In my last column, I talked about what to say to your patients. This month, I want to talk about the things that we should all stop saying to our patients. I hear patients say over-and-over that they have been told these same things, and we need to quit it.

Almost All Patients Can Wear Contact Lenses

First, stop telling patients that they can’t wear contact lenses! I mean it. Many patients have told me that their last practitioner told them that they can’t wear contact lenses. Seriously?

Rather than being truthful and telling patients that we are uncomfortable prescribing, for example, toric multifocal hydrogel lenses, many of us are telling these patients that contact lenses are not for them. It is a disservice to our patients and to our practices.

So, if the contact lens wearing population is aging, and some of them need multifocal torics, then maybe, just maybe, we should all learn to get comfortable with prescribing them, or sclerals, or whatever. OK?

Keratoconus Patients Are Not Going Blind

The next thing that we absolutely have to stop doing is telling our keratoconus patients that they are going blind and will all need corneal transplants. Patients have come into my office scared to death about their future because some colleague of ours had told them this. Now, to be fair, we might be correctly explaining corneal ectatic disease, and all the patient hears is “BLINDNESS!!” Even so, it is vitally important to tell these patients that they are not going blind.

I know that we now live in an era of alternative facts, but come on people—with cross-linking and with scleral and corneal lenses that have sophisticated new materials and designs, not only are our ectatic patients not going blind, they are seeing better than ever.

In my experience, 30 years ago, we shepherded over a group of immiserated people who were crying out for better options and better vision. Today, I have keratoconus patients wearing their lenses for 500 hours a day and griping about the quality of their 20/20+ vision. It is both awesome and annoying at the same time.

While we have moved the needle, even at its worst, only about one in five keratoconus patients ended up needing a transplant. As far back as 2014, according to the U.S. Eye Bank Annual Report, endothelial failure accounted for 40% of transplants, while ectasia accounted for about 10%. So, who’s going blind?

Stop Focusing on the Price of Daily Disposable Lenses

Another thing that we need to stop telling people is that daily disposable lenses are expensive. First, cost is not our concern; prescribing the best lens for our patients is. We should present each patient with the available choices in an environment of complete informed consent, then let the patients choose what to do.

Part of presenting options to patients is making sure that the value proposition is well-illuminated. If patients fully understand the benefits of a particular option, then, and only then, can they make an informed decision about whether the option is best for them.

Watch What You Say

I guess what I am saying in this column, and in my last column, is that you should talk to patients as you would have others talk to you. Do you want a practitioner telling you that you are not a good candidate because he or she is uncomfortable with an option? CLS

For references, please visit and click on document #259.