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Eyecare Business

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Focus On Contact Lenses

Soft Sell

By: Karlen McLean, ABOC, NCLC
Eyecare Business June 1, 2005

HANDS ON - Focus On Contact Lenses
Soft Sell
by Karlen McLean, ABOC, NCLC

In the past, patients with astigmatism in the 0.75D range were offered two contact lens options: Spherical soft CLs with less than 20/20 vision, or oxygen-permeable (GP) CLs with better vision but less comfort and convenience. Fitting toric/astigmatic CLs was viewed as a time-consuming hassle by many ECPs. Those days are history.

Utilizing today's toric CL technology, combined with top-notch soft toric CL insider information, a little time to educate, and a savvy staff, you can develop practice protocol that will increase patient wearing comfort and visual satisfaction.

FITTING SUGGESTIONS

"One of the most important and sometimes overlooked procedures is educating the patient about options for the correction of astigmatism," says Stephen Cohen, OD, PC, in private practice in Scottsdale, Ariz.

"Some of these patients were previously fit with spherical CLs," Cohen adds. "Today, CLs for astigmatism are no longer considered a specialty fit, and toric lenses can make a notable difference in the quality of vision achieved."

Suzanne Offen, OD, of Offen Eye Associates in Westfield, N.J., adds: "Don't be afraid to create change if a patient has no complaints. Many patients may need to be refit into a different material due to dryness and deposits. If a patient wears toric contact lenses, recommend the convenience of a daily toric."

ECPs recommend these seven steps for fitting torics:

1. Determine spectacle Rx.

2. Get a baseline topographical measurement (K readings).

3. Fit using trial set lenses (diagnostic fitting). In special cases with made-to-order lenses, fit empirically.

4. Let lenses equilibrate for 10 to 20 minutes, or, with today's advanced astigmatic contact lens technology, some toric lenses can be assessed almost immediately.

5. Dispense lenses after successful evaluations. Keep a stock of toric CLs on site for same-day dispensing.

6. Follow-up one week later.

7. Set up three-month and six-month follow-ups to confirm fit.

"We reinforce the idea that CLs are a medical device, and successful CL wearing includes ECP care," affirms Chris Cooper, OD, of West Tennessee Eye, LLC, with three locations in Memphis, Tenn.

"The goal is comfort, vision, and stability," sums up Michael H. Greenberg, OD, MS, in private practice in Chagrin Falls, Ohio.

 

quick tips

 

Most non-spherical corrective CLs have been referred to and marketed as "toric" CLs. Recently, a change in nomenclature has resulted in a new way to refer to non-spherical CLs, naming them CLs for astigmatism. Toric, a term not widely known outside the industry, has made way for astigmatism, due in large part to consumer's knowledge in using the term. Should you change your chairside and in-office terminology? Do what you're comfortable with, but be aware that consumers have become most at ease with astigmatism.

ADVANCED FITTING TIPS

Fitting toric CLs is a blend of facts, knowledge, and gut instinct, plus taking time to do it right.

"Know the products you work with well. With each trial lens, we assess lens movement, orientation, and stability." Greenberg says.

"We also ask the patient about their visual perceptions in the lens, so their feedback is part of the diagnostic process," he adds.

Carmen F. Castellano, OD, of The Koetting Associates, a group practice specializing in CL care in St. Louis points out that CL Rx changes must be based on the spectacle Rx.

"If you have one manufacturer's CL on a patient's eye and it rotates, compensate for that rotation if you're staying with the exact same lens design and manufacturer," he says.

When changing manufacturers or lens curvatures, reselect the lens power and axis based on the spectacle Rx.

Castellano adds: "Remember to consider vertex distance with higher powers. Put the corneal plane powers on an optical cross and calculate the lens Rx."

patient FAQs

Here are some of the most common questions and concerns astigmatic from patients, and answers from the doctors.

Patient: I have astigmatism, so I can't wear contact lenses, right?

Stephen Cohen, OD, PC: These are my favorite patients, because I can show them there are CLs available and supply lenses that provide vision that's comparable to spectacle acuity. Some may have tried toric CLs before and believe that only GP CLs work, or that soft CL designs won't provide consistent vision. I can demonstrate that newer soft CL designs adequately deal with these concerns.

Patient: Will my new lenses be comfortable?

Chris Cooper, OD: Patients want CLs that feel like nothing is in their eyes. I ask patients, "What time of day do you first notice your lenses?" This gives me a quick assessment of their lens comfort issues so I can work to meet their needs.

Patient: There's no CL that can fully correct my vision.

Carmen F. Castellano, OD: Patients are often unaware that toric lenses exist. Too many patients with mild-to-moderate astigmatism have been discouraged from pursuing CLs by their ECPs. I work with them to debunk that myth and amaze them with stellar visual acuity and comfort in new soft CL designs.

Patient: My astigmatism is so slight that I really don't need a corrective CL for it.

Michael H. Greenberg, OD, MS: We do contra-lateral fitting, trying several different astigmatic CL designs. We also fit small degrees of astigmatism, even 0.50D. We try both spherical and toric CLs on a patient, and then ask them which they see more clearly from and which they prefer. Then they understand that they'll see better for the extra money they spend on toric technology.

Patient: My vision changes from near to far, and I see a marking on the lens.

Suzanne Offen, OD: Some highly astigmatic patients may note that initially their visual acuity fluctuates from near to far due to rotation. We explain that this is normal in the beginning of wear, and these patients adapt within a few days. Some notice the toric marking on the lens; we assure them that this doesn't affect vision or comfort.

 
Toric lenses, or lenses for astigmatism, have expanded applications providing enhanced visual and wearing comfort. Shown clockwise from top left: FreshLook ColorBlends in green from CIBA Vision, CooperVision torics, doctor examining patient courtesy of Vistakon

 

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