Consider applications that go beyond basic refractive correction

Optometrists are integral in the care and comanagement of patients who require contact lenses (CLs) for reasons other than basic refractive correction. Managing medical and prosthetic cases with CLs boosts clinical satisfaction and provides unique practice opportunities.

Here, I review how ODs can help patients who need CLs for other than refractive error.

Medical applications

Medical applications of CLs fall into two categories: (1) therapeutic and (2) rehabilitative:

1. Therapeutic. These are used for the treatment of ocular discomfort and pain, or to optimize corneal healing after surgery. Additionally, they are used to treat the ocular surface for an underlying condition, corneal dystrophy, or to protect the cornea from the environment or mechanical interaction with the lids. Therapeutic CLs also often involve adjunctive strategies. For example, while wearing a bandage lens post photorefractive keratectomy, the patient is prescribed topical antibiotics and steroids.

Examples of conditions for which optometrists can consider therapeutic CLs are minor corneal abrasions, ocular surface disease, graft vs. host disease, and post-glaucoma surgery bleb leaks, among others. Some of these CLs are specifically labeled and FDA approved for use as bandage CLs or for therapeutic purposes. (The CL must be FDA approved to bill insurance.)

Clinical pearl. When fitting bandage CLs, I select those that have high-oxygen permeability to fulfill the minimum requirement (Dk/L=125) for overnight wear. This is to prevent corneal hypoxia. Further, I ensure full corneal coverage with minimum lens movement to reduce friction over the fragile epithelium.

2. Rehabilitative. These are prescribed for conditions such as keratoconus, that prevent a patient from achieving adequate visual function with spectacles because of a high, irregular, or asymmetric refractive error.

Clinical pearl. ODs should consider all options and modalities, factoring in topography, best-corrected spectacle vision, and lifestyle. Optometrists should also consult www.gpli.info .

Prosthetic applications

Prosthetic CLs are often life altering for patients who have corneal scarring, glare from traumatic aniridia or iris coloboma, or severe photophobia from albinism. Partially or completely occlusive CLs that improve function or cosmesis after trauma, surgery, or stroke also fall under this category.¹

Clinical pearl. ODs should set realistic patient expectations and perform a careful diagnostic workup: measuring corneal diameter and pupil size. Also, working with lab consultants through digital image documentation of the healthy eye aids in a successful result. (For additional action steps, see “Prescribe Cosmetic Contact Lenses,” at bit.ly/OMJan2020CosmeticCLs .)

Looking ahead

Future unique applications could include “smart” CLs containing embedded biosensors for monitoring IOP,² as well as systemic conditions, such as diabetes,³ and a CL that can protect against corneal melting.⁴ OM

References are available in the online version of this article.

DR. RESNICK is president and managing partner at Drs. Farkas, Kassalow, Resnick, and Associates, a contact lens and anterior segment specialty practice in New York. She is a diplomate in the Cornea, Contact lens, and Refractive Technology section of the AAO, a diplomate of the ABO, and a fellow of the Scleral Lens Education Society.