Article

SPECIALTY LENS FITTING: GET THE SUPPORT YOU NEED

Custom specialty lenses are more difficult to fit, but many resources are available to help practitioners succeed.

The September issue article titled “Get the Support You Need” highlighted resources that are helpful in basic contact lens practice including spherical soft and GP lenses, myopia control, and patient education materials.1 This article focuses on resources that can help practitioners with both optimizing specialty contact lens patient success and building their practice with these lenses.

GENERAL RESOURCES

Organizations and Associations A number of organizations and associations have resources and programs to assist eyecare professionals (ECPs) (see sidebar “Organization and Association Resources on p. 39). Most of these organizations and the resources that they offer will be discussed in detail later in this article.

As mentioned in the September article on resources for basic contact lens fitting, the American Optometric Association Contact Lens & Cornea Section offers many resources related to general contact lens fitting. In addition, supplements on specialty lens designs are also available.

The GP Lens Institute (GPLI) has approximately 100 archived ECP and student/resident webinars online pertaining to GP and custom soft lenses. Likewise, the organization offers a coding and billing module, an online case grand rounds troubleshooting book, and a downloadable GP clinical pocket guide. A professional fee calculator for determining all types of fees for different types of lenses as well as a “Find a GP Practitioner” database are also available.

Texts Several comprehensive contemporary textbooks have published within the last few years that have an emphasis on specialty contact lenses. These include texts by Nathan Efron, AC, DSc, PhD, BScOptom; Anthony (Tony) Phillips, MPhil, and Lynne Speedwell, BSc, MSc(Health Psych); and Edward Bennett, OD, MSEd, with Vinita Henry, OD (Table 1).

TABLE 1 CURRENT CONTACT LENS TEXTS AND JOURNAL RESOURCES
SOURCE LINK, RESOURCES
Efron N. Contact Lens Practice (3rd edition), 2017.
Stone AJ, Speedwell L. Contact Lenses (6th edition), 2019.
Bennett ES, Henry VA. Clinical Manual of Contact Lenses (5th edition), October 2019.
Contact Lens Spectrum 2019 Contact Lenses & Solutions Summary (supplement), July 2019.
  • www.clspectrum.com/CLASS
    • Listing of custom soft lenses including all lens parameters and material for custom torics and multifocal torics as well as keratoconus designs
    • Listing of GP lens materials
    • Listing of hybrid lens design parameters
Your Guide to Specialty Contact Lenses. Contact Lens Spectrum Special Edition, October 2017.
Optimizing Practice Success with GP and Custom Soft Multifocal Lenses. Contact Lens Spectrum (supplement), September 2017.

Lens Design and Material Guides There are several quarterly or annual guides as well as journal supplements that list currently available GP and custom soft lenses and materials. This would include Contact Lens Spectrum’s Contact Lenses & Solutions Summary. The GP Lens Institute also has a searchable lens database for all types of specialty GP lenses including corneal GP, scleral GP, multifocal, keratoconic, and post-surgical designs manufactured from Contact Lens Manufacturers Association (CLMA) member laboratories (Table 1).

The November 2017 Contact Lens Spectrum special edition “Your Guide to Specialty Contact Lenses” is another beneficial resource on specialty contact lenses, as are the articles archived on the websites of this and other contact lens publications.

Symposia There is a growing number of contact lens symposia worldwide in which attendees have the opportunity to increase their expertise in all forms of specialty contact lenses. Many of these include the opportunity for hands-on workshop training. The Global Specialty Lens Symposium (GSLS) (https://www.gslsymposium.com ), which will take place from Jan. 22 to 25, 2020 in Las Vegas, typically offers more than 100 hours of specialty contact lens education from which to choose.

Another comprehensive and (likely to be) very well attended symposium is the Dutch Contact Lens Congress NCC 2020 (https://www.contactlenscongress.com/en ), a biennial event that is an initiative of the NAC (Dutch Association of Contact Lenders Suppliers) in cooperation with the ANVC (Dutch Contact Lens Specialist Association). March 15 and 16, 2020 marks the 8th NCC, which will take place in Veldhoven, The Netherlands. The theme of this edition is “Beyond 2020,” which will take a look into the future of contact lenses and will discuss how contact lenses are for more than just correcting visual acuity. This year’s NCC will also feature the NCC’s and the British Contact Lens Association (BCLA)’s collaborative research symposium, which is designed to showcase world-class clinically relevant research and also aims to nurture new researchers, clinicians, and young academics to present at this level.

The BCLA is also well known for conducting exceptional contact lens symposia. Its next biennial meeting will take place in 2021.

A popular contact lens symposium that has been presented annually for more than 45 years is the Bronstein Contact Lens and Cornea Seminar (www.azoa.org ). The next one will take place Jan. 10 to 12, 2020 in Scottsdale, AZ.

Vision By Design, the annual symposium presented by the International Academy of Orthokeratology and Myopia Control, allows ECPs interested in myopia control to receive comprehensive education on this increasingly popular and important topic. The 2020 meeting is scheduled for April 15 to 19.

Laboratory Resources Laboratory consultants can essentially guide ECPs through every step of the specialty lens selection, fitting, and problem-solving process. Their knowledge and skill with fitting their specific lens designs can help ECPs feel more confident and comfortable with fitting these lenses. It is not uncommon for successful specialty contact lens practices to contact a consultant—either by phone, email, or online—as often as daily to help optimize their lens fits. According to Woo et al,2 common questions that ECPs ask consultants include those related to the lens-to-cornea fitting relationship, billing and coding, warranties/return policies, and information about scleral, irregular cornea, and multifocal lenses. A lab consultant FAQs (Frequently Asked Questions) module is available online at www.gpli.info . It is helpful to consultants when ECPs provide photos or videos of the lens-to-cornea fitting relationship or corneal topography maps of challenging patients. Certainly, the partnerships that ECPs have with their laboratory consultants are strongly associated with achieving satisfied, successful specialty lens patients.

In addition to the wealth of information provided by the lab consultants, the specialty lens laboratories often provide numerous online resources such as fitting guides and videos, calculators, and webinars. Many of them also streamline the fitting process by providing successful lenses based upon empirical design while at the same time matching the lens design with an appropriate GP material.

RESOURCES FOR SPECIFIC LENS TYPES

Scleral Lenses Excellent resources are available for developing an expertise in scleral lenses. In addition to the aforementioned symposia that are beneficial in this area, a number of organizations and resources are very helpful as well (Table 2).

TABLE 2 SCLERAL LENS RESOURCES
SOURCE LINK, RESOURCES
Scleral Lens Education Society (SLS)
GP Lens Institute (GPLI)
  • www.gpli.info
    • More than 20 narrated webinars, Clinical Pearls Pocket Guide
    • GPLI/SLS: Scleral Lens Troubleshooting FAQs
Global Specialty Lens Symposium (GSLS) Jan. 22 to 25, 2020, Las Vegas
A Guide to Scleral Lens Fitting (2nd edition) (van der Worp)
Scleral Lens Fit Scales
Contemporary Scleral Lenses: Theory and Application (Drs. Melissa Barnett & Lynette Johns)
Scleral Lenses: Assessing and Addressing the Needs of OSD Patients. Contact Lens Spectrum (supplement), October 2018
Presbyopia Correction with Scleral Lenses. Contact Lens Spectrum (supplement), October 2019

The Scleral Lens Education Society (SLS) provides workshops and courses at a number of meetings, and its website features educational programs and videos including one for patients on scleral lens handling and care. Note: free registration is required to access some of the resources.

The GPLI offers more than 20 webinars on scleral lenses as well as a laminated card with patient care and handling tips. The SLS and the GPLI have collaboratively produced a comprehensive Scleral Lens Troubleshooting FAQs—an illustrated guide that is available on both websites—as well as student-based scleral lens workshop programs.

Among resources that offer fitting and general information about scleral lenses, the Scleral Lens Fit Scales, available from the Michigan College of Optometry, are an excellent resource for helping to determine whether the scleral lens fitting relationship—both central and peripheral—is acceptable. “A Guide to Scleral Lens Fitting” authored by Eef van der Worp is available on the Pacific University website (https://commons.pacificu.edu ). Contact Lens Spectrum published a supplement to its October 2018 issue titled “Scleral Lenses: Assessing and Addressing the Needs of OSD Patients” and one to its October 2019 issue titled “Presbyopia Correction with Scleral Lenses.” The most comprehensive resource in this regard, however, is the text “Contemporary Scleral Lenses: Theory and Application” authored by Drs. Melissa Barnett and Lynette Johns.

ORGANIZATION AND ASSOCIATION RESOURCES

  1. GP LENS INSTITUTE (www.gpli.info )
    • Resources for each of the following: bitorics, corneal reshaping, multifocals, keratoconus/post-surgical designs, corneal and scleral GPs, and custom soft lenses
    • More than 100 webinars (ECP and student)
    • Coding and Billing Module
    • Lab Consultants FAQs
    • Spherical and Toric Lens Calculators
    • Specialty Lens Directory and Lens Designs
    • Grand Rounds Troubleshooting Guide
  2. SCLERAL LENS EDUCATION SOCIETY (www.sclerallens.org )
    • Provide scleral lens workshops
    • Lectures/webinars (living library)
    • Fitting guides, forms, and videos (including care and handling)
    • Fellowship program
  3. INTERNATIONAL KERATOCONUS ACADEMY (www.keratoconusacademy.com )
    • Resources on keratoconus and the many forms of treatment
    • Forum to share ideas and discuss various topics related to keratoconus
  4. NATIONAL KERATOCONUS FOUNDATION (www.nkcf.org )
    • Videos and FAQs about keratoconus
    • Patient education booklets
    • ECP referral list
  5. INTERNATIONAL ACADEMY OF ORTHOKERATOLOGY AND MYOPIA CONTROL (https://aaomc.site-ym.com )
    • Vision by Design annual symposium
    • Find a Doctor list
    • Fellowship program
  6. BRITISH CONTACT LENS ASSOCIATION (www.bcla.org.uk )
    • Biennial conference
    • Lectures online
    • Fellowship program
  7. AMERICAN OPTOMETRIC ASSOCIATION CONTACT LENS & CORNEA SECTION (https://www.aoa.org/optometrists/membership/aoa-sections/contact-lens-and-cornea-section )
    • Where to report illegal contact lens vendors/sites
    • Contact Lens Safety FAQs (www.contactlenssafety.org )
    • FAQs on contact lens prescriptions
    • Specialty design supplements
  8. AMERICAN ACADEMY OF OPTOMETRY SECTION ON CORNEA, CONTACT LENSES AND REFRACTIVE TECHNOLOGIES https://www.aaopt.org/membership/sections-sigs/fellows-sections/fellows-sections-cclrt
    • Google group to discuss cases
    • Position papers
    • Diplomate program
  9. ASSOCIATION OF OPTOMETRIC CONTACT LENS EDUCATORS (www.aocle.org )
    • Healthy Scleral Lens Habits
    • Living library
    • CL Pocket Guide (2014)

Custom Soft and Hybrid Lathe-cut custom soft lenses can be manufactured in soft toric or soft toric multifocal designs with virtually any power, axis, or cylinder as well as in keratoconus and post-surgical soft lens designs. Latheable silicone hydrogel materials allow some of these custom soft lenses to be manufactured in a higher-Dk material. Several laboratories offer lathe-cut hydrogel lenses for this purpose as well. As mentioned in the previous article from the September issue on basic lens resources,1 CooperVision has a tool (online and app versions available) that suggests trial lenses for both toric and multifocal lenses based on patients’ spectacle prescription, and the company provides a cross-cylinder calculator for when a toric over-refraction occurs with a soft toric lens (https://coopervision.com/practitioner/tools-and-calculators ).

Likewise, SpecialEyes (specialeyesqc.com/tools-and-resources.php ) offers a number of calculators and fitting tools for custom soft lenses.

SynergEyes offers a calculator for empirical fitting of its hybrid lens design for regular corneas at www.synergeyes.com . The site also features online video tutorials for the company’s irregular cornea hybrid lens design.

Resources for Keratoconus There are two organizations with the sole purpose of keratoconus education. The National Keratoconus Foundation (NKCF) has numerous resources and programs to educate patients who have this condition. Included are a popular booklet about the condition that can be ordered online for keratoconus patients and an extensive ECP referral list. In addition, NKCF’s website provides videos on the condition and insurance tips related to corneal cross-linking.

The International Keratoconus Academy, recently established by internationally renowned experts in this area, includes resources on keratoconus and its many forms of treatment. In addition, it offers a popular online forum for members to share ideas and discuss various topics related to keratoconus.

GP Multifocals As with other GP specialty designs (i.e., scleral, irregular cornea, etc.), the best resources are the laboratory consultants and the many online guides and programs that their laboratories offer. The GPLI has numerous webinars and a comprehensive module “Building Your Practice with GP Multifocals” consisting of 17 ECP, staff, and patient educational resources. “Optimizing Practice Success with GP and Custom Soft Multifocal Lenses,” a supplement to the September 2017 issue of Contact Lens Spectrum, is a beneficial resource as well.

GP Torics GP lens manufacturing technology has advanced such that bitoric lenses can often result in patient success simply through empirical fitting. Each laboratory has its own nomogram based upon patient refraction and keratometry (or topography) readings. In addition, the GPLI has two calculators for this purpose: the GPLI Toric and Spherical Lens Calculator and the Mandell-Moore Guide. The GPLI website also offers the Newman GP Toric Guide developed by Dr. Clarke Newman.

CONCLUSION

In summary, numerous resources are available to help increase ECP interest and success with specialty contact lenses. Once you fit your first few patients into a scleral, multifocal, keratoconus, or other custom specialty contact lens design, you become comfortable with fitting those designs and excited about the quality of life improvements experienced by your patients. The tools are out there for you to successfully fit patients with these lenses. Do not hesitate to use them. You will not be disappointed. CLS

Editorial support for this article provided by Amrit Jawanda, OD, cornea and contact lens resident, The New England College of Optometry.

REFERENCES

  1. Walsh K, Lenz Y, Behrens R. Get the Support You Need. Contact Lens Spectrum. 2019 Sep;34:32-37.
  2. Woo S, Gelles J, Potter R, Barnett M. The Laboratory Consultants. Contact Lens Spectrum. 2019 Apr;34:28-30,32,33,40.