Decisions, Decisions: Making the Best Choice
BY THOMAS G. QUINN, OD, MS
Whew! I almost made a terrible mistake. But thanks to wise guidance from a knowledgeable and caring expert, I'm back on the right path. You see, my wife and I have recently decided to re-build our deck. We presented our "dream" deck plan to our contractor, and, after a few thoughtful questions, he pointed out to us that our plan was going to seriously curtail our view of the beloved sky. Needless to say, our plans have changed.
What's my point? How often do you have prospective contact lens patients requesting soft contact lenses when, after gathering some information, you realize that rigid gas permeable lenses (RGPs) would meet their needs more effectively?
Don't you agree that it's our job to inform patients about the advantages of RGPs? Our contractor could have taken our plans and built a marvelous deck that matched our drawings perfectly, but would he have been serving in our best interest? Obviously, not. Neither are we serving in our patients' best interest if we simply provide them with the modality they think they want, even if we do it impeccably. Here are some ideas on how to act in your patients' best interest.
Be a Team Player
Don't view the above scenario as an "us against them" relationship. You don't have to say, "No, you can't wear soft contact lenses." Instead, discuss the benefits of each lens type with the patient. If the list of RGP benefits is more compelling, he will most likely decide to pursue this mode of correction. This way, you are working together to determine the best modality.
Don't bombard patients with lens features (e.g., a high oxygen transmissibility level) without explaining the resulting benefit (e.g., improved ocular safety). Demonstrate to the myopic astigmat how RGPs will correct his astigmatism better than soft lenses, resulting in better vision. Explain to the young progressive myope with small apertures and his parents how RGPs will be easier to handle than soft lenses and how they may help curb changes in his vision.
RGP Confidence Booster
In a recent study conducted at Pacific University, 40 percent of patients who would have typically been considered ideal soft lens candidates preferred RGPs over soft lenses after wearing both types of lenses. Additionally, out of 200 prospective contact lens candidates presented with the pros and cons of both soft and RGP lenses at Park Nicollet Medical Center in Minneapolis, 48 percent chose RGPs. At this same site, out of 200 current soft, RGP and PMMA wearers experiencing problems, 46 percent were refit from soft lenses to RGPs (the primary complaint being reduced vision), and only 9 percent were refit from RGPs to soft lenses (the primary complaint being reduced comfort).
These studies strongly suggest that 40-50 percent of the population should be enjoying the benefits of RGPs, but the reality is that only 10-15 percent currently are. How are you doing at meeting the needs of your patients?
When deciding which lens is best for the patient, be sure to explore the patient's needs, assess his ocular status and inform him of the benefits of each lens design. Remember, always do what's best for your patient! CLS
Dr. Quinn is in group practice in Athens, Ohio, and has served as a faculty member at The Ohio State University College of Optometry.