actual
percentage was higher because some wearers of reusable soft lenses
did not select or name their care system, possibly because it was
a private label one for which there was no picture, and some wearers
may have selected a brand name care system because it looked
similar to their private label care system. A higher proportion of
lapsed participants reported topping up their cases with solution rather
than completely replacing the solution each day; however, because
this study did not fully investigate compliance with all aspects of lens
care, it is not known whether wearers who do not look after their
lenses appropriately are more likely to lapse from lens wear. Previous
studies have shown a higher rate of complications in patients who are
not compliant with lens wear and it is possible that these patients may
discontinue lens wear as a result of the complications.
42,50
CONCLUSIONS
Despite the introduction of new contact lens materials, modal-
ities, and designs to the market, discontinuation from lens wear
continues to occur at a similar rate to that reported in the 1990s.
The rate does seem to be slightly lower in wearers of SiHy lens
wearers, but the difference is relatively small, and the introduction
of these materials does not seem to have had a profound effect on
a perpetual problem of discontinuation of lens wear, although they
do seem to represent a step in the right direction. Wearers of SiHy
lenses were also found to be more compliant with the MRRF.
ACKNOWLEDGMENTS
The authors wish to thank Dr Tyler Anderson for his help in
generating the online survey.
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