Contact Lens Practice Pearls
Tips for Getting Started With Corneal Reshaping
BY JOHN MARK JACKSON, OD, MS, FAAO
Corneal reshaping is a rewarding addition to a contact lens practice. Recent studies have confirmed the reduction in myopia progression in children who wear corneal reshaping lenses (Cho and Cheung, 2012; Santodomingo-Rubido et al, 2012). Adults love their visual freedom from daytime lens wear. I would like to share some clinical pearls for those just getting started with this therapy.
1. Start with Low Rxs My favorite: −2.00D. They are dependent on their correction and have an easy correction with reshaping. At this level, the fluorescein patterns look like textbook pictures, so fit adjustment is straightforward. They quickly transition into no daytime lens wear in four to seven days with only one or two soft lenses in the transition period. In short, a high rate of success with these patients.
2. Pick a System and Stick With it All corneal reshaping systems work well. Look at several designs and find the one that fits your practice. Go with a design in which the fitting system makes sense to you, the pricing and return policies work for your practice, and you have a good relationship with the lab and consultants. As you hone your skills, your consultant is your best friend. After you get some experience, you might try a second system for some flexibility.
3. Patient Consents and Contracts Corneal reshaping is different from daily wear and extended wear, and patients need to be fully informed of the benefits and risks. A specific reshaping consent document is recommended, and sample ones are available from the labs. Have a contract specifying the fees and policies for any refunds that patients may receive if they discontinue treatment. Most of your time and expertise is in the initial consultation and starting treatment, and that should be reflected in these policies as should credits for returned lenses.
Figure 1. A good fit with a corneal reshaping lens.
4. Spare Lenses Patients should have a spare pair of lenses. A lost or broken lens means a break in treatment, which is inconvenient at best. Build the cost of two pairs of lenses into the initial fees so there is no debate about getting that second pair.
5. Don’t Change the Base Curve! For standard GP contact lenses, the base curve is usually the first thing you change to improve the fit. But changing a reshaping lens base curve will change the treatment effect and actually not make much change in the way that it fits. Depending on the design, hold off changing the base curve unless you need to change the amount of treatment.
6. In-office Trials If the lens doesn’t center, you won’t get a good treatment. Before sending a patient home, do a 30-minute, closed-eye, reclined-chair “test run” with the lenses. Take the lenses off and do topography. You will immediately be able to see whether the lens centered properly with eyes closed and can make adjustments to the design.
I hope that these tips help you get a good start with corneal reshaping. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #205.
Dr. Jackson is an associate professor at Southern College of Optometry where he works in the Advanced Contact Lens Service, teaches courses in contact lenses, and performs clinical research. You can reach him at email@example.com.