Without a doubt, with each passing year, there is increased attention on the medical model, as well as an increased interest in practicing full-scope optometry. For many practitioners, this shift in focus has translated into decreased attention on what is too frequently referred to as “the basics.” Unfortunately, contact lenses are among these so-called basics. I find this generalization to be a bit unjust because there is nothing basic about today’s contact lenses. These are complex medical devices, backed by technology and chemistry that reaches far beyond common understanding. But contact lenses aren’t a sexy topic—unless, of course, there’s an Acanthamoeba outbreak or some other devastating, news-making event.
Perhaps the public perception that a contact lens is a mere commodity is at the heart of this trivialization. Or perhaps familiarity with the concept of lens wear, coupled with the fact that soft lenses are celebrating their 40th anniversary (the first soft lens was introduced by Bausch + Lomb in 1971), makes them seem boring, commonplace and even, perhaps, outdated in terms of modern methods of refractive correction.
But just because something has been around for a long time doesn’t make it old fashioned or rudimentary. Combining plastic and water to create a hydrogel material was a remarkable scientific breakthrough, accomplished by Czech scientists Otto Wichterle and Drahoslav Lim in the late 1950s. Likewise, the ocular environment is complex and can easily become destabilized. The impact of contact lens wear on the ocular surface can be huge.
Advances in lens care product formulations have also added to the complexity of contact lenses in clinical practice, because there is known potential for interaction between certain combinations of materials and lens care components. Lens care solutions are complex and sophisticated products that are formulated to efficaciously cleanse while simultaneously achieving enhanced lens wettability and biocompatible disinfection. As it turns out, this is not so simple—although, it may represent a smaller obstacle than patients do. Who knew that being an optometrist would also require you to be a psychiatrist at times, reading into the wayward minds of non-compliant patients?
Oh, and then there is the small matter of contact lens dropout. Industry data show that, every year, approximately the same number of patients discontinue contact lens wear as those who become new wearers! I’d say that in itself is evidence that fitting contact lenses—or at least fitting them properly—is no easy task. Although manufacturers try to make it so—perhaps at their own expense—there is nothing straightforward, basic or uncomplicated about contact lenses.