Fast versus gradual adaptation of soft monthly contact lenses in neophyte wearers

Aim: To determine if a gradual adaptation period is necessary for neophytes when fitted with modern hydrogel or silicone hydrogel reusable disposable contact lenses. Method: Across four sites, 74 neophytes (18-28 years) were randomly assigned to a reusable lens: Proclear® (hydrogel) or Biofinity® (silicone hydrogel) and an adaptation schedule: fast (10 hours wear from the first day) or gradual (4 hours on the first day, increasing their wear time by 2 hours on each subsequent day until they had reached 10 hours). Masked investigators graded ocular surface physiology and non-invasive tear breakup time (NIBUT) and a range of comfort, vision and lens handling subjective ratings (0-100 visual analogue scales) were recorded at the baseline visit and after 10 hours of lens wear, 4-6 days and 12-14 days after lens fitting. Subjective scores were also repeated after 7 days. Results: There was no difference (p>0.05) in ocular surface physiology or NIBUT between fast and gradual adaptation groups at any time point in either lens type with the exception of increased corneal staining (p=0.019) in the silicone hydrogel fast adaptation group after 4-6 days. Subjective scores were also similar across the visits and lens types with the exception of ‘lens awareness’ (p=0.019) which was less in the gradual versus the fast adaptation silicone hydrogel lens group at 12-14 days. Conclusion: There seems to be no clinical benefit for recommending a gradual adaptation period in new wearers fitted with modern soft reusable disposable contact lenses. The findings of this work add to a growing body of evidence suggesting that such advice is unnecessary in regular soft contact lens wear, which has important ramifications for the initial clinical management of these patients.