Dispensing Optics managing editor, Nicky Collinson, caught up with 2019 British Contact Lens Association Medallist, Professor Lyndon Jones, at the BCLA conference in Manchester…
1. Your BCLA Medal Address looked at three decades of research investigating how hydrogel and silicone hydrogel materials interact with the tear film. Can you tell me more about this?
My three main areas of applied research over the past 30 years – contact lens deposition, solution-induced corneal staining, and ocular drug delivery – all evolved from the work I carried out in clinical practice before moving to academia.
I first began looking into contact lens deposition after I graduated in 1986, when high water content lenses were becoming available. These lenses delivered more oxygen to the cornea than HEMA-based materials, but they tended to split quite quickly and also deposited fairly rapidly, and ideally needed to be frequently replaced, which was not an option at the time.
I was fortunate to be given the opportunity to work with Professor Brian Tighe at Aston University on this issue of deposition. Whilst still in clinical practice, I undertook a research project to look at protein and lipid deposition on these high water content materials, with an emphasis on kinetic uptake over time. Taking the lenses to Aston for analysis, we were able to show the advantages of three-monthly wear over monthly wear. Next, we examined protein and lipid build-up over time from one-day up to one-month and found that protein and lipids levels varied depending upon the ionicity of lenses. For the first time, we showed that kinetic deposition rates varied between different types of lens materials – concluding that wearing schedules should be ideally tailored to the material.
After moving to the University of Waterloo in 1998, I began to look at deposition rates on silicone hydrogel contact lenses. We were among the first to show that silicone hydrogels deposited less protein than hydrogels but higher levels of lipid. These findings were of interest to industry and helped in the modification of material composition and surface treatments and development of contact lens care systems.
With regards to my second area of interest, it was a chance observation in practice that led me to researching whether solutions made an impact on corneal staining. At the University of Waterloo, I became involved with silicone hydrogel corneal staining studies and lens interactions with certain solutions. The development of staining grids later helped clinicians identify the best solutions for different types of contact lenses.
My interest in ocular drug delivery methods also came out of my work in clinical practice, looking at how to best deliver allergy medications for contact lens wearers. Again, at the University of Waterloo, we looked at the uptake and relevance of drug delivery from contact lenses with support from a government grant. So, now we are developing contact lens materials to deliver therapeutic drugs to the ocular surface at therapeutic levels over two weeks. Soon, we are hoping these will be moving to clinical trials.
2. What remain the main barriers to low uptake of contact lenses – and high rates of dropout?
Low uptake is principally driven by practitioners not recommending contact lenses to patients. Proactive recommendation is a missed business opportunity because there are great products out there at reasonable prices. The reasons for drop-out tend to differ between new patients and experienced wearers. New wearers mostly drop out because of problems with handling lenses, especially where not enough attention has been paid to teaching by the prescribing practitioner. Another reason is simply poor vision.
The problems for experienced wearers remain end-of-day discomfort and dryness – so we need to make sure we are offering alternative lenses when problems arise. Investing time and effort in patient retention comes down to short-term pain for long-term gain. And it shouldn’t be just a case of looking at different lens materials, but different modalities should be considered too.
3. What can CLPs do best (or better) in practice to help grow their contact lens patient base – and retain these patients?
Daily disposable lenses offer great convenience and optimum comfort for lens wearers, but practitioners are often concerned about the price for patients. Cost is only really a consideration for some patients who want to wear their lenses seven days a week. So I would advise practitioners to think about lens wear in terms of cost per wear per month. Think about getting patients on a direct debit scheme to make it easier for them to obtain their lenses and stay with you. Providing contact lens wearers with extra comfort and convenience will always help with patient retention.
4. There have been many technological developments in the world of contact lenses over the past decade. Which breakthrough do you think will have the most significant impact?
The ocular surface is so important when it comes to the success of new technologies. One of the most exciting areas for development at the moment is in multiple measurements of the ocular surface, and seeing the ocular surface in greater detail. Being able to analyse the ocular surface more closely and treat underlying causes of dry eye disease in contact lens wearers, for example, is particularly important for comfort and retention.
We are also seeing an explosion of instruments that measure axial length, which is extremely important for myopia control. There is continuing to be more emphasis from contact lens companies in these areas, not just from instrument manufacturers. In my mind the three big growth areas are: myopia control, ocular surface analysis, and specialty contact lenses, such as sclerals.
5. What words of wisdom can you impart to today’s CLOs (and future CLOs) to help them provide the best care they can to their patients?
If I had to sum it up in one piece of advice it would be to never be prepared to accept ‘Ok’. Always look for excellence for your patients, whether it be in comfort or convenience, because just ‘ok’ leads to contact lens drop-out. Be prepared to try out new products and keep up-to-date with research findings, whether it be online or by attending events such as the BCLA conference.
Lyndon Jones is a professor at the School of Optometry and Vision Science, University Research chair and director of the Centre for Ocular Research and Education (CORE) at the University of Waterloo, Canada.