Stable and Moisturized Material = All Day Clear Vision

Do you feel like your lenses get more blurry at the end of the day?  That's a common complaint, and can best be explained by the lens drying out as your eye also dries out with long hours of computer and digital device use.  It's not just that your eyes are tired; your contact lens absorbs moisture from your eye's tear film, and if they are dehyrdated enough, your contact lens will start to lose its clarity too.  To get great vision all day long, we need a lens that can keep a stable surface even when your tear film starts to get less than perfect after a long day on the computer or phone.  Because we blink less frequently on digital devices (about 50% less often), our vision can be greatly affected if our contact lens isn't staying moisturized in between our blinks.  On average we should blink about every 13 seconds, but in computer or digital device users it can be double this.  For the study reported on here, doctors measured the optical clarity of the lens in logMAR units (see image below) for a period of 30 seconds (and please let's hope you blinked after this!).  As you can see, image quality can change greatly.  This testing was performed in a simulated lab environment and not on an actual human eye.

Table showing roughly good consistency in wetting ability across all lens brands compared.  Dailies Total 1 (CIBAVision's excellent single use lens) gets the best marks here.  Table from Contact Lens Spectrum Special Edition Volume 14 "Breaking the Cycle of Discomfort"

Table showing differences on the surface of the contact lens when new, and after 30 or 15 (in the case of Oasyss) cycles of cleaning and rubbing with solution.  Table from Contact Lens Spectrum Special Edition Volume 14 "Breaking the Cycle of Discomfort"

Take Home

When I first saw this edition of Contact Lens Spectrum, I was blown away by all of the favorable studies that were reported for Bausch and Lomb's new Ultra lens.  My patients have had a lot of success with the lens also, but seeing it perform on so many different levels was a page-turning read for me.  There are some things to consider about this reporting -- the studies were all reported by those within the Bausch and Lomb or Valeant family, and the results of the studies used here were done in lab simulations and not on actual human eyes.  There were also great subjective reports for patient comfort, vision, and doctor ease of fit included in the magazine supplement, however that were meant to speak to "real life" lens performance.  I look forward to seeing more head to head lens comparisons from third party groups in the future, but any time a genuinely new product enters our industry, it is exciting to be able to offer a different option to patients who have been living with contact lens dissatisfaction in their previous lenses.  Ultra remains a great choice for me in patients who want a monthly wear lens, but have been dissatisfied with previous monthly lens options.  

There are no official reports that have been published, but based on anecdotal evidence, within 2-3 days of lens wear some patients were experiencing redness around the cornea (or limbal hyperemia in its technical term).  This redness  typically had no associated pain, discomfort, dryness, or vision change.  The eyes were just a little red.  Within a day or two, the redness would be entirely gone in most patients, even if they had not discontinued lens wear.  

I have spoken with representatives for Bausch and Lomb, and they suggest that redness complaints should be handled on a cases by case basis, as any patient may have issues adjusting to a new lens material.  The Ultra silicone hydrogel polymer is extremely oxygen transmissable (163 dk/t in a -3.00D lens), so breathability issues seem an unlikely culprit. They suggest that if your patient experiences any pain, discomfort, or vision changes, to of course discontinue the lens immediately, and contact your office.  But if they are having no other symptoms, I was told by the Bausch and Lomb representative that the patient may continue to wear the contact lenses and in many reported cases, the redness resolved in a day or two without any complications.  Of course, they recommend that if the redness persists or other symptoms develop, the patient should come back in to be seen immediately. As with any new contact lens being prescribed for a patient, a 2-3 week follow-up for all new fits is often a good way to check for any problems that may arise with lens wear.

As a personal experience, I did not experience any limbal hyperemia on my first day of lens wear, but I did find that my eyes were slightly injected at the end of my second day of lens wear.  I removed the lenses for bed, and woke up with clear eyes again in the morning.  I thought nothing of it because I am solely a daily contact lens wearer at this time, and even if this is the best monthly contact lens in the world, it can never deliver what a daily contact lens can.  As a precaution I did not wear lenses on day 3, and I experienced no discomfort or symptoms.  On day 4 I wore the lenses again, and this time no redness at end of day.  Of course, this is all anecdotal, but it may be true that your eyes just need time to adjust, and the redness your patient may experience could potentially resolve without any further issue.

While Bausch and Lomb has no official comment on what may be causing this redness in some patients, there are a number of possible theories being floated by ODs.  The lens is a 8.5 base curve, and many doctors theorize that the lens may be tightening up as certain patients wear the lens through the course of the day.  If this is the case, and a tight lens syndrome was developing, then discomfort and vision issues would be expected to develop, and the lens would need to be refit for patient safety.  The fact that the redness in many reported cases resolves without other symptoms may make tight lens syndrome less likely, but it should always be ruled out in patients by a discussion of symptoms, and careful evaluation of the movement of the lens on the eye.  

Other possible culprits reported include a possible solution interaction.  There have been several case reports that show that a minority of patients may experience comfort issues when pairing Acuvue products with Opti-Free Replenish or Express solutions.  Since Bausch and Lomb Ultra was designed with a similar lens shape and edge design as Acuvue Oasys (and by the same person), it may be that this lens also has interaction issues with certain lens solutions.  There are no official staining grid reports since this lens is so new, but Bausch and Lomb does suggest pairing their lens with Biotrue, or their new PeroxiClear hydrogen peroxide solution.  In the FDA trials performed by the company to bring this lens to market, these solutions were used with good success.  As a personal aside, I was using PeroxiClear with my lenses and still experienced day 2 hyperemia, but it did resolve quite quickly the next morning after the lenses were removed overnight.

So what do these reports of redness with the Ultra lens mean to you?  I still think that this lens could be a great option for patients that are experiencing dryness and end of day comfort issues with other monthly lens options, but aren't ready to jump into daily contact lenses due to price.  The Ultra is also ideal for refitting those Acuvue lens overwearers that are trying to get a month out of a 2 week product -- the edge profile of the lens is almost identical to Oasys, making for the easiest transition to monthly lens products that I have had in my office.  I have been very careful as to the K values that I have fit this lens on, and to this point have only had myself experience redness, and none of my patients.   I have proactively instructed my patients to call me if redness or other symptoms develop, but have not heard from anyone.  I have also been following Bausch and Lomb's advice to recommend Biotrue or hydrogen peroxide solutions with this lens, just in case it is a solution interaction issue in sensitive patients.   If fit with a proactive attention to detail, I think that you will have the same success in transitioning patients to this new, very comfortable and highly breathable lens material.

Have you had issues with hyperemia after wearing Ultra for a few days, or have a theory of your own why this side effect is showing up in doctor's anecdotal discussion of the lens?  I would love to hear more input as to other people's experience with this lens, whether you are a prescribing doctor, or a patient that is trying it out for the first time!

UPDATE: I was at a meeting last night, and a culprit for the redness complaints has been found!  Issues were isolated to a single manufacturing plant, where they found that too much NaCl (salt) was being used in lens manufacture.  That increased salinity created redness when the lens was put on hte eye.  Bausch and Lomb has remedied this problem and moving forward does not expect any continued redness issues.

Disclaimer:  I am not a Bausch and Lomb employee, or in any way affiliated with their company except that I have worn their lens and am fitting it for my patients with good success.  The conversation provided in the post above is all anecdotal and I have performed no actual studies on the lens myself and would not consider myself qualified to do so.  To this point, there are no official reports as to how many people experience redness with the lens (we know it is a minority, but we do not have a percentage) and there is no official statement from the company concerning the most likely cause for hyperemia reports in these patients other than these situations should be investigated by the doctor on an individual basis.

Bausch and Lomb's Ultra lens is made from a new silicone hydrogel material, with excellent oxygen permeability (dk/t is 163 for a -3.00D lens!).  The real draw of this lens is the edge profile design.  Designed by the guy (sorry I don't have his name) who worked to bring Acuvue Oasys to the market for Vistakon, the new Ultra lens has an 8.5 base curve and an incredibly thin edge, causing very limited lens awareness as the eyelids blink.

Another bonus?  The Ultra lens also has aspheric design optics, giving an extra boost to vision based on average amounts of distortions on the eye (called spherical aberrations) for individual powers.  Biofinity is the only other monthly lens besides Bausch and Lomb's products to offer aspheric technology (but theirs are averaged over much broader power spectrums).

Here comes my personal review:  I have to make a disclaimer though that I haven't worn monthly lenses in about 5 years.  And it is allergy season in North Carolina, and while I have been persistent with my Lastacaft, I am still having irritation when I wear contact lenses (it is just a bad time of year here for allergy sufferers).  With all that being said, I was overall impressed with Ultra.  The initial comfort was spectacular -- very similar to Acuvue lenses in fit and feel.  I can't say that I felt vision was better than any other contact lens, but I am not excessively particular to vision (I have a low Rx).  I was able to wear the lens quite comfortably, except for intermittent allergy issues, for 18 hours.  And the best part -- typically in monthly lenses my eyes feel like sandpaper when I remove the lenses at night.  But with Ultra the lens came off comfortably and without burning or stinging.

One other plus, is anyone else sensitive to the preservative-filled storage solutions of most contact lens packages?  That burning and stinging when you put a new lens in your eye means that you are. The Ultra lens it is stored in a great, low-preservative solution (their Biotrue formula), so there is no initial discomfort for solution-sensitive wearers.

Do you have older patients that need a good handling tint to see their contact lenses in the packaging?  I was impressed with the strong blue handling tint of this lens because most lenses on today's market are nearly invisible.  This is not an issue for most, but as an optometrist it is great to have a lens that older patients would be able to see.

Other perks of Ultra: Bausch and Lomb is rolling out this lens with a universal pricing policy, meaning that you are guaranteed to pay the same price whether you buy from your doctor or an online retailer.  They will also have rebates with the initial roll out, to help save you even more money (something Ciba did not do when they started this policy with their Dailies Total 1 lens).  

Another little tidbit: the new Ultra lens will be replacing Bausch and Lomb's current Purevision 2 lens, so if you are an optometrist, start moving your patients over.  There is no set timetable for the transition away from Purevision 2, but the new lens has the same vision perks, but with better comfort.  Purevision 2 has lost market share since its recent roll out, falling to an abysmal 2-3% market capture, and is being recycled potentially to another retailer as a "generic" type lens Not sure that this is set in stone so I won't give any firm statements.

In summary, I think Bausch and Lomb's Ultra might have the right combination of comfort and vision to become a major power player on the monthly scene.  It should make for the easiest transition yet for Acuvue wearers wanting to change to a contact lens approved for monthly lens wear.  Would I switch to Ultra?  Absolutely not -- you can never happily go back to monthlies once you experience the amazing-ness that is daily contact lens wear.  But I do think this was the best monthly lens that I have had on my eyes, and I can't wait to see what my patients think when we get the fitting set next month.  Keep me updated on your personal opinions and experiences with this lens!