To provide the highest quality of care for our patients, we must educate them on the treatment options that can benefit them, based on their visual, comfort, and lifestyle needs. Contact lenses can often meet these needs for various patient populations, but such patients are often unaware of this unless we raise the subject.
With that said, this article provides example patient scripts I have used with success on various patient populations to propose contact lens wear. Each script is based on an evaluation comprised of a comprehensive exam, patient history form, and conversation regarding the patient’s vision, comfort, and lifestyle needs. As examples, I ask patients what they do and do not like about their current vision and/or treatment option, and I ask about their professions and hobbies.
Based on this evaluation, here’s a look at what I have said to patient populations who can benefit from contact lens wear:
I have found that children and their parents are often surprised to hear contact lens wear is feasible. The primary reason I hear for this is that these children “don’t think they’re allowed” and their parents don’t think contact lens wear is “safe” at childhood ages. I have overcome these preconceived notions by using the following scripts on the contact lenses germane to this patient population.
• Example patient script for soft contact lens wear for refractive needs. “Jacob, I think you and your mom should consider contact lens wear for you, given your participation in sports throughout the year and the fact that you don’t want to have to wear your glasses all the time. Children can safely and happily wear contact lenses. In fact, a recent study shows child contact lens wearers are no more likely to develop an infection than adult wearers. I’m suggesting daily disposable lenses. They are the safest choice here, as children put on a fresh lens for every use.”
I find that pointing out the safety of this modality is helpful for parents who wear two-week or monthly lenses and wonder why I don’t provide those wearing schedules as an option for their children.
• Example patient script for soft contact lens wear for myopia control. “Madison, I think you and your mom should consider contact lens wear to both correct your nearsightedness and slow its progression. This is because the prescription differences over the last three visits indicate advancing nearsightedness, which increases the risk of other eye conditions. Children can safely and happily wear contact lenses. In fact, a recent study shows child contact lens wearers are no more likely to develop an infection than adult wearers. Adhering to the required wear schedule — throwing each lens out at the end of the day — is the key to success.”
• Example patient script for orthokeratology. “Jason, given that you don’t like to wear glasses or contact lenses during the day and that your nearsightedness is advancing, which increases your risk for other eye conditions, I think you and your mom should consider contact lenses that can reshape the front part of the eye while the patient sleeps. Called orthokeratology contact lenses, they will provide temporary vision correction during the day, and they will slow that advancing nearsightedness when worn at night. What they will need, however, is proper disinfection and sterilization to maintain the health of your eyes. This means, you’ll need to follow the required care schedule.” (See “Orthokeratology: Overcome Parent Hesitancy,” at https://bit.ly/OM 23JanFebOrtho.)
As a brief, yet related aside, parents, patients, and I sign a contract that the patient will follow the proper lens hygiene regimen thoroughly.
• Example patient script for scleral lenses. “Lucy and Mrs. Williams, I’m happy to tell you that contact lenses are available to fit Lucy’s unique cornea. Called scleral contact lenses, they actually rest on the white part of the eye instead of the cornea to provide crisp vision. Additionally, by virtue of their material, they provide a high level of oxygen permeability, which promotes corneal health.” (See “Scleral Fits Simplified,” at https://bit.ly/OM2011JanScleral.)
• Example patient script for rigid gas permeable lenses (RGP). “Griffin and Mrs. Smith, I’m happy to tell you that contact lenses are available to fit Griffin’s unique cornea. Called rigid gas permeable lenses, they allow for tear flow and oxygen permeability, which promote corneal health. Another benefit is that their material makes them easy to handle, which can be particularly helpful for children and their parents.”
I should mention that I fit RGP lenses in patients whose prescription is outside the parameters offered in soft contact lenses.
Active/busy adult patients
In my practice, I have discovered that this patient population appreciates the offer of contact lens-wearing times that fit their schedules. How I propose these wearing schedules with this patient population:
• Example patient script for part-time wear. “Johnny, you mentioned that you go to the gym three to four times a week, though no longer wear your glasses to work out because they kept falling off. Have you thought about having a pair of contact lenses reserved for the gym? In addition to offering you the freedom of movement without worrying about the frames slip-ping, bouncing, or falling off, you’ll have clear, uninterrupted vision.”
• Example patient script for extended or daily wear. “Julie, in hearing that you love the freedom contact lenses provide, but that your long hours and travel as a lawyer make sticking with the wear and care schedule of your current contact lenses challenging, I think you should consider contact lenses that allow for a longer wearing time, or daily disposable lenses, which don’t require a cleaning regiment. I am happy to discuss the additional benefits and requirements of these lenses with you, so you can decide which option makes the most sense.”
Fashion-forward adult patients
Often, these patients are not difficult to spot. They present dressed to the nines, wearing the latest runway looks. They are also the patients who are drawn to and purchase high-end frame brands and sunglasses to complete their look. And so, naturally, it makes sense to discuss contact lenses designed for fashion purposes:
• Example patient script for soft contact lenses. “Stacy, in noting that a hobby of yours is to stay up to date on the latest fashions and changing up your personal style, I would be doing you a disservice if I didn’t mention that contact lens wear will enable you to wear high-fashion sunwear.”
• Example patient script for colored contact lenses. “Janine, in noting that a hobby of yours is to stay up to date on the latest fashions and change up your personal style, I would be doing you a disservice if I didn’t mention that colored contact lenses are available to enable you to do just that. Would you be interested in hearing about the available colors?”
Many presbyopic patients new to my practice are unaware they can wear contact lenses. Juliet, a 49-year-old African-American woman who recently presented for a comprehensive exam is emblematic of this. Specifically, when I told her multifocal contact lenses were available, she replied, “Really?! I always wanted to wear contact lenses but didn’t think they were available for both distance and reading.” Now, she happily wears them. How I bring up these contact lenses:
• Example patient script for multifocal contact lenses. “Kim, based on your desire to maintain a youthful appearance and your visual needs, I think you should consider a multifocal contact lens. Multifocal contact lenses provide close, intermediate, and distance vision.”
There is an excellent variety of multifocal con-tact lens designs to fit most of our presbyopic patients. I often let these patients try on a pair in the office, and then I provide a couple of dailies for them to try at home. Often, they return to purchase a year’s supply. (For additional information on fitting multifocals, visit https://bit.ly/OM21JanFeb MultifocalCLs.)
Adult patients with corneal conditions
Another patient population often unaware that contact lenses are an option are those who present with astigmatism and irregular cornea conditions, such as keratoconus, and pellucid marginal de-generation, just to mention a couple. How contact lens wear is proposed with this crew:
• Example patient script for toric contact lenses. “Declan, you mentioned that you love watching “Jeopardy,” but wish you didn’t have to wear your glasses to do it, as you like to stretch out on your couch. Based on this and your visual needs, I think you should consider a contact lens that can enable you to do this, among other activities, glasses-free. Called a toric contact lens, it is specifically, designed to correct your astigmatism. Toric lenses are available in monthly, two-week, and daily disposable wear schedules. Let’s figure out which wear schedule would work best for you.”
• Example patient script for RGP contact lenses. “Darlene, you mentioned that your glasses are always fogging up and sliding down your face in the kitchen of the restaurant where you work. I’m recommending rigid gas permeable contact lenses. This is the best solution for you because they can resist high heat, and they can give you sharp
• Example patient script for scleral contact lenses. “James, the radial keratotomy you un-derwent 10 years ago resulted in your left cornea thinning and bulging outward, which is why you’re having difficulty seeing. Scleral contact lenses will create a smooth surface that will compensate for these issues, enabling you to see better.”
• Example patient script for hybrid contact lenses. “Alison, what I’m hearing is that you like the vision your RGP lenses are providing, but they aren’t comfortable to wear. Hybrid contact lenses are available to provide you with the same vision that your current lenses provide, though they have soft lens edges to meet your comfort needs. Hybrid contact lenses are worn on a quarterly replacement schedule. You will need to properly disinfect and sterilize them nightly to maintain eye health.”
• Example patient script for prosthetic contact lenses. “Jeremy, you mentioned that you feel self-conscious about your micro-cornea condition. I have colleagues who specialize in creating cosmetic contact lenses for this, among other corneal issues. The lens can actually mask your condition.” (See “Prescribe Cosmetic Contact Lenses,” at https://bit.ly/OMJan2020CosmeticCLs.)
By using the comprehensive exam, patient history form, and conversation, we can confidently craft patient scripts to propose contact lens wear. Remember, many patients don’t know contact lens wear is an option unless we ask. So, let’s ask. OM
Dr. Aleman-Moheeputh practices in Florida, where she specializes in contact lens fitting, with a particular interest in orthokeratology.