Don't Slight Your Patients, Fit Them With Gas Permeables
BY EDWARD S. BENNETT, OD, MSED
Did you know that the number of eligible candidates for gas permeable lenses who are instead fit into soft lenses is increasing? Not coincidentally, the number of satisfied gas permeable lens wearers who are refitted into soft lenses is also on the rise. But why compromise your patients' vision because one option is more convenient than another? Give gas permeable lenses a chance to change your patients' lives.
Why 'Fix' What's Not Broken?
Lack of confidence, inadequate training, little desire to learn new procedures, not enough time to fit contact lenses or not wanting to take the time to successfully fit a patient into these lenses are several common reasons why good gas permeable candidates are fit or refit into soft contact lenses.
This presents an ethical dilemma: How can you justify fitting a patient into a lens that's an easier alternative for you, but isn't in the best interest of the patient?
Justifying a Change
The next five scenarios illustrate the many cases in which you can better serve a patient's needs with gas permeable lenses.
1 The soft bifocal failure. Presbyopic patients, if provided with contact lenses as a viable option, are often not provided with the option of gas permeable bifocal lenses. True, disposable soft bifocal lenses allow you the option to trial different lenses for one week at a time, but if the patient's vision is unsatisfactory -- or even if he's "20/Happy" but his vision is significantly compromised relative to baseline -- it's your responsibility to refit him into gas permeable bifocal lenses. Contact your CLMA member laboratory about obtaining gas permeable aspheric multifocal and segmented translating diagnostic fitting sets.
2 The soft toric failure. Once refractive astigmatism exceeds 2.00D in a soft toric wearer, the likelihood of reduced vision increases resulting from the need for an exact fit with little to no rotation with the blink. Use gas permeable lenses as your lens of choice for these individuals with bitoric lenses recommended for greater than 2.50D of corneal astigmatism.
As lens rotation tends to increase with oblique cylinder patients, you should also fit these individuals with gas permeable lenses.
3 The soft spherical failure. Patients who have 0.50D to 0.75D refractive cylinder and critical vision demands are often disappointed with their vision from a spherical soft lens and will potentially appreciate their vision from gas permeable lenses.
4 Soft lens-induced complications. You can remediate a wide variety of soft lens complications (contact lens papillary conjunctivitis, infectious keratitis, neovascularization) by refitting a patient with gas permeable lenses. They should also reduce edema-induced myopia progression.
5 The young myope. Young progressive myopes are often fit into soft lenses because fitting and adaptation are easy. But it's been demonstrated that soft lenses have little effect on the progression of myopia, whereas gas permeable lenses have been shown to slow down the progression. The use of orthokeratology lens designs with young people is also increasing with the potential to reduce existing myopia.
Give Your Patients a Chance
The common bond among these five cases is quite straightforward. You can argue that patients representing any of these cases shouldn't have been originally fit into soft contact lenses, but it does happen. Unfortunately, so many of these patients are never allowed the opportunity to experience the quality of vision provided by gas permeable contact lenses.
Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis and executive director of the RGP Lens Institute.