Reprinted from Clinical and Experimental Optometry
Has the 'McDonalds' Contact lens resulted in the demise of the Contact Lens Practitioner?
After 41 years of Contact lens practice, one cannot but reflect on the changes that have occurred in our specialty. My training in Australia and in the UK, where I was fortunate to have worked with Dallos, Bier, Ridley, Fletcher and Reuben, emphasized and taught skills where the contact lens specialty was a realty.
The advent of the disposable lens has been described and reported to be a healthier lens for our patients. The idea of a new clean lens, one that does not require cleaning and the concept of a lens that is worn once and then discarded, is excellent. No longer will practitioners see nasty lens induced problems. These will be described in our text books but not seen in practice. Unfortunately, this is not the real world and the problems that the concept promised to have eliminated are still occurring.
With every 'advance', there is a downside. This is the case with the disposable lens.
Times have changed. Contact lenses are now marketed directly to the patient. Contact lenses have been turned into a commodity. Often it is not the clinician who decides what the best option is for his patient. Direct marketing strategies offer the public incentives in the form of watches, cosmetics and would you believe ' a trip of a lifetime' if a certain brand of lens is purchased. We have allowed this to happen! The professionally committed contact lens specialist is a threatened species.
The regulation of the disposable contact lens as a McDonald's lens that requires no skill to fit ( the one size fits all philosophy does have its problems), and the availability of the lens by mail order, on the internet and in pharmacies, has regulated the contact lens to the same category as a tin of coffee or a packet of biscuits.
The one size fits all philosophy is great for the marketers. There are no skills needed for the lens to be fitted. Patients leave with a pack of labeled lenses. It is quick and easy for the practitioner. The McDonalds contact lens era is here. It may not be perfect but does it matter? It is only an eye. It is instant gratification for the patient (vision may not be perfect but it is better than nothing) and it is easy money for the practitioner. And when further lenses are required, why not purchase these from the cheapest source. Its human nature. The growth of these outlets, with their large and growing share of the replacement lens market, clearly demonstrates this trend.
Another downside of this 'progress' is that practitioners are losing the skills to fit non- routine patients. Those who must wear a contact lens to achieve optimal vision are often not afforded the professional skills to have the benefit of a correctly fitted lens. Basic practitioner skills, may not have been taught or used for long periods, because it is easier and gives a better cash flow (at least initially) for the practitioner to go the McDonald's route. It may not be the best or even the correct option but it is quick and no skill is required.
Should we now ask: 'Why is there such a high drop out of contact lens patients estimated to be two million each year, when the availability of a convenient, easily sourced lens that does need maintenance is here.?'
The replacement of lenses from a non professional source has the potential to and does cause problems. Somehow the patient-practitioner contact with the necessary after care does not seem important and is not needed. Problems occur which were supposed to be eliminated by the frequent replacement of lenses. We frequently see this in our practice. Are we unique?
Lenses that are supposed to be worn for a day, for two weeks or a month and discarded, are worn for much longer periods. Just as patients purchase lenses from the cheapest source to save money, so they do not dispose of a lens that appears not to cause a problem and they keep wearing a 'disposable' lens until it becomes uncomfortable or splits. It is human nature and a common story.
Unfortunately, the one-fit McDonalds lens is often very thin and it is not possible to rub and to clean it without tearing. So this important procedure is not done. Again, thin lenses cling to the cornea with no flushing of normal metabolic waste products from the cornea. A dirty lens with a cling fit is a recipe for disaster. And disasters happen.
Here is a case where a disaster programmed to happen, actually occurred. Patient A was supplied with replacement well-marketed brand lenses and freely admitted that he used the lenses until they broke. The lenses were never cleaned ' because they tended to rip'. He has very flat corneas.
The wrap around McDonalds lenses clung to his corneas and did not move. He had not seen a practitioner for some years and replaced his lenses by 'shopping around'. A dirty tight fitting lens in our harsh environment. The result was inevitable.
The bacterial infection and abscess resulted in severe corneal scarring and an extremely distorted cornea. What lens option would now give this patient vision? A McDonalds lens?.
We are now in the McDonalds era of contact lenses. What is quick and easy for the practitioner and gives a quick return is the way practice has evolved. The lens is being mass marketed directly to the consumer with all the marketing gimmicks of hair shampoo and coffee. The contact lens has been regulated as a device that was once carefully related to the cornea, that needed professional care and after-care, but is now an off the shelf commodity.
The marketing deluge to the consumer has overridden practitioner advise, for which, as I understand, the profession are trained. This commodity lens is available on the Internet, in pharmacies and by mail order. There is no skill needed. One size fits all. There is no skill needed. Why not have an auto refractor in the super market?. All that is needed is a number. It is just a matter of time? As professional skill is no longer needed, are we no longer professionals but shopkeepers?
As a result of this 'progress', patients who have an ocular condition that necessitates the wearing of a contact lens to obtain optimal, vision may not have , and even today do not have, the option of a contact lens practitioner with the necessary skills to fit these needy patients with suitable lenses.
Because patient-practitioner contact is lost, problems that the concept of the disposable lens promised to eliminate do occur and these problems are often severe and sight threatening. Tragically for these patients, the contact lens practitioner is a threatened species.