The Business of Contact Lenses
Eye Care First, Contact Lenses Second
By Clarke D. Newman, OD, FAAO
Yesterday, I was reading an article in Cornea authored by Rabbanikhah et al (2011), about the association between corneal hydrops in patients who have keratoconus and mitral valve prolapse. The long and the short of the article is that the odds ratio of a hydrops patient having a mitral valve prolapse is almost 27-to-1 compared to controls.
That finding made me, who sees keratocones frequently, perk up and go “What?” The finding was not that surprising, considering the long-standing believed association between keratoconus and connective tissue disorders. After all, the mitral value is pretty much made of connective tissue, and prolapse is pretty much a connective tissue disorder. However, an odds ratio of 27-to-1 is startling.
Now, it is easy for something like this to catch your eye when you have a dog in the fight, but it got me thinking about the association between ocular and systemic disease and lens wear.
We sometimes get so focused on the task at hand that we forget other important stuff. The problem is that many ocular and systemic conditions that we encounter routinely affect lens success.
Often, the key to sorting out struggling contact lens patients is to address their other issues. The obvious ones are lid disease and inflammatory ocular surface diseases, such as obvious and non-obvious tarsal gland dysfunction and dry eye syndrome. Drug-induced dryness and lid wiper epitheliopathy are examples of more subtle ones.
The important point is that we need to still be doctors—even when most of the money is in prescribing. Keeping the bigger picture in mind is always important. We sort of pledge to, “First do no harm.”
Even contact lens prescribers need to remember that they are in the vision correction business and not the contact lens business.
We have offices and staff so that we can help people see. We heal the eye so that it can see. We correct the eye, even with a contact lens, so that it can see. If we leave untreated some condition of the eye that makes contact lens wear impossible or more difficult, then, I submit, we have failed in our duty to our patients.
Expanding our Knowledge
So often, our instinct in response to a complaint is to adjust the contact lens. Sounds reasonable, but it is often not the best course of action. We fall prey to the patient's desire for a quick fix.
I wonder whether we sometimes resist discontinuing contact lens wear for some period because the patient considers it to be an inconvenience. In the quest to make people happy, we sometimes do the expedient thing. I know that that is controversial, but it is just human nature.
When you're a hammer, everything starts to look like a nail. The problem is that there are many different types of hammers out there, and we need to have more than one hammer in the quiver! Sorry, mixed metaphor.
Anyway, it is important to learn as much as we can about conditions that might be outside our wheelhouse, and find ways to apply that knowledge in a context-free manner to contact lens tolerance and good visual acuity.
How contact lens wear is affected by laser-assisted in situ keratomileusis (LASIK) neurotrophy is as relevant to a patient's success as what solution regimen he is using. That is why it is time for me to read my American Society of Cataract and Refractive Surgery (ASCRS) journal. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #185.
Dr. Newman has been in private practice in Dallas, Texas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine and refractive surgery. He is also a consultant or advisor to B+L and Inspire Pharmaceuticals. You can reach him at email@example.com.