The Era of the 'McDonalds' Contact Lens

[Donald F. Ezekiel]

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.

[Ethan Ranipka]

Reprinted from Clinical and Experimental Optometry


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.

...Tragically for these patients, the contact lens practitioner is a threatened species.

I disagree that there aren't skilled CL practitioners today...

So what's the solution? Fit everyone with conventionals? Funny that the clinicians who believe that disposables are bad for the profession are also the clinicians at the top of certain CL manufacturers who also mass-produce new disposables as competition to the J&J, B&L and CIBA giants also...
So what's the solution then?

[Richard_Hom]

[quote=Ethan Ranipka]I disagree that there aren't skilled CL practitioners today...quote]

Ethan,

I agree with Dr. Donald F. Ezekiel to the extent that they may be masters of the soft contact lens, but I must say that few of today's graduates are masters of the rigid gas permeable lens. I think today's graduates have a narrow mind set of only using silicon or hydrophilic lens materials for all of their problems.

What has probably caused this are the potential RGP pateints are problem going straight to refractive surgery. That leaves those think refractive surgery is not the best solution for their situation.

[Tom Miller]

I'd bet we could find a very similar story from a typewritter manufacturer. "Who needs those new fangled computers anyway with that spell checking thing just making people lazy and uninclined to learn to spell"

Some people just can't accept progress and the fact that 98% people can be fit in the "McDonalds mode" with excellent vision.

The sky is blue.
The grass is green.
And CLs are very, very easy to fit nowadays.

[Richard_Hom]

"...And CLs are very, very easy to fit nowadays.

True,

In fact the eminent Joseph Aquavella of U of Rochester says that 95% of the patients cannot differentiate the comfort of one contact from another.

[Ethan Ranipka]

[quote=Richard_Hom]

I disagree that there aren't skilled CL practitioners today...quote]

Ethan,

I agree with Dr. Donald F. Ezekiel to the extent that they may be masters of the soft contact lens, but I must say that few of today's graduates are masters of the rigid gas permeable lens. I think today's graduates have a narrow mind set of only using silicon or hydrophilic lens materials for all of their problems.

What has probably caused this are the potential RGP pateints are problem going straight to refractive surgery. That leaves those think refractive surgery is not the best solution for their situation.

I'm not saying that kids straight out of university are masters of RGPs... to say that there aren't any contact lens practitioners who have the necessary skills around is a very sweeping statement... it is a mix of personal interest, training, continuing education, and clinical experience. and exposure...

YES there are clinicians who have all of these and who do fit the most complex of cases

[Richard_Hom]

"...There are clinicians who have all of these and who do fit the most complex of cases

Ethan,

Yes, it is sweeping because once it was the norm for optometric graduates to be skillful in RGP or PMMA fitting. Now it takes extra motivation to be so skilled. In fact, what amazes me that the contact lens residencies have receded swiftly in importance as medical optometry-focused residencies have grabbed the spotlight.

[Ethan Ranipka]

Ethan,

Yes, it is sweeping because once it was the norm for optometric graduates to be skillful in RGP or PMMA fitting. Now it takes extra motivation to be so skilled. In fact, what amazes me that the contact lens residencies have receded swiftly in importance as medical optometry-focused residencies have grabbed the spotlight.

Grads are taught to see medical optomology as sexy.

[Ken Elder]

Ethan,

Yes, it is sweeping because once it was the norm for optometric graduates to be skillful in RGP or PMMA fitting. Now it takes extra motivation to be so skilled. In fact, what amazes me that the contact lens residencies have receded swiftly in importance as medical optometry-focused residencies have grabbed the spotlight.

Part of the reason for that though is that modern soft lenses are so good and come in so many different Rxs that the need for RGPs is greatly reduced.

Even 5 years ago, if you had a patient with an Rx like -4.00-4.00 X 160 it would have been almost unheard of for them to get good vision out of a soft CL. An RGP was almost a must.

Now you can easily get a person like that to a stable 20/20 with soft lenses.

[Leonard Fine]

Sound and reasonable comments indeed. If all you say is true and I have been fitting lenses for a similar 40 years then one must consider some other variables in this market. The ease with which lenses may now be fitted has not brought about the huge swing to contact lens wear that one would have expected. Better materials, concepts of continuous wear, maintined corneal integrity and so on but the market remains static and unmoved. Why is that so? What factors have emerged to prevent this swing to the easy wear contact lens? What has produced this consumer resistance to an easy solution to a visual problem? If it is so easy why than re optometrists not pushing the easy solution? Costs, profitability,responsibility among others????? These factors have been concern to many and I would invite comments on this phenomenon from other optometrists to explain and satisfy my own curiosity.

Leonard Fine
Sydney
Australia

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.

[Herman Salmenson]

It is interesting. One would think that with the increase in comfort, health, vision and ease of fitting that there would be a significant increase in the number of people wearing contacts, but alas that is not the case.
It is good to see that Lenny is still practicing Optometry.
Herman Salmenson

[Jim Kokkinakis]

The Era of the "McDonalds Contact Lens" has been an interesting read. There have been massive changes and improvements to contact lens products in the last twenty years. So why is it that the contact lens market is really not growing?

I am a central business district practitioner and there is always an interest in contact lenses but in the last twenty years:

1. Frames and lenses are significantly more attractive and comfortable to wear.
2. Laser Vision correction is an option for 2% of the spectacle wearing population.
3. Computers are used extensively.
4. Airconditioning is more common.
5. Immune diseases seem to be more common (anaecdotal)
6. Diets have changed

There are probably another half dozen issues that I have not thought of, but there is a significantly different environment today that we are recommending contact lenses in. Something to think about is that maybe if we had not had a significant change in contact lens products and solutions, maybe no one would be wearing contact lenses - jsut some food for thought.