Retinal Physician Article Submission Guidelines-Prescribing for Astigmatism and Presbyopia

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Article Date: 9/1/2004

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Don't Just Present Options, Make a Recommendation
BY THOMAS G. QUINN, OD, MS, FAAO

Consider the astigmatic patient interested in contact lens correction. Being the astute clinician that you are, you immediately recognize the possible treatment modes. These include a spherical GP lens, a toric GP lens, a toric soft lens, an aspheric soft lens or even a spherical soft lens in certain cases. Now what?

Don't Pass the Buck

I've heard many colleagues say they share all contact lens options with the patient, discuss the pros and cons, then leave it up to the patient to make a decision. I call this the "Passing the Buck" approach to contact lens treatment.

Not only is this time consuming (a big no-no in today's healthcare environment), but it's like turning the airplane over to the passengers. They know where they want to go, they just don't know how to get there. You, not your patients, have been trained to sit in the driver's seat.

Unless you're fitting a fellow eyecare provider, your patient isn't likely to have the tools he needs to make a valid decision. He's likely to base his decision on what he's heard from friends and family or advertisements. You, on the other hand, bring knowledge and expertise to the encounter.

Set Your Perspective Early

Be sure to make early inquiries regarding interest in contact lens correction. Consider including it in a questionnaire that the patient completes before the exam. This lets you view his case from a contact lens related vantage point from the start. You can appreciate how valuable this is by reflecting on how you felt the last time you were winding down an examination and the patient popped the question, "Could I wear contact lenses?" This is usually followed by an awkward silence as you reboot and review the case anew.

Don't find yourself in this uncomfortable situation. Be proactive and inquire up front.

Gathering the Data

You already know the contact lens options, their strengths and drawbacks. Most of your job now is getting to know the patient. Again, a pre-examination questionnaire can prove invaluable in this endeavor. It should inquire about the patient's visual activities during job and leisure activities to help you gain an appreciation of his visual demands.

Aside from gathering the raw data of refraction, corneal shape and ocular health, pay attention to the patient's response during testing. How sensitive is he in responding to choices during the refraction? This provides insight into his visual sensitivity. How did he respond during eyelid eversion as you checked on the condition of the superior tarsal plate? How did he respond to tonometry? These observations cue you in to his physical sensitivity.

The Great Matchmaker

Now you know all the pieces of the puzzle intimately: The patient, his objective findings and personal characteristics and the lens options available. You're the uniquely qualified matchmaker.

Communicate, Demonstrate

Let's go back to the astigmatic patient we first discussed. You decide a spherical GP lens is the best choice for this patient, but you know he expects to get spherical disposable soft lenses. How do you bridge the gap?

Get him on your side by outlining the advantages of GP lenses over spherical disposables. A powerful tool in this case is to position the patient behind the phoropter and take out the astigmatic correction. The resulting blur sends a strong message that you must correct the astigmatism to achieve clear vision. This fosters an attitude of cooperation as the two of you embark on your mutual quest for clear, comfortable vision.

Dr. Quinn is in group practice in Athens, Ohio, and has served as a faculty member at The Ohio State University College of Optometry.

 


Contact Lens Spectrum, Issue: September 2004

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