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  the way i see it

Staying Put

Three ways to keep patients in contact lenses.

MARC R. BLOOMENSTEIN, O.D., F.A.A.O.

As an O.D. who has spent his career working with refractive surgery patients, I speak from experience when I say that problems associated with contact lenses drive the refractive surgery business. Really, without contact lenses, there would not be millions of spectacle-free LASIK patients.

Do you know the main reason your contact lens patients are opting for LASIK? They feel that their contact lenses are making their eyes dry. Yet, here is the rub (or no rub depending on the multi-purpose solution they are supposed to use): Refractive surgery induces dry eye.

The ugly truth

The truth is, contact lens patients are right: Contact lenses do make their eyes dry.

Yet, there is a simple way to help keep your patients in contact lenses — and in your chair — longer: Keep their eyes more lubricated. What? Were you expecting some long-winded philosophical reasoning?

Preventing dryness

Here are three simple yet effective ways you can help prevent dry eye and keep your contact lens patients satisfied.

1 Recommend the use of compatible products.

Make sure your patients use a multi-purpose solution that is biocompatible with the eye and works to kill the bugs. Or, you could switch patients to a one-day contact lens.

2 Treat the ocular lid disease and allergy.

Be aggressive with your contact lens patients and their lids. In fact, leave no meibomian gland un-massaged. The use of long-term treatment is mandated for long-term contact lens wearers.

3 Prescribe medications to help promote lubrication.

Contact lenses induce inflammation, and this, in turn, causes dry eye. It doesn’t take a fellow of the AOA’s Cornea & Contact Lens Section to “see” that by virtue of wearing the contact lens, we have a diagnosis of KCS.

The good news is that there is a treatment readily available to ensure that your patients stay in their contact lenses — and you need to prescribe it. Yes, you have to actively participate in your patients’ contact lens-wearing ability in order to keep them satisfied.

Fortunately, the treatment, cyclosporine ophthalmic emulsion 0.05% (Restasis, Allergan) is a simple twice-a-day drop. But more importantly, it provides an emulsion to stabilize the lipid layer, increases lacrimal aqueous output and increases goblet cells, which produce mucin.

I will let you in on a little secret: We use it on all our refractive surgery patients. After all, they came to see us because their contact lenses weren’t working.

In addition, don’t overlook the use of plugs as adjunct to the use of that cyclosporine drop you prescribed. This combination is tantamount to folding a waffle and then adding eggs — it’s a brilliant idea.

Sustaining business

If you want to keep your contact lens patients in your chair — and more importantly, out of mine — address their concerns with contact lenses before they become a huge problem. OM

DR. BLOOMENSTEIN CURRENTLY PRACTICES AT SCHWARTZ LASER EYE CENTER IN SCOTTSDALE, ARIZ. HE IS A FOUNDING MEMBER OF THE OPTOMETRIC COUNCIL ON REFRACTIVE TECHNOLOGY. E-MAIL HIM AT MBLOOMESTEIN@GMAIL.COM.