As we get into the holiday season, I thought I would start working on my wish list. I am not sure I deserve anything—I’ve been kinda naughty—but I thought I’d ask anyway.

What I Want

The first thing on my wish list is some new GP materials. Sure, we have some really good materials, but it has been awhile since we’ve had a new one. We need a material that is really stiff, really clear, really wettable, really deposit resistant, high index, and dimensionally stable, but easy to lathe. How hard could that be, right? The modern specialty lens practice would be so much better off if we had this material. The greatest threat to the viability of the modern contact lens practice is the huge dropout rate among the presbyopic age group. If we solve the dryness/end-of-day comfort issues and the presbyopia issues, then we will be golden because a significant number of our current lens patients are in this at-risk age group. We can’t keep relying on the expansion of the market to grow our practices. We need to keep the patients whom we already have. What a novel idea.

Second, and being mindful of what I just said, I wish most contact lens practitioners knew that soft and GP multifocal lenses are a thing and would try them before trying monovision. Some of the newest soft lens and GP lens designs have really made multifocal prescribing a lot easier and a lot more successful. Nothing is more reliable than an enthusiastic multifocal patient. They refer like crazy, and they come back to see us. How great is that?

Third, I wish that vision care plans would all rewrite their medically necessary contact lens (MNCL) policies to allow prescribers to balance bill for the difference between a single-vision scleral GP lens and a multifocal lens. Currently, the plans cover the cost of a single-vision lens, but forbid balance billing of the patient. So, if the patient wants a multifocal scleral lens, there is no way for the prescriber to recoup the additional cost; that is untenable for the prescriber. It is a simple fix that enables the MNCL patient to get the benefits of a multifocal lens. If CMS can do it with the multifocal IOLs, then there is no reason for the vision care plans not to follow suit.

Next, I wish patients would be more forthcoming about the problems that they are having with their lens wear. News Flash: We won’t take away your lenses if you tell us you are having comfort and vision issues—I promise. Current data suggests that only 20% of patients tell their prescriber that they are having problems (Schnider and Wales, 2016). And, a huge percentage of those who don’t currently have problems have no plans to do so if they encounter them.

When you combine that with the fact that a large percentage of prescribers don’t ask about specific comfort and acuity issues, we have a perfect storm of missed opportunities to solve problems that may eventually lead to patient dropouts.

The prescribers need to do a better job of getting these complaints out in the open and dealing with them. Sometimes, the best way to address these complaints is not to change the lenses or solution, but to change the patients by addressing their eye dryness and allergies.

What Do You Want?

Will I get my wishes? Who knows. But, I can’t wait to find out what is in my stocking this year. What would you wish for? CLS

For references, please visit and click on document #253.

Dr. Newman has been in private practice in Dallas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine, and refractive surgery. He is a Diplomate in the AAO and a consultant or advisor to Alcon, Allergan, AMO, B+L, EyePrintPro, GPLI, Johnson & Johnson Vision Care, SynergEyes, TruForm Optics, and Zeiss Optics. Contact him at