Cases in Point: RGPs = Real Good Practice
BY EDWARD S. BENNETT, OD, MSED
I've always enjoyed comedies that disguise themselves as mysteries, notably the "intellectually challenging" series of movies by the Zucker brothers ("Airplane," "Naked Gun"). You always realized that the good guys would prevail and the case would be successfully solved. A parallel can be drawn with the following myriad of cases, all remedied via RGP lens application.
An 18-year-old female has been wearing soft toric lenses for four years. She has never been satisfied with her vision through her lenses and, since leaving for college, has noticed symptoms of eyestrain after prolonged reading or computer use. Her refraction is the following:
OD : 3.75 1.75 x 168
OS : 3.50 2.25 x 8
Assuming minimal to no residual astigmatism, this type of patient often makes an excellent RGP candidate. When fitting this patient, provide either through empirical ordering or a diagnostic lens that is similar to the power indicated good vision at the initial fitting so she can appreciate the benefit of RGPs. Often these individuals have been given a negative view of RGPs, but once they observe the vision achieved with this modality, they are quite enthusiastic.
This patient is a 24-year-old male with a history of contact lens-induced complications, often resulting from poor compliance with care and wearing time. He has worn disposable lenses for seven years. He was originally provided with a six nights on, one night off schedule. However, he admitted to often wearing the lenses as long as four weeks prior to removal. He has had two ulcerative keratitis episodes and discontinued lens wear on several occasions due to moderate papillary hypertrophy. His refraction is:
OD : 7.00 1.00 x 010
OS : 7.25 1.25 x 172
As a result of the oxygen transmission, wettability and tear exchange associated with RGPs, this patient, if receptive, would make an excellent candidate. Obviously, as a result of his history of poor compliance, a daily wear schedule would be recommended. However, if he is non-compliant and wearing a high Dk lens material, it is unlikely that he will experience further corneal compromise.
This patient is a long-term spherical RGP lens wearer who, at age 44, is experiencing blurred vision at near. He is still quite active athletically, playing in a basketball league in the winter and a softball league in the summer. He also is an avid computer user. His refraction is:
OD: +2.50 1.00 x 180
OS: +2.75 1.00 x 175
Although some practitioners would be tempted to automatically fit him into monovision, most likely he would enjoy better vision and binocularity in RGP aspheric multifocals. They are easy to fit (often 1D to 2D steeper than K) and, if good centration is achieved, patients are often quite satisfied with their vision at all distances.
These three patients, like many successful RGP lens wearers, were quite satisfied, if not ecstatic, about their new contact lenses. This passion often translates into referrals. Although no one can deny the realism of an adaptation period, there often is a pot of gold waiting for both the patient and the practitioner once successful adaptation has occurred.
Quite simply, practitioners will find it is "real good practice" to fit rigid 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.