By Amy Hellem
There’s no cookie-cutter approach to successfully fitting astigmatic patients with contact lenses. On the contrary, one-size-fits-all solutions are a sure-fire way to fail when treating this diverse group of eyes. But fitting specialty lenses, and educating patients about their use and benefits, likewise requires an assortment of strategies for success.
There’s no need for apprehension. It’s true that Duette looks different than other lenses. But don’t let that intimidate you, says Golie Roshandel Keovan, OD. “It’s rigid, but it acts like a soft lens,” she says.
Practice makes perfect. In each patient that has a successful fit, you become more and more confident with the lens, says Brooke Kaplan, OD. So don’t let yourself get frustrated during the learning process. “The first patient, you are going to have humps; there is a learning curve with this lens, but give it three patients and you will be very happy with the outcome,” she says.
Stick it out. If you want to be the best at what you want to do, you have to keep trying, says Brian Dembo, OD, PC. “It does take some practice.” So if you put a lens on someone and it doesn’t work the first time, don’t give up, he says. There is a learning curve.
Identify the Right Patients
Determine how visually discriminating your patient is. One of the great debates in specialty lenses is when it’s sufficient to use a soft toric versus a specialty lens like Duette that isn’t subject to visual fluctuation due to lens rotation.
To determine this, Brian Brightman, OD, suggests you carefully consider how visually discriminating a patient is and how crisp and clear they want their vision to be. Ask questions to discover the most detail oriented tasks they perform, and use that to gauge their ideal vision correction.
Find out what needs improvement. If the patient says his contact lenses are fine, don’t leave it at that. Instead, find out what they’d like to improve. Alan Berman, OD presses for details by asking “If you could make one thing better, what would it be?” This opens the door to making things better.
Provide Education on Specialty Lens Features
Make the patient feel special. When Todd Pfeil, OD, places an order for a hybrid lens, he informs the patient that he is not just pulling a lens off the shelf. He explains that Duette is based on your prescription, your eye shape, and your ocular structure. When the patient realizes that the lens is truly tailored for their needs, they take great ownership in that, he says.
Highlight the positive. When fitting patients with Duette, the first thing Dr. Brightman tells them is that we now have technology available that lets us fine tune vision beyond what traditional soft contact lenses can provide. He then explains that, between the time they get their Duette lenses and the time he sees them back, they are going to instantly enjoy clearer vision.
Although they may have to build up their wearing time a little bit and the lens might initially take a little longer to get in and out, it’s just like everything else you do that’s new—you just have to learn it and get used to it. But in the long run, he adds, the vision will be crisper and more consistent.
Explain that the adaptation period is normal. Let patients know in advance that there is an adaptation period and that it’s all very normal, says Dr. Burman. “I tell them that it doesn’t hurt and it is not painful, but you might be slightly aware of the lens in your eye.” Explain that, over time, this gradually goes away and should not be an issue at all.
Reinforce Benefits and Responsibilities
Coach the patient on insertion and removal. On their initial fit, Dr. Pfeil lets patients know that the way they are going to insert and remove Duette is different. You begin as you would with a traditional soft contact lens, by balancing it on the finger to insert.
But when removing the lens, one of the key tips is to tell patients to make sure their fingers are dry, says Dr. Pfeil. “Then when they look up, they grab that soft skirt,” he says. Instruct them to pinch the skirt at the 5 and 7 o’clock positions and then count for a two second hold to remove the lens. This allows tears to get underneath the lens, which assists greatly in removal.
Recognize that not everyone’s experience will be the same. Some patients are lucky and right away the lens is comfortable and works perfectly, says Dr. Keovan. This happens a lot with high cylinder patients who’ve never found a lens that has worked well.
But if your patient is used to a paper-thin daily lens, they are going to have some awareness, she adds. In these cases, Dr. Keovan encourages the patient by explaining that it will feel forty per cent better by the next day. “By the week, it will feel eighty percent better; by two weeks, it is perfect and you will fall in love with the lens,” she says.
Give the patient hope for a better tomorrow. When the patient first puts on the Duette, there will be some lens awareness. To get them through this, Dr. Pfeil explains, “This is the worst this lens is ever going to feel.” Most of the time, setting an expectation that, from here on out, they can only expect improvement is wonderful, he says.
Give it time. When educating patients on Duette, you cannot repeat two weeks enough, says Dr. Kaplan. Warn against making any judgments until after the full two weeks. Let the patient know that the lens should be worn all day, every day, and explain why the brain needs to adapt to this lens as it would to any progressive lens.
Draw comparisons. Dr. Keovan compares Duette to a pair of fine Italian shoes. When you first take them home, you might worry that they weren’t worth it. But once you “break them in a little bit,” you’re thrilled with your choice because they are the most comfortable shoes out there.
Amy Hellem is an independent writer and researcher who specializes in ophthalmology and optometry. Previously, she served as editor-in-chief of Review of Optometry and Review of Cornea & Contact Lenses and directed the custom publishing division for Review of Ophthalmology.