CLINICAL

  CONTACT LENSES

OPTIMIZING PATIENT COMFORT

TWO STEPS HELP ENSURE SUCCESS AND PREVENT DROPOUT

WITH THE availability of varied contact lens materials and modalities, I believe that there is most likely a perfect match for everyone. The challenge is that we, as eyecare professionals, do not know all the variables involved in the ideal fit. What’s more, patients’ reluctance to speak about their discomfort or dissatisfaction puts us at an even greater disadvantage when it comes to lens selection.

However, achieving the right fit is not impossible. Here are two steps to help increase your odds of finding that perfect match to optimize patient comfort and minimize dropout.

STEP 1: DETERMINE THE VARIABLES

To know as many of the variables as possible up front, answer these questions:

• How does the patient expect to wear his lenses? For example, does he wear them full-time, part-time, overnight, just for sports, just for work, etc.?

• How do the patient’s eyelids and ocular surface look? Take a thorough look with vital dyes (sodium fluorescein and lissamine green) of the eyelids, lid wiper area, cornea and conjunctiva. If there are any underlying conditions, such as dry eye disease, those must be addressed and treated before a successful contact lens fit.

• How does the patient utilize his vision throughout the day? If the patient is on the computer all day, expect some middle-of-the-day dryness. If your patient is presbyopic, understand his visual preferences ahead of time. Fully understanding the patient’s expectations and ocular health can help identify the modality that best suits his lifestyle and needs.

Subtle lissamine green staining on the lid wiper area and bulbar conjunctiva reveal some potential comfort concerns with contact lenses. I refit this patient into a daily disposable lens to improve this situation in order to prevent a potential contact lens dropout.

STEP 2: MATCH IT

Once you have answered the above questions, choose the lens that satisfies most, if not all, variables the best.

For example, if the patient has some underlying eyelid and/or ocular surface disease, treat that condition prior to fitting. After that, follow up with a contact lens that has a low coefficient of friction, or the force that acts at the surface of two solid surfaces to resist sliding over one another. We want this force to be minimized and as close to zero as possible.

Lipid deposits will create a less smooth surface, so if this is a variable, choose a contact lens material that has the best combination of deposit resistance and oxygen permeability if your patient requests reusable lenses. Otherwise, consider starting with a daily disposable lens, as it provides a fresh lens surface everyday.

MADE FOR EACH OTHER

Finding that perfect match is not easy, but taking the time and effort to identify the variables and, thus, meet your patients’ needs, makes good healthcare and business sense. Not only will doing so provide value to your contact lens exam, it will keep your contact lens patients happy and healthy — and in their contact lenses. OM

JASON R. MILLER, O.D., M.B.A., F.A.A.O. is a partner at Eyecare Professionals of Powell, in Powell, Ohio, a member of Vision Source, and is an adjunct faculty member for The Ohio State University College of Optometry. To comment on this article, visit tinyurl.com/OMcomment.