One Size Doesn't Fit All
BY JANE J. BEEMAN, COA, NCLC-AC, FCLSA, PRSA
An explosion in manufacturing technology in the past few years has given contact lens fitters more product options than ever before. New cast molding and lathing technologies have presented us with improved aspheric, toric and multifocal contact lens designs, and polymer chemistry has given us improved oxygen flow, handling and surface characteristics. Question is...what do we do with it all?
One Product, All Patients
Some practitioners like the simple approach: Find one contact lens product, and use that product on every patient who walks in the door. Their lens selection may be driven by a corporate purchasing agent, a special pricing deal, a good sales representative or years of experience fitting that product. For those practitioners, all they need is an auto keratometry reading and their fit is done. Product consistency, low cost manufacturing and limited parameter offerings make this scenario work for the average myopic daily wear patient.
Not the Average Patient
What happens when your patients don't fit into that "average" mold? Refraction shows they have astigmatism; they may be hyperopic or need high amounts of myopic correction. Prefit workup reveals steep/flat corneas, large/small iris diameters or tight/flaccid eyelids. Patient history tells of contact lens failures due to rapid lens spoilage, solution intolerances or handling difficulties. Prefit consultation shows patient interest in extended wear or presbyopic correction. It may even be worse: his comprehensive eye examination may have diagnosed a corneal disease such as keratoconus or recommended the patient for a post refractive surgery contact lens fit. Forget "average," you're on your own now.
Stay in the Know
Fitting patients such as those described above demands more than a "one size fits all" approach. Successful contact lens fitting requires a specialized knowledge base. Following are some tips to help you expand your understanding of specialty contact lens fitting:
- Know your contact lens inventory: what brands you stock and what parameters you have on hand
- Understand material characteristics for each brand: ionic/ non-ionic, water content, oxygen flow and deposition profiles
- Use reference materials: keep contact lens product guides and textbooks at your fingertips
- Research seldom used/historical products: manufacturer and laboratory fitting consultants have a vast knowledge of their company's products
- Keep up to date on specialized research: go beyond continuing education class and check out the research posters and papers
- Learn to use your in-office verification and modification equipment because verification of contact lens parameters is essential: wet cells, magnifying loupes, lensometers, and radiuscopes and slit lamps are the tools of the trade
Like every good puzzle, the answers are always available, if you just know where to look.
The past director of professional services for Bausch & Lomb, Jane is now in clinical practice in Rochester, NY, and is a frequent guest speaker at leading academic and professional programs around the world.