Identifying Candidates for Wavefront Lenses

Patient selection is key when offering this technology.

Read on to learn about the best approaches to take.

Dr. Karpecki: We've discussed how wavefront technology is used to make premium ophthalmic lenses and how to introduce the technology to your practice. Now let's discuss patient selection. What percentage of people who visit your practices benefit from this technology, and what do you tell them about it?

Fitting the criteria

Dr. Lowe: We've had the iZon technology for about 6 months. We use the Z-View Aberrometer algorithm to identify good candidates. So far, we've found that the technology is ideal for about 50% of our patients.

Dr. Gindoff: I certainly don't prescribe the iZon lens for every patient. I carefully consider whether he or she will benefit from this lens technology. A major drive of our practice is to meet or exceed the expectations of patients who want to see without eyeglasses — whether we accomplish this with LASIK or some other type of refractive surgery, such as premium lenses. So we really think hard about these options before writing a prescription for iZon lenses.

Dr. Quon: There is a learning curve when you begin prescribing iZon lenses. You have to choose candidates carefully and manage some of their excessive expectations. I've encountered a couple of patients who expected ultra-high definition vision beyond what was possible.

I tell patients subjectively that they'll experience a 10% to 20% increase in resolution, contrast and color perception and improvement in night vision. In many cases, patients will experience an improvement in visual acuity of about 1 to 3 more letters on the Snellen Acuity Chart compared with conventional lenses. The key to success is targeting patients who will be satisfied with this level of improvement. In my practice, we try not to overpromote the lens.

Marginal vision

Dr. Gindoff: Patients who have marginal vision, such as those with mild macular degeneration, can benefit from the iZon lens because it provides optimal visual acuity. However, I will rarely prescribe the lens for a patient who's developing a cataract that will be surgically removed in, say, a year or sooner. And I see a great number of cataract patients.

Dr. Campisi: My philosophy is the same as Dr. Gindoff's. I refit patients in low cylinder contact lenses if their vision will improve even slightly. Why wouldn't you want to improve their spectacle Rx the same way? We want to avoid the risk of over-marketing or over-prescribing iZon lenses. However, you can minimize this by keeping your explanations of the technology realistic. I believe using the terms low-definition and high-definition television give patients an idea of what to expect. It's like seeing with a low-cylinder toric as opposed to a spherical contact lens correction — the vision is crisper. Why should patients settle for less in their eyeglasses?

I don't give patients improvement percentages or discuss obscure aberration numbers. I've had only two patients return disappointed during the 2 years I've offered this technology. The patients' disappointment was a result of a mistake we'd made, but when we fixed the problem, the patients were satisfied with the results.

Scanning all patients

Dr. Lowe: We scan every patient with the Z-View Aberrometer, whether or not they're candidates for the lenses. The scan establishes a baseline for higher-order aberrations to which we can refer later even if the patients aren't candidates right away. It also plants the seed in their minds about the technology.

Dr. Campisi: We use the Z-View Aberrometer on all patients and make sure they walk away with a printout so they can tell their friends and relatives. That's one of the reasons why we attract so many new patients each month.

Dr. Karpecki: That's so effective. An advanced eye diagnostics printout goes home with the patient. It becomes refrigerator art and serves as a marketing tool.

Dr. Lowe: We put the map up on a screen in the exam room. It makes quite an impression. If patients are appropriate for this correction, you don't need to say much to convince them.

Dr. Karpecki: Do you ask certain questions or look for specific conditions to identify candidates?

Dr. Lowe: I'm prepresbyopic, but I wear the lenses to see more clearly, reduce eye strain and, who knows, maybe they'll keep me out of progressives longer. I use this logic with patients who are about my age, and they respond to it well.

Dr. Campisi: I'm an emmetrope, but I've always had a problem driving at night because of glare. I never could understand why until I saw my iPrint scan. I have laminated my scan, and now I show it to all patients who also might have trouble driving at night. I say, "Look, I'm worse than you are, and I don't wear eyeglasses." They understand right away what I can do for them.

This technique has helped me identify about 20 patients a month who would benefit from the iZon lenses — just by showing the scan and talking about the glare while driving at night.

Occupations and hobbies

Dr. Karpecki: Do certain occupations or hobbies make patients better candidates for wavefront lenses than others?

Dr. Layman: We see a lot of truck drivers who tell us these lenses help them see better than ever on the road. Sales people also are ideal candidates because they're always looking for addresses and directions. In addition, patients who can't achieve sharp, 20/20 vision due to any ocular pathology do well. Heavy computer users typically benefit, too.

Dr. Gindoff: As a pilot, I can tell you that flying, especially at night, is much easier when wearing these lenses. I don't just recommend these lenses for pilots; this is one instance in which I always prescribe them.

Dr. Campisi: We can all identify ideal settings to find potential patients. Small airports, limousine and taxi services, state trooper barracks and ambulance driving syndicates are all good places to locate ideal candidates. All it takes is one patient to brag about how much the lenses help him or her to see and that will lead to several word-of-mouth referrals.

Dr. Quon: I have many patients who drive at night and are uncomfortable with their depth perception, visual acuity, the glare and halos around headlights. Generally, I recommend the iZon lens to compensate for these problems. I find that engineers also are interested in this technology. I've had quite a few engineers from Boeing visit my practice after researching the iZon technology on the Internet.

Dr. Gindoff: As I mentioned before, these lenses play a role in improving vision after refractive surgery. However, you must be careful how you communicate this to patients to avoid giving them the impression their surgery was a failure. We tell patients they may see glare and rings around lights for a while after the surgery. "If you're bothered by this," I explain, "and you find you can't drive at night, I have a way to solve your problem."

People who benefit the most from these lenses are refractive keratotomy (RK) patients and those who underwent LASIK before wavefront-guided technology was introduced to customize surgery. Their refraction is next to nothing, but they still have difficulty seeing at night. Once they put on the iZon lenses, immediately they're very happy. I've seen tears in my patients' eyes once they've gotten their eyeglasses. No joke.

Dr. Campisi: I agree with this approach. However, keep in mind that no controlled clinical trials have been conducted in post-LASIK patients, although there are cases where iZon lenses prove successful in the post-refractive surgery population. In the short time I've used this technology, I've prescribed the iZon lenses to two patients who've had previous refractive surgery. And they were most impressed by the change in their visual acuity. Multifocal implants and intraocular lenses also may produce glare, so these patients may be potiential candidates.

Dr. Layman: We had a post-LASIK patient who was overwhelmed by his visual acuity after we prescribed these lenses. He said, "These are the most fantastic eyeglasses I've ever had in my life." And he'd come in just for reading glasses. It's fascinating that such low prescriptions provide so much benefit.

IMPROVED NIGHTTIME DRIVING

Nearly eight out of 10 consumers, age 18 and older, report that nighttime vision is a challenge (Source: Nationwide survey conducted by Ophthonix). And this is often a complaint practitioners hear from patients on whom they've performed refractions. The most frequently reported causes of this challenge include poorer vision during low-light conditions, along with glare, halos and starbursts from street lights, car headlights and reflections from rearview mirrors. The iZon High Resolution Lens can be a good solution for patients who experience difficulty with nighttime vision. In addition to providing generally sharp vision, iZon Lens wearers also are very positive about their vision for both daytime and nighttime driving (Source: iZon patient feedback questionnaires). The benefits of the iZon Lens for nighttime driving have been demonstrated in a controlled clinical trial, using an FDA validated simulator. In this study (Source: Clinical study conducted by US Navy Refractive Surgery Center, San Diego, Calif.), 27 subjects were evaluated in night driving conditions wearing both the iZon Lenses and conventional lenses. Both lenses were made of matching materials and coatings, and were mounted in identical frames. The single difference between the lenses was that the iZon Lens was based upon a patient's individual optical fingerprint, or iPrint. (The iPrint contains all second to sixth order aberrations.) A clinical study showed that iZon lenses provided wearers with the ability to react more than 20 feet sooner at 55 miles per hour than when wearing conventional lenses. The night driving simulation included 12 tests, where the subject had to detect and then identify potential hazards. The tests included glare and nonglare conditions. In all 12 tests, the iZon Lens held an advantage for improving reaction time, with 10 of the tests being statistically significant. For example, in one of the tests, involving a pedestrian near the highway under glare conditions, the iZon lens provided an improved reaction time of 0.25 seconds or a 20-feet shorter stopping distance when traveling at 55 mph. This is better than one full car length, which could be the difference between life and death.

Dr. Lowe: In our practice, we had a post-LASIK patient who had to wear Polaroid sunglasses to drive at night — but not anymore thanks to these lenses. And she couldn't be happier. The closer to plano, the greater the wow factor in patients who are symptomatic due to uncorrected higher-order aberrations.

Managing dissatisfied patients

Dr. Layman: Identifying the right patients is essential, of course. But what if your patient has a poor visual outcome?

Dr. Gindoff: When I began using the technology, I prescribed directly from the iZon printouts. Some patients complained of less optimal vision. But we got around that by scanning each eye five times instead of three times. Ophthonix recommends three readings with the Z-View Aberrometer and only recommends modifications of some sphere with select patients. In my experience, the more scans you make, the more data the computer can analyze and the better off the patient will be. If the technician can't get five scans, I won't use the data and we'll refract normally. If I have five clean scans, I'm fairly comfortable that we can use the data to prescribe directly from the Z-View Aberrometer. This doesn't mean that the doctor's judgment is ignored in the prescribing phase (i.e. a patient's been wearing -0.75 cylinder and now the Z-View measures -1.75 cylinder). Some "doctoring" still occurs to determine if I want to prescribe all or some of that cylinder power. Many times, I'll modify the sphere finding for the very same reason. But what's important to understand is that this data is accurate if you get five clean scans.

Progressive lens wearers

Dr. Karpecki: How do you approach wavefront progressives? Do you recommend them for early presbyopes? Late presbyopes? Are there any issues associated with converting existing progressive addition lens (PAL) wearers?

Dr. Lowe: We've fit almost everyone who's been wearing PALs into one of the new wavefront PALs, and we've had very few issues. We've had some comments about the corridor. Patients say their vision is great in the iZon, but they feel more restricted than they were in the Physio 360°. They need a little more time to adapt. In addition, with experience, we've improved our readings, making sure everything is in alignment. So now we have more success. However, we have the greatest success with first-time PAL wearers because it's easier for them to adapt.

Dr. Quon: Presently, I position the iZon progressive as the premium progressive. I firmly believe in the lens because I wear it. I have several top-of-the-line progressives, including many wavefront-guided and free-form designs. Most of these new progressives are excellent products, but when compared to the iZon progressives, the iZons provide me with a wider intermediate distance, larger reading area, clearer distance vision and greater visual comfort.

Initially, you'll experience what I call a little bit of visual overload when you wear them the first day. But you'll quickly adapt to the clarity of vision. Other than that, I think the iZon progressive is excellent.

Will patients pay?

Dr. Campisi: Many of our colleagues say they avoid this technology for fear of not being able to sell a premium lens to patients — even ideal candidates. But I don't believe prescribing this lens is about selling a product. It's about using a technology to help patients see better and improve their quality of life.

I've done the price comparisons with other premium products, and my message to our colleagues is this: If you have patients who will buy any premium lens, you have patients who will want a wavefront lens, such as the iZon.

Dr. Quon: If a patient wants the best lens available, price generally isn't an issue. When you offer iZon lenses, you encourage patient loyalty and internal product purchasing within your practice. As we all know, many people take their prescriptions out the door with them. But they can't fill an iZon prescription everywhere. As far as I know, iZon lenses are available only through independent practitioners. This supports independent optometry and differentiates your practice from the "big box" optical stores.

Dr. Karpecki: What about customization? So many products in the consumer marketplace are customized. Isn't this technology consistent with this trend?

Dr. Campisi: Because I'm the first doctor in New England to introduce this technology, I hear my colleagues' concerns that their patients might not want to wait a couple of extra weeks for their eyeglasses.

People who benefit the most from these lenses are refractive keratotomy (RK) patients and those who underwent LASIK before wavefront-guided technology was introduced.
— Stuart A. Gindoff, O.D.

I explain to them that I drive a luxury car, and that they probably do, too, and didn't mind waiting an extra 2 or 3 weeks for the heated steering wheel, which many people in New England appreciate.

My patients understand the word "custom." There's a 2 to 3 week wait for custom toric multifocal contacts or out-of-range eyeglass/contact lens orders. The women often come in with expensive handbags, and they drive nice cars. I tell them up front: "This lens is a custom item. I'm sure you've waited for every high-end item you've ever ordered. This is no different." And they're fine with that.

Dr. Karpecki: Setting the right expectations is important.

From the top down

Dr. Quon: In optometry, we've always used the phrase, "top-down" selling. You start with Cartier, Swarovski and so forth, and everything else looks a lot less expensive by comparison. The same principle applies to the iZon. You present the top-of-the-line lens to patients, and it's up to them to decide if they want the Mercedes or the Chevrolet. In the end, you have to leave the decision to patients. OM