Keep these items in mind when making your choices

If you feel overwhelmed by the constant flow of new contact lens diagnostic kits, you’re not alone. While optometrists appreciate these advances, they are often faced with limited storage space, the challenge of determining the number of kits needed, and which to keep.

Although the trend toward empirical fitting is increasing in the areas of specialty and custom lens designs, my practice’s approach to standard soft lenses largely remains diagnostically based. We rely on fit sets (“trial kits”) in performing in-office clinical evaluations and to provide patients with a “starter” supply.

Here, I suggest a practical strategy for selecting both the types and number of contact lens diagnostic sets.

MATERIAL CONSIDERATIONS

With silicone hydrogels (SiHy) lenses comprising the bulk of the newest designs, ODs should consider limiting their diagnostic inventory to these materials. Ease of handling, increased oxygen permeability, and improved surface hydration are notable benefits of SiHy lenses. Optometrists can order trial lenses on an individual basis for patients whose physiology or historical preference demand a traditional hydrogel.

PLANNED REPLACEMENT DESIGNS

As a significant percentage of patients still desire or are best managed with planned replacement designs, optometrists may need to mix and match modalities depending on clinical preference for brand or design.

For example, ODs may have better success with a two-week replacement lens for spherical prescriptions and a monthly design for toric prescriptions. Thus, optometrists should choose their preferred “go-to” lens in each of these categories. It’s helpful to work with a minimum of two designs in astigmatic presbyopes, as these cases are more complex.

DAILY DISPOSABLES

A practical strategy to limit fit sets with these designs is to have two materials or designs for both spheres and torics. I have found that selecting a “workhorse” lens and a “premium brand” allows the optometrist to satisfy most clinical needs and patients’ budgets. One exception to the two-design rule may be the multifocal category. Having three brands here, all with different optical designs, increases the success rate for challenging patient profiles.

One addition to the daily disposable category is myopia control lenses. One brand is FDA-approved, but ODs may also wish to have an extended depth-of-field design to accommodate a broader range of refractive needs.

RGP AND SPECIALTY DESIGNS

Custom soft and hybrid toric and multifocal designs for regular corneas may be conveniently ordered empirically, according to the manufacturers’ fitting protocols.

I have found that custom soft designs for corneal ectasia are best fit diagnostically.

RGPs for regular corneas can be easily fit empirically.

Irregular corneas can be managed with one or two fit sets from the optometrist’s preferred laboratory. The key here is to have sets that have different diameters and curvature profiles to diagnostically evaluate both prolate and oblate corneas.

I have found that having two-to-three scleral lens fit sets should more than adequately meet most patients’ needs.

Advanced fitters may rely more on software or impression-based technology. Fortunately, these designs’ diagnostic kits are compact and portable.

CLEAR THE CLUTTER

With this organized scheme of lens selection and storage, ODs can clear both the physical and mental clutter. This, in turn, allows them to achieve clinical success and management efficiency. OM

DR. RESNICK is president and managing partner at Drs. Farkas, Kassalow, Resnick, and Associates in New York. She is a diplomate in the Cornea, Contact Lens, and Refractive Technology section of the American Academy of Optometry, a diplomate of the American Board of Optometry, and a fellow of the Scleral Lens Education Society.