ANNUAL CONTACT LENS ISSUE

PROMOTE SPECIALTY CONTACT LENSES

WITH SO MANY OPTIONS, THERE’S NO TIME LIKE THE PRESENT TO EXPAND YOUR CONTACT LENS OFFERINGS

Melissa Barnett, O.D., F.A.A.O., F.S.L.S., Sacramento, Calif.

YOU SHOULD consider offering specialty contact lenses, if you don’t already, for two reasons: First, these patients tend to be your most loyal and the biggest ambassadors for your practice because you’ve enabled them to achieve contact lens wear — something they were told for years “wasn’t possible.” You are their hero! Second, these patients are so motivated to ditch their glasses, they are willing to pay for the required doctor time for the specialty contact lens fitting, even if it exceeds their customary insurance reimbursement.

Here, I discuss the types of specialty lenses available, the ideal candidates and how to become proficient in their fitting, so you can promote specialty contact lenses in your practice.

SCLERAL LENSES

These are ideal for patients who have ocular surface disease (OSD) and visual needs that exceed standard lens parameters, as is the case with corneal ectasia, high astigmatism, post-LASIK refractive errors and presbyopia. The reasons: The scleral lens’ post lens fluid reservoir provides constant lubrication to the ocular surface, alleviating the symptoms of OSD, and corrects for corneal irregularities.

Scleral lenses are great for sports, especially in challenging environments. They provide excellent vision, do not decenter and protect the eye from harsh environments, such as dust, dirt or chalk.

To become proficient at fitting scleral lenses, attend hands-on workshops, join the Scleral Lens Education Society (SLS), visit scleral lens related-lectures, follow the fitting guides and visit the Gas Permeable Lens Institute (GPLI) website (gpli.info).

Hands-on workshops, offered by several scleral lens manufacturers, help you to identify appropriate sagittal depth, learn how to evaluate a lens on the eye and how to insert and remove scleral lenses. If possible, recruiting five to eight of your own patients and having the workshop at your office is an incredibly effective way to learn fitting. Another place to obtain education is at an industry meeting, such as the Global Specialty Lens Symposium.

With regard to the SLS, it provides up-to-date news and access to multiple webinars about the specifics of fitting scleral lenses. One video, in particular, communicates insertion, removal, troubleshooting and lens care. (See http://tinyurl.com/scleralvideo.)

When fitting scleral lenses, it is critical to follow the fitting guide, and it is particularly important to allow scleral lenses to settle and “sink” into the scleral conjunctiva for about 30 minutes, depending on the design, prior to evaluating the lens on the eye. Scleral lens fitting may have a steep learning curve, however, after you become familiar with a few designs, fitting can be done relatively quickly. For example in patients with regular astigmatism, scleral lens fitting takes minimal time.

Finally, visit the GPLI website, as it has a wealth of information, including webinars about GP and specialty soft contact lenses. Patient brochures and practice management resources are also available.

MULTIFOCAL LENSES

As the name implies, these lenses are designed for presbyopic patients, who currently number 111 million and are expected to grow to 121 million by the year 2020 in the United States alone, according to Market Scope’s “Global Presbyopia-Correcting Surgery Market Report.” These lenses are attractive to this population because they provide simultaneous vision, while enabling a youthful, glasses-free appearance.

Multiple types of multifocal contact lenses are available, including soft, soft toric, GP, hybrid and scleral. Therefore, if your patient has tried a multifocal design without success, reach for another option. If you are stuck, laboratory consultants can guide you to determine which design to use.

While it is important to assess for OSD in all patients interested in contact lens wear, as both dry eye disease (DED) and ocular allergy can cause contact lens discomfort, which could lead to dropout, it is particularly crucial to do so in presbyopic patients. This is because DED becomes more prevalent with age. Thus, examine the presbyopic patient’s adnexa, eyelid and eyelashes, cornea and conjunctiva, and evert the eyelids to evaluate for DED and ocular allergies. Further, gently push the lower eyelid to express the meibomian glands, even in otherwise normal-appearing eyelids, as meibomian gland dysfunction is often the most frequent cause of DED, according to the International Workshop on Meibomian Gland Dysfunction.

To become proficient at fitting multifocal lenses, use the most recent refraction, as this will provide the best outcome (today’s visit vs. six months ago). It is critical to push plus at distance (monocularly) to get the best visual clarity and comfort at distance, intermediate and near. In addition, as is the case with scleral lenses, follow the fitting guide provided by the manufacturer. Each fitting guide is unique to each product and increases the chance of success in the shortest amount of time. Even if the fitting guide suggests a change that is not intuitive, there is a reason for the suggestion. If you get stuck, call a company consultant, who can provide useful information to generate success.

Prosthetic lenses are ideal for patients who have iris defects, as they reduce the amount of light entering the eye.

CUSTOM SOFT LENSES

These are ideal for presbyopic patients who have astigmatism, patients who have a larger or smaller horizontal visible iris diameter, corneal diameter or flatter or steeper corneal curvature and patients who suffer from DED (as the lens material can be customized).

To become proficient at fitting custom soft lenses, select one or two companies to start with, and become familiar with each company’s lens design and specific attributes.

GP LENSES

GP lenses provide excellent vision, are resilient, more deposit resistant than soft contact lenses and are extremely safe, as they allow oxygen to reach the eye. Given these attributes, they are ideal for patients who have a high refractive error, astigmatism, irregular astigmatism and presbyopia. In addition, GP contact lenses are easier to handle compared with larger diameter lenses. This is helpful for elderly patients or those with conditions, such as rheumatoid arthritis.

To become proficient at fitting GP lenses, consult the GPLI, which can provide courses and education to accelerate the GP learning process.

You can become the local superstar fitter, as not as many practitioners are currently fitting GP lenses, and there are still patients who want to wear them.

HYBRID LENSES

These part GP, part soft lenses are ideal for those who have irregular astigmatism, regular astigmatism and presbyopia. With a GP center and soft skirt, hybrid lenses can provide incredible vision with a stable lens on the eye. Patients who are intolerant to GP lenses can benefit from hybrid (or scleral) lenses.

The scleral lens’ post lens fluid reservoir provides constant lubrication to the ocular surface, relieving OSD.

SynergEyes is currently the only company that provides hybrid lenses, so the best way to become proficient in hybrid lens fitting is to check out the company’s website (http://synergeyes.com/) and contact its laboratory consultants.

PROSTHETIC LENSES

These are ideal for patients who have iris defects, as they reduce the amount of light to the eye. Multiple colors and underprints are available to color match the opposite eye. Also, a custom black pupil can be extremely beneficial to block light. If desired, hand-painted contact lenses are an option as well.

Prosthetic lenses are straightforward to fit.

GET GOING

Now is the time to utilize specialty contact lenses and wow your patients. You’ll not only become their heroes, which creates patient loyalty and referrals, you’ll also increase your practice revenue. OM

DR. BARNETT, is a principal optometrist at the University of California, Davis Eye Center in Sacramento, Calif., where she specializes in anterior segment disease and specialty contact lenses. She is a fellow of the AAO, a diplomate of the American Board of Certification in Medical Optometry and serves on the board of GPLI, SLS, Women of Vision and Ocular Surface Society of Optometry. To comment on this article, visit tinyurl.com/OMComment.