In the RGP Practice
BY EDWARD S. BENNETT, OD, MSED
Success or failure with RGP wearers often results from their interactions and training with staff members. If the practitioner values RGP lenses as an important part of his eyecare practice, staff members can either complement or detract from this goal.
Educate Your Patients and Staff
Reinforce the benefits of RGP lenses to new patients. For young people, indicate that these lenses may slow down the progression of their myopia. Reassure them that some lens awareness is common and simply the result of the lid feeling the edge of the lens, a sensation that will go away.
If a staff member is not confident of success, he can pass that on to the patient. Avoid words like discomfort and pain. Use a topical anesthetic to improve the initial experience, and fit from an inventory or empirically to provide the patient with good vision.
Many RGP patients fail within the first month due to frustration with lens handling. Your staff needs to make sure the patient is proficient in insertion, removal and recentration prior to leaving the office. The key is proper lid retraction. The fingers must be positioned under the upper lid/lashes and over the lower lid/lashes so the lid margin is against the sclera. For removal, I place the middle and forefingers of the opposite hand (than eye) on the upper eyelid margin and the middle and forefingers of the same hand (as eye) over the lower lid, push in toward the globe and then temporally while the patient blinks. With the lid margin against the sclera, the lens ejects due to the interaction between edge and lid margin. Current generation RGP lenses, especially aspheric designs, typically have less edge lift, so using one finger at the lateral canthus to eject a lens is often unsuccessful.
Care and Compliance
You or your staff must review each step of the care regimen and have patients repeat it back. Discuss lens removal, cleaning, disinfection and rewetting prior to application. Mention liquid enzyme cleaners such as Supraclens (Alcon) or The Boston Liquid Enzyme (Polymer Technology) for patients who have dry eyes, a flexible wearing schedule and/or are relatively noncompliant with their daily cleaning.
Do not assume that patients will read everything that your office provides to them. Verbally emphasize the important components of care and, as mentioned, have them repeat care instructions. At the one-week follow-up visit, make sure you or a staff member reviews and resolves any handling problems with patients and ensures that they are caring for the lenses as instructed.
Make sure that the patient has multiple cases. Cases often become contaminated, lost or damaged. If possible, have patients regularly replace their cases, at minimum every three months.
Staff member ability to effectively communicate care guidelines is vital for patient
compliance. Patients must know that they need to clean the second lens as thoroughly as the first, to totally replace their disinfecting solution at night, not simply "top off" old solution and to not use tap water, especially after disinfection. Discourage brand-switching of solutions due to possible eye irritation and compromised lens surface wettability. Try providing a two- to three-month supply of solutions at dispensing or sell bulk packs of solutions in-office.
Obtain educational resources on rigid lenses to help in staff education. Texts by Stein & Slatt, Lowther & Snyder, and the Paraoptometric Section of the AOA are beneficial guides. The AOA also has brochures and videos
(www.aoanet.org). The RGP Lens Institute has several educational brochures and videos
Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis and executive director of the RGP Lens
Contact Lens Spectrum, Issue: March 2001