Hubble Trouble


During a recent contact lens research spiral, a recommended article came across my screen: “Hubble Proof Your Contact Lens Practice.” If that isn’t a perfect summary of the industry’s attitude toward that product, I don’t know what it is. The resistance to this so-called “market disruptor” is almost universal. But, the question is: why? Why are we so worked up about a company that has a single-digit market share? Because the biggest issue facing the profession is that eyecare professionals are conservative, and change is not something we tend to embrace.

The second biggest issue is the elephant in the room with “lost contact lens revenue” written across its side. However, a lot of the articles out there tend to conveniently sidestep that point and double down on the “patient health and safety” aspect of the anti-Hubble argument. Let’s dig into some of those arguments.

Oxygen permeability

Low oxygen transmission of the lens material is probably the biggest argument against Hubble’s service. Hubble contacts are made of Methafilcon A, material that has a Dk of 18. That’s…not very high. According to the Holden and Mertz criteria of 1984, daily wear contact lenses should have a Dk value of approximately 24 in order to prevent any corneal edema.1 However, in that study, the permalens material with a Dk of 18.4 caused the cornea to swell, on average, 1.6%. That’s less than the daily variation of your corneal thickness with no lens on.

Anything less than 4% is considered acceptable by most folks in the scleral community. So why are doctors perfectly fine with fitting a scleral on a normal eye and inducing a small amount of swelling but not a daily disposable soft lens? Obviously, there are better materials for transmitting oxygen on the market, but no one quantifies the “risk” the patient is at by wearing a lens with a Dk of 18. Turns out the risk for “starving” the cornea of oxygen in Hubble lenses is quite low.

HEMA vs SiHi

Another argument has been made that is focused on the inferiority of hydrogel materials compared to silicone hydrogels. For whatever reason, the myth exists that silicone hydrogel lenses are more comfortable than hydrogel lenses, but this has never been validated in a study. In fact, a recent paper from the Brien Holden Institute suggests there is no significant difference between daily disposable silicone hydrogels and hydrogels in either comfort, vision quality, or ocular health.2 The only recommendation the authors make is to fit high-risk patients (those with compromised endothelial function) into a higher Dk silicone hydrogel material to prevent significant corneal swelling and perpetuate endothelial damage.

Single Use vs. Reusable Lenses

Reduced ocular health is really the crux of the argument against Hubble, but it is also the place where many ethical arguments against them break down. Go to any contact lens industry-sponsored luncheon, and you’ll have the fact drilled into you that daily disposable lenses are superior to reusable lenses from an ocular health standpoint. And the data supports that argument. You have to keep in mind, regardless of patient, that fitting someone with a daily disposable lens decreases their risk of a contact lens-related adverse event by 12.5x when compared to a reusable lens.

In addition to being at an increased risk of adverse events, your reusable lens wearers are not going to be as compliant with their lens replacement compared to daily disposable wearers. 50% of lenses wearers and 30% of monthly lens wearers will overuse their lenses compared to 15% of daily disposable wearers.4 Ironically, many of the patients being educated on the health risks of Hubble contacts are instead being fit into reusable lenses in order to match the price.

Innovation

While nothing about the Hubble lens itself is inherently innovative (the material is certainly outdated), their model of selling and distributing the lenses is. With the “subscription-ization” of a number of products, it was only a matter of time before contact lenses became one of them. And that’s good for the contact lens market.

If you think that the $200 rebate on claritiⓇ 1-day lenses (which conveniently places it at a very competitive price point to Hubble lenses) wasn’t in some way influenced by Hubble’s emergence, think again. “Disruptors” like Hubble hold larger manufacturers accountable and force them to develop superior products at reasonable costs. That’s the beauty of the free market.

Innovation is essential which is why we’d also ask you to stop and think about your practice style. How frequently you do something as simple a dilation? Should you change it up?

Cost

Hubble lenses cost about $1.00 a day if the patient is wearing the lenses in both eyes. That’s slightly more than the cost of many reusable lenses when you factor in rebates (about $0.90 a day on average). But it’s really not much less than the cost of claritiⓇ 1-day lenses if patients use the rebate ($1.10 a day). So depending on how you’re pricing your lenses in your clinic, you can honestly explain to your patients that they aren’t getting a great deal by using Hubble lenses. There are superior daily disposable products at competitive price points that are available to them. You just have to educate them on that.

Fit

The argument against Hubble that actually holds water is the lack of lens fit assessment. Patients can have lenses dispensed to them that a practitioner has never seen on their eye. In most cases, the fit will be acceptable, but this is not always the case. Based on diameter and base curve, the risk of CLARE and limbal irritation with large corneas is present. I believe this should be the key things explained to patients if they are considering using Hubble lenses.

If a patient is deadset on using Hubble lenses, our practice will tell them to come back in wearing the lenses for a quick fit evaluation to confirm its acceptability. Our fitting fees are structured to allow for this from a chair cost standpoint. You’ll build a lot more trust this way than reprimanding them for using the service.

Inevitably, the previous statements will likely be interpreted as being “pro-Hubble.” In reality, they are simply clarifications of points that have been misrepresented, spun, or outright lied about. We owe it to our patients (and ourselves) to be honest about cases like these and consider why we take certain positions, not just regurgitate what may be incorrect or incomplete information. Do I want my patients wearing Hubble lenses? Not really. That’s why we offer superior daily disposable products at competitive prices. You can do the same.

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References

1. Holden BA, Mertz GW. Critical oxygen levels to avoid corneal edema for daily and extended wear contact lenses. Invest Ophthalmol Vis Sci 1984;25:1161–7.
2. Diec J, Tilia D, Thomas V. Comparison of Silicone Hydrogel and Hydrogel Daily Disposable Contact Lenses. Eye Contact Lens 2018;44 Suppl 1:S167–72.
3. Chalmers RL, Keay L, McNally J, Kern J. Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates. Optom Vis Sci 2012;89:316–25.
4. Dumbleton K, Richter D, Woods C, Jones L, Fonn D. Compliance with contact lens replacement in Canada and the United States. Optom Vis Sci 2010;87:131–9.

About Steven Turpin

Steven Turpin
Newest member of Cascadia Eye, an OD/MD group practice in Washington. Currently building a specialty lens practice from the ground up. Myopia control and contact lens design are my guilty pleasures.

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