Retinal Physician Article Submission Guidelines-Prescribing for Astigmatism and Presbyopia


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Article Date: 6/1/2008

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Understanding the Aging Eye
Making Contact

Understanding the Aging Eye

Here's what front desk staff, technicians and opticians need to know

A couple of ways to help patients age 40 and older receive optimal vision correction is to learn how the eye ages, understand the visual challenges they face and learn about the treatment modalities available.

Patients 40 and Older

By 2010, roughly 1/3 of the U.S. population will be 40 and older. Patients who've already reached the milestone age of 40 often are called presbyopes because the majority of them have presbyopia, a condition that prevents them from focusing on reading material and objects up close. If you haven't experienced this yourself, certainly you've seen presbyopes straining to focus on a menu or magazine held at arm's length. Eyeglasses for reading, progressive eyeglasses, bifocals or multifocal contact lenses can correct this problem.

While almost everyone age 40 and older can expect to notice the effects of presbyopia, a Harris survey of 2,000 American adults found that 83% weren't aware of the condition and only 27% expected to need bifocals or eyeglasses for reading in the future. Presbyopes often are surprised to learn they may need vision correction, but educating them about the options available can set their minds at ease.

"Many patients have an idea that their near vision is getting worse," says David L. Kading, O.D., F.A.A.O., of Specialty Eyecare Group in Kirkland, Wash. "When I tell them they'd benefit from some correction, they express either relief that help is available or dread as they realize their age is catching up with them."

In this issue:

Understanding the Aging Eye

We Have Just the Lens For You!

How Would You Handle This Challenging Scenario?

Ann Madden, O.D., of Boling Vision Center in Elkhart, Ind., has had a similar experience. "Patients who already wear eyeglasses or contact lenses find it easier to accept that they may need further correction," she explains.

Patients may not know that contact lenses for presbyopia are available, such as Biomedics EP, Proclear Multifocal, Frequency 55 Multifocal and Proclear Multifocal Toric soft contact lenses (CooperVision) for presbyopes who have astigmatism. So take the opportunity to inform them about soft multifocal contact lens options for presbyopia.

Lens changes starting at age 40 can lead to presbyopia, a condition that prevents you from focusing on reading material and objects up close.

Aging Eyes

Aside from the decreased ability to focus on reading material and objects up close, aging also affects other aspects of vision and eye function.

Crystalline lens. Beginning at birth, the crystalline lens loses its transparency, gradually becoming cloudy. A cloudy lens that impairs vision is called a cataract. Cataracts can increase glare and negatively affect night driving and color perception. Eventually, patients may need their cataracts removed and replaced with a clear artificial lens to improve vision.

Contrast sensitivity. This is defined as the ability to see fine detail at low contrast levels, such as at dusk and in rainy, foggy and snowy conditions. Some vision correction options, such as Frequency 55 and Avaira (CooperVision), have aspheric front surface optics designed to provide optimized vision.

Tear film. The tear film is the liquid layer that covers the cornea and conjunctiva. It contains a mucus layer, watery layer and oily layer that trap and flush out foreign substances and inhibit bacterial growth. As we age, the quantity and quality of the tear film decline. "Hormonal changes can affect the tear film in women who are in their 40s and 50s," Dr. Madden explains. "Clogged oil glands in the eyelids can cause dry eyes, too."

Dr. Kading agrees: "Many patients over age 40, especially post-menopausal women, present with decreased tear production and/or inflammatory dry eye." If patients have inflammatory dry eye, they can continue to wear contact lenses, but the doctor may need to prescribe lenses in the PC Hydrogel family that minimize dryness, such as Proclear Multifocal, Proclear Multifocal toric and Biomedics EP.

"Many patients have an idea that their near vision is getting worse. When I tell them they'd benefit from some correction, they express either relief that help is available or dread as they realize their age is catching up with them."

David L. Kading, O.D., F.A.A.O.

Can You Fill the Gap?

Inevitably, as patients age, they'll experience vision changes. And you can help them prepare for those changes. When they begin to occur, use your knowledge about the aging eye to answer their questions – and reassure them that clear, comfortable vision isn't a thing of the past. It can be maintained for a lifetime. ■


We Have Just the Lens for You!

Spot the perfect candidates for presbyopia-correcting contact lenses and communicate what's available in a way they can understand.

Presbyopes who need vision correction don't always know what treatment options are available. So they need advice from you and others on the front lines.

Here are some characteristics of patients who might be good candidates for multifocal contact lenses and suggestions on how to effectively communicate not only what's available but also the benefits these lenses offer.

5 Ways to Suggest Multifocal Contact Lenses
Most patients don't know about multifocal contact lenses. Here are five ways to pique their interest so you can tell them about the benefits.
  1. Ask patients if they're satisfied with their reading eyeglasses or bifocals by phone or through a mail survey. If they're dissatisfied with them, consider offering a free trial of multifocal contact lenses.
  2. Hang up posters, play a video loop or place pamphlets in the reception area to tell patients about multifocal lenses. Be ready to discuss their benefits and features.
  3. Explain to monovision contact lens wearers that their near, intermediate and distance vision probably would improve with multifocal contact lenses.
  4. Chat with patients about your own positive experience with multifocal lenses (or that of a coworker, friend or family member).
  5. Talk about the advances that have been made in multifocal lens designs. Patients who've stopped wearing multifocals in the past should consider trying them again.

Who Are the Candidates?

When a patient who's been diagnosed with presbyopia visits the office, take a look at her chart. Is she wearing spectacles or monovision contact lenses? Does the patient have astigmatism? Ask if she's experiencing stress-related problems during computer use. If the answers to these questions are "yes," this patient may be a candidate for multifocal contact lenses. Newly diagnosed presbyopes may be candidates as well – especially if they don't like the idea of wearing eyeglasses.

"When I have a patient who doesn't want to wear eyeglasses for reading, I recommend contact lenses if they're compatible with the patient's lifestyle and ocular health," says Ann Madden, O.D., of Boling Vision Center in Elkhart, Ind. "These patients usually are satisfied with their vision and comfortable in contact lenses."

According to David L. Kading O.D., F.A.A.O., of Specialty Eyecare Group in Kirkland, Wash., "Even if the patient is an advanced presbyope who wears eyeglasses or distance-vision contact lenses and single-vision eyeglasses for reading, I discuss the benefits of multifocal contact lenses to reduce their dependence on spectacles."

Saying All the Right Things

You, too, can discuss the benefits of multifocal contact lenses with presbyopic patients. These quick conversation starters will help you discuss these lens options and answer patients' questions.

Front desk staff. In the reception area, you have the perfect opportunity to start a discussion about contact lenses with presbyopic patients on the phone and in person. When a patient completes his paperwork, review the questions about current symptoms. Ask questions such as:

■ Are you familiar with the new contact lenses for people who need eyeglasses for reading?

■ Are you satisfied with wearing your bifocals or progressive eyeglasses (or monovision contact lenses), or would you like to learn about other options?

■ Is wearing eyeglasses an inconvenience?

Answers to these questions will give you an idea of what the patient is experiencing. Use the patient's responses as a starting point to discuss the benefits of presbyopia-correcting contact lenses. Tell patients that they provide good near, intermediate and distance vision. Let patients know that if they're interested, the doctor can evaluate them for contact lenses. Give patients pamphlets, fact sheets and other materials to read about the lenses while they wait to see the doctor.

Technician. As a doctor's assistant, you have the opportunity to get to the technical part of the discussion. If patients ask you about multifocal contact lenses because the front desk staff piqued their interest, here's what you can say:

■ Discuss the reasons some patients choose multifocal contact lenses, such as lifestyle and appearance preferences. Ask questions about the patient's occupation, hobbies, computer use and the amount of reading he does to help determine if contact lenses are a good option.

■ Describe the different types of multifocal contact lenses, and explain that the choices patients make depend on their age, type of prescription and lifestyle.

■ Explain that multifocal contact lenses have an adjustment period that varies from one patient to the next.

■ Tell them they may need eyeglasses as a back up, and explain why.

10 Ways to Keep Abreast of Lens Types for Presbyopes
Does everyone on your team know about the current vision correction options for presbyopes? Technology changes fast, so try these tips to keep everyone in the loop.

1. Hold staff meetings. They're the best way to get everyone together to discuss what products and services the practice is offering.

2. Discuss what's new at every staff meeting to keep everyone up to date.

3. Plan for the future. Tell employees what new products and services are in the pipeline so they can make preparations to introduce them.

4. Use sales reps. They can give presentations about new products to educate staff.

5. Circulate journals and other professional publications around the office. Staple a list of names to each journal cover and give everyone a chance to review it. Cross off your name after you're finished, and pass it on to the next person.

6. Create product information lists. These lists are great as a quick reference to answer patients' questions. List all the current products and services and include brief details on each.

7. Use brochures and fact sheets to talk to presbyopes about their vision-correcting options.

8. Relay a consistent message. Ensure everyone communicates the same information about contact lens options by discussing different scenarios you may encounter with patients.

9. Develop a script. Write down exactly what to say to patients in different situations, especially when new products and services are introduced.

10. Keep documentation on the training you and the staff receive in one place so that it's easily accessible to the doctor and other employees.

"When I have a patient who doesn't want to wear eyeglasses for reading, I recommend contact lenses if they're compatible with the patient's lifestyle and ocular health. These patients usually are satisfied with their vision and comfortable in contact lenses."

Ann Madden, O.D.

Optician. When patients see you, they may inquire about trial lenses and a pair of eyeglasses as a back up. So you're in the best position to identify presbyopes who are unhappy with their bifocals or eyeglasses for reading. Continue the education process by explaining the benefits of multifocal lenses and asking these questions:

■ Are you unhappy with your eyeglasses for reading?

■ Have you ever worn contact lenses before? Maybe the patient has avoided the idea of wearing contact lenses. This is an opportunity to describe the contact lens options in greater detail. Ask if they'd like to schedule a contact lens fitting with the doctor.

In addition, remind patients that they can work with the doctor and staff to address placement or comfort issues associated with contact lenses.

Office manager. At the end of a patient's visit, try to gauge how the staff succeeded in discussing the different contact lens options available. Ask questions such as:

■ Did you decide to give the multifocal contact lenses a try?

■ Would you like to receive some information in the mail about the options we offer patients with your vision concerns?

■ Have we answered all of your questions today? If the answer is yes, you can be sure that he's received a thorough education.

When you notice that someone has had a contact lens fitting and has decided to become a contact lens wearer, encourage the patient to keep you abreast of how the lenses are working and to call you if any difficulties arise.

By educating patients, you'll encounter many who are pleasantly surprised to learn that multifocal contact lenses exist, so ask them to tell their family and friends. ■

How Would You Handle This Challenging Scenario?

Angry Patient Hangs Up on Receptionist After Receiving the Wrong Information

"Hello, Dr. Underwood's office," said Sarah Jacobson, one of the receptionists.

"Yes, this is Jason Kozak, one of Dr. Underwood's patients. I'd like to make an appointment for my annual eye exam."

"Sure," Sarah said, as she tapped a few keys on her computer keyboard to access the appointment schedule. "What day is good for you?" she asked.

"Ya know, I'd like to get rid of my eyeglasses and try those new SightLux contact lenses," Jason blurted. "The ones from that TV commercial. They're supposed to be great for dry eyes."

"Let me see," Sarah said, as she quickly scanned her list of contact lenses. "It looks like we don't carry SightLux."

"What do you mean you don't carry SightLux?" Jason snapped.

"We carry other lenses for dry eyes," Sarah assured him.

"SightLux is the biggest thing now. The lenses are advertised on TV all the time!"

"Sir, I'm sure we have other lenses that are just as good," Sarah said, raising her voice.

"You must have those lenses!" Jason persisted. "Why don't you ask the doctor?!"

"I can't do that. The doctor's seeing patients right now," Sarah shot back.

"You know what? Forget it!" Jason yelled, hanging up the phone.

Practice manager Cindy Brennan overheard Sarah's tense exchange. "Is everything okay, Sarah?" Cindy asked. "That patient was so rude!" Sarah exclaimed. "Remember, we carry a comparable lens to SightLux," Cindy said. "It's called the AcuLens."

"I didn't know that," Sarah said.

"And we actually ordered the SightLux lens. It should be coming in next week," Cindy said.

"If I'd known that, I would've told the guy," Sarah snapped. If you were Cindy, what would you do or say next?


► Amy Endo, C.P.O.T., N.C.L.E.-C., A.B.O.M., certified paraoptometric technician/master optician, Edwin Y. Endo, O.D. and Associates, Aiea, Hawaii

After Sarah completed the call, I'd suggest that whenever she encounters a rude patient on the phone she should ask for the person's phone number and say that she'll call him back after she speaks with the doctor and gets answers to his questions. That way, she'll be in control of the call and be able to end the conversation on a positive note.

For the future, I'd make a cheat sheet, listing all of the products we carry with bullet points explaining their features and benefits. Then Sarah and the other employees will know that we carry a comparable contact lens for dry eye other than the SightLux lens. I'd also ask our sales representatives to make product presentations to our staff regularly to keep everyone informed on what we offer and what's coming down the pike.

► Carri Russell, F.C.L.S.A., C.O.T., contact lens specialist, Jeffrey T. Shaver, M.D. (private practice), Edmond, Okla.

If I were Cindy, I would've interrupted the phone call and asked Sarah to put the caller on hold so I could take the call and inform the patient that we had a comparable lens for dry eye, and that we were planning to offer the SightLux lens when it came in the following week. Afterward, I'd politely instruct Sarah to always remain calm when speaking to patients on the phone – or in person. I'd tell her that it's OK to put a caller on hold and double check her answers with the practice manager, a technician, optician or another employee. I'd say that new contact lenses often are introduced weekly, so never assume we don't carry it or won't carry it in the near future.

► Deb Ward and Lori Abelar of Granger Family Eyecare, Granger, Ind.

As practice managers, we'd explain to Sarah that whenever she encounters an impatient or rude caller like Jason, she should politely ask him to hold, or write down his telephone number and promise to call him back with the answers to his questions. That way, she can check to make sure she has the correct information.

Because Sarah was upset, one of us would've called the patient back and said something like, "We're sorry for the misunderstanding. The SightLux contact lenses you're asking about will be available next week. When the doctor examines you, you can ask him about the lenses and determine if they're an option for you. If they're not, the doctor will find a comparable lens that will meet your needs."

To prevent this in the future, we'd hold regular staff meetings to discuss the products we carry, the new products we've ordered and the services we offer. Afterward, we'd pass out a memo on what we discussed to ensure everyone has the correct information for callers and patients. ■



Contact Lens Spectrum, Issue: June 2008

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