As an optometrist, my goal is to seamlessly deliver clear, comfortable vision to all of my patients. This can be especially rewarding when successfully fitting a patient with contact lenses, particularly those who might have an active lifestyle or significant visual demand at work. Understanding past experiences with contact lens wear, while addressing underlying factors that may complicate success, is critical to helping the patient have an exceptional lens-wearing experience. It all starts with careful patient selection which includes a comprehensive understanding of the patient’s visual needs at all ranges, establishing expectations to match their visual goals, and building an appropriate clinical profile with a thorough assessment of the ocular surface.
It is imperative to remember that placing a lens on an eye can change the ocular surface environment. As we know, when a patient inserts a contact lens, the material subdivides the tear film into two different layers: a pre- and post-lens tear film, which can potentially cause biophysical changes that might lead to increased tear film evaporation and changes in ocular surface homeostasis.
Subsequently, we understand from longitudinal research that patients who experience contact lens-related dryness and resultant discomfort have a high likelihood of dropping out of lens wear.1,2 It begs the question—what might I do next for these patients to help them have a comfortable experience?
I have found in my practice that using a lens technology designed to help maintain ocular surface homeostasis can increase the chances that patients will have a successful outcome with their contact lenses. New lenses are developed each year, but what impresses me most are technologies that leverage the latest research and discoveries about ocular surface health, of which homeostasis plays a key role.
What the TFOS DEWS II Report taught us about the importance of homeostasis
In 2017, the Tear Film and Ocular Surface Society (TFOS) published a follow-on to the original 2007 Dry Eye Workshop (DEWS) report—now referred to as the TFOS DEWS II report, which provides insights into the biophysical and biochemical aspects of tears, the role of tear film osmolarity, tear film integrity, and the importance of electrolytes in maintaining ocular surface homeostasis.
When specifically looking at the importance of electrolytes—including sodium chloride, potassium, chlorine, magnesium and calcium—these biochemical elements are known to play a role in regulating homeostasis and optimal osmolarity as well as glycoproteins. From a tear film stability and contact lens perspective, the integrity of the corneal epithelium can be maintained with a buffered lens solution containing potassium, calcium, magnesium, phosphate, bicarbonate and sodium chloride, with potassium being particularly important.3
Tying these threads together, one of the key findings was that a stable and balanced precorneal tear film (comprised of the external lipid layer, an intermediate water layer, and an internal mucus layer)4 can be considered a hallmark of ocular health,5 largely because it can impact vision, contact lens comfort, and moreover the potential to protect and moisturize the cornea.
The corneal epithelial surface is best maintained with a buffered solution containing potassium, calcium, magnesium, phosphate, and sodium chloride, with potassium being particularly important.3
Why homeostasis is key to a balanced tear film
A healthy and functioning ocular surface relies on the harmony and balance of the tear film, corneal and conjunctival epithelium, meibomian and lacrimal glands, and eyelids. Hyperosmolarity of the tear film is considered an important trigger for inflammation.6 Conversely, maintaining homeostasis of this microenvironment can lead to a stable, precorneal tear film (essential for comfort and clear vision) and prevent discomfort and dysfunction of the ocular surface.6
The interplay between osmolarity and contact lens discomfort
The TFOS DEWS II report describes tear film osmolarity as a single measurement that can provide insight into the balance between tear production, evaporation, drainage, and absorption.5 Subsequently, tear osmolarity could be considered a relative barometer of tear film stability.7 For example, heightened tear evaporation might increase tear osmolarity (hyperosmolarity),8,9 which can cause both burning and stinging leading invariably to contact lens wear intolerance.
Contact lens discomfort can be difficult to discern from patient to patient in how they may articulate the symptomatology. However, despite each patient’s differences in sensitivity and subjectivity, studies have established relationships between comfort and contact lens osmolarity and between tear osmolarity and production.10
Technological Leap Forward: The Bausch + Lomb INFUSE® One-Day lenses
I’ve never been as excited about a lens as I have been about the Bausch + Lomb INFUSE® One-Day daily disposable lenses. This innovative lens separates itself from the pack in how it is designed, the materials, and even the packaging solution—INFUSE® was specifically engineered to maintain 96% of its moisture for 16 hours.11
INFUSE® is made of kalifilcon A, which is a novel silicone hydrogel material developed by Bausch + Lomb to deliver comfort and exceptional vision.12
What is kalifilcon A?
Kalifilcon A is a next generation silicone hydrogel contact lens developed by Bausch + Lomb that has been commercially available since 2020. It is exceptionally moist, flexible, and breathable for all-day comfort.
What is ProBalance Technology®?
INFUSE® lenses feature ProBalance Technology,® which refers to the proprietary blend of electrolytes, osmoprotectants, and moisturizers that can help maintain contact lens comfort, potentially minimize contact lens dryness, and aid in the maintenance of ocular surface homeostasis
The ingredients utilized in ProBalance Technology® can be broken down into three groups:
Electrolytes
INFUSE® lenses with ProBalance Technology® contain potassium. Potassium is an electrolyte required for the normal functioning of cells, nerves, and muscles. It can also be found in high concentrations in our tear film with some research suggesting that it can play a role in protecting the corneal epithelium from UVB radiation and helps to maintain normal corneal thickness. Studies have demonstrated that ocular surface integrity could be best maintained when there is a buffered solution containing potassium, calcium and magnesium, with potassium being of particular importance.3
Osmoprotectants
INFUSE® lenses feature a proprietary combination of ingredients inspired by the Tear Film & Ocular Surface Society’s DEWS II report. In addition to potassium, erythritol and glycerin can support a proper-functioning, lubricious tear film which could help to reduce tear film break-up and tear evaporation. Osmoprotectants have also been incorporated into the INFUSE® lenses to help maintain the integrity of the corneal epithelial tissue during hyperosmotic stress.11
Moisturizers and Wetting Agents
Poloxamine 1107 and Poloxamer 181 help retain hydration, provide a smooth, wettable surface, and maintain tear proteins in their healthy state.
How presbyopia may impact ocular surface homeostasis
Presbyopes can present additional challenges in achieving exceptional vision at all distances in multifocal contact lenses wearers due to age-related changes that can impact ocular homeostasis secondary to decreased tear flow and volume, greater tear evaporation and osmolarity, and increased meibomian gland dysfunction.13
Coupled with biological and physiological challenges, environment and lifestyle demands pose additional obstacles to achieving success with multifocal contact lens wearers. For example, they may spend up to nine hours or more on digital devices. Six of ten GenX’ers (63%) reported symptoms of digital eye strain.14
1 in 3 presbyopes who wear multifocal contact lenses may drop out due to discomfort and poor vision.15
As an eyecare professional, I appreciate the innovative approach Bausch + Lomb took to address the dynamic visual needs presbyopic patients may have. Additionally, the company took the initiative to optimize seven key biometrics (see more details below) to potentially enhance a presbyope’s visual experience.
Pro Fitting Tip:
Patient lifestyles can have a profound effect on their contact lens wearing experience. For example, the amount of time all of our patients spend on digital devices surely impacts not just blink rate, but tear meniscus height, tear breakup time (TBUT), osmolarity, and pupil size. Asking my patients lifestyle-focused questions helps me to truly understand their day-to-day activities. As a result, I can provide a solution that meets their unique visual needs. Additionally, this is a conversation that can explain the why behind my prescription, as well as how this lens may be able to fulfill their specific needs.
Optimizing seven key biometrics to enhance the visual experience
While we have been addressing ocular health and homeostasis, it is equally important to remain focused on how to alleviate the potential for visual, ocular, and contact lens discomfort, respectively—considering these aren’t separate when it comes to our presbyopic patients. There’s a huge overlap. In my professional medical opinion, this is an area where we can do our patients a great service by considering their ocular health and both their visual needs and lifestyle considerations.
During the R&D process for the INFUSE® Multifocal lens design, experts at Bausch + Lomb analyzed the ocular biometrics of a diverse population of patients. These measurements went beyond the typical eye exam to include:
- Subjective Refraction (Reminder: Always perform a fresh refractive analysis to assess their current visual needs rather reusing an older prescription)
- Pupil Size
- Higher-order aberrations
- Residual accommodation across 9 distances
- Corneal topography and diameter
- Anterior chamber depth
- Axial chamber depth
After analyzing thousands of data points, Bausch + Lomb varied the ADD power, change of power within a zone, and the widths of the intermediate and near zones. Their goal was to identify a distinct lens design that would provide optimized vision in a diverse population of presbyopes.
I personally appreciate the proprietary 3-Zone ProgressiveTM Design, which, for me, enables a rather straightforward fit, as I only need to define a low and high ADD across the entire range. The INFUSE® Multifocal lens has definitely simplified my workflow and is a positive addition to my practice. I also rely on the Bausch + Lomb professional site to listen to peer-to-peer success stories, leverage the fit guide, and learn more about the technology.
A solution for presbyopes
Bausch + Lomb INFUSE® One-Day Multifocal Contact Lenses provide a smooth transition between lens powers. They also have a 3-Zone Progressive™ Design for clear vision at all distances. This allows for an intuitive, natural transition between activities like reading, working on the computer, and watching TV.
3-Zone Progressive™ Design
INFUSE® Multifocal contact lenses can provide clear vision at all distances, thanks to 3-Zone Progressive Design. With three zones for near, intermediate, and far, presbyopes can transition between reading, watching TV, and driving.
INFUSE® Multifocal lenses can make a difference for your practice
When I believe a patient might do well in a multifocal lens, I know I can rely on Bausch + Lomb INFUSE® lenses in my clinical experience for three key reasons:
1. A next generation silicone hydrogel material that can enable the lens to retain up to 96% of its moisture for a full 16-hour day.11 The high oxygen transmissibility of 134Dk/t* and low modulus of 0.5MPa lead to exceptional breathability and minimal impact to the ocular surface.
*Oxygen transmissibility @ -3.00D
2. ProBalance Technology,® inspired by the TFOS DEWS II Report, delivers a steady infusion of electrolytes, osmoprotectants, and moisturizers that can help maintain ocular surface homeostasis.
3. The 3-Zone ProgressiveTM Design, rooted in the seven key biometrics, can help me streamline the fitting process and assist my presbyopic patients achieve clear vision and a seamless transition between near, intermediate, and distance.
My Final Takeaway Message
If you are like me and deal with a wide range of patients in your chair, then the INFUSE® One-Day family of lenses could easily be a welcomed addition to your practice. Whether you have patients spending a considerable portion of their day on digital devices or those who lead active lifestyles, you can be confident that the research that went into the INFUSE® lens design can not only help you meet your patients’ visual needs, but contribute to maintaining ocular surface homeostasis for those patients who might experience contact lens dryness or discomfort.
Take the next step today by proactively prescribing a lens meant to address the dynamic visual needs for your patients.
