Contact Lens Practice Pearls

Choosing the Right Lens

Contact Lens Practice Pearls

Choosing the Right Lens


From first-time lens wearers to presbyopic refits and everything in between, choosing the right contact lens from the start can make all the difference. So, how do we do that?

First Things First

It starts with listening. Assess patients’ visual needs, including their occupational and recreational demands, and allow patients to prioritize those visual demands. Understanding patients’ visual requirements will enable you to address their most important needs and improve their overall success rates. Find out how they plan to wear contact lenses and why they want to wear them. Choosing the right lens can be the difference between success and failure.

Some of the most challenging contact lens fits may provide the biggest opportunities. For example, an unprecedented number of current soft contact lens wearers are developing presbyopia. Their lifestyles and satisfaction with soft contact lenses compel them to remain in soft contact lenses, creating motivated lens wearers.

Is the Surface Clear?

During the physical exam, pay close attention to the ocular surface and eyelids. Look for conjunctival or corneal redness or chemosis. Eversion of the upper and lower eyelids may reveal the presence of papillae or other complicating factors. These can both be visualized more easily with fluorescein.

When there are complicating factors such as ocular surface disease or allergic conjunctivitis, treat those first prior to taking on the lens fit.

Have All of the Tools

From daily disposable and frequent replacement options to specialized soft, hybrid, GP, and scleral lenses, expand your contact lens toolbox to maximize potential candidates. There are small differences in every lens design, and even small changes can make large differences in success rates. Make it a point to add a new fitting set, and remove a set that is rarely used anymore.

Additionally, utilize technology to enhance the fitting process. For example, there may be times when topography is critical in choosing the right lens.

Give It Your Best Shot

Contact lens practitioners today are able to choose from a variety of new contact lens materials, lens care solutions, moisturizing eye drops, and prescription therapies to help with various contact lens-related comfort issues.

If you feel that a patient has specific concerns that would benefit from a particular design or modality, don’t wait. Go with the best option from the start. Changing designs or modalities mid-stream complicates things and lengthens the fitting process.

For example, if presbyopic patients have dryness or comfort concerns, consider a daily disposable multifocal design from the start. Even if there are concerns about cost, let patients know why this lens is their best option.

For your highly astigmatic prescriptions, you can also consider starting with a specialty contact lens design to provide the best vision. It may be a toric corneal GP or other design, but attack the astigmatism from the start. Soft toric contact lenses may be unstable and not able to meet their visual demands.

Keep Patients Involved

During the fitting process, make sure that the lenses are meeting and exceeding patients’ expectations. If patients are challenged with the vision that they have achieved, consider another path early on. No lens offers 100% success, but keeping patients involved will enable practitioners to fine-tune the process quickly.

Contact lenses are an important profit center within many of our practices. Understanding our options can help deliver maximum comfort and vision to our patients. It can also help generate referrals and potentially prevent contact lens dropout. CLS

Dr. Miller is in a partnership private practice in Powell, Ohio, and is an adjunct faculty member for The Ohio State University College of Optometry. He has received honoraria for writing, speaking, acting in an advisory capacity, or research from Alcon, Allergan, CooperVision, and Visioneering Technologies. You can reach him at