By Amy Hellem

Whether you’re fitting a specialty lens on an irregular cornea or putting a standard silicone hydrogel on a healthy, active teen, the goal is always the same—to offer excellent vision with a lens that meets the patient’s ocular surface needs and wearing habits. It sounds so simple, but as prescribing trends over the past several decades illustrate, it is exceedingly complex.

Several strategies—aimed mostly at delivering comfort, convenience and cost—have garnered attention over the years. Some of the many tactics that have enjoyed modest success and popularity include the rollout of soft lenses, more frequent replacement schedules, silicone hydrogels, continuous wear lenses, soft torics and, most recently, daily lens platforms.

Each of these developments has moved the profession one step closer to keeping patients comfortable and compliant. However, since none of these strategies adequately address the optical demands of patients with higher visual standards or irregular corneal surfaces, dropout persists.

To ensure that all of your patients are happy with their lenses and remain loyal to you and your practice, a specialty lens design often is best for everyone involved.  The challenge, of course, lies in determining when to make the recommendation. In some cases, the choice is obvious.

For instance, if a patient has keratoconus, pellucid marginal degeneration, or a history of RK, specialty lenses are the definite first choice. But, certain custom-made lenses can benefit several other groups as well, including toric wearers who struggle with lens rotation, visually sensitive patients, athletes, and anyone who has difficulty performing an essential visual task, such as driving at night.

Toric Lens Wearers

Lens rotation may bother your toric lens wearers more that you thought. In fact, 82% of toric lens wearers say they frequently experience issues with their lenses. Furthermore, 85% must manually reorient their lenses to realign their vision.¹ A recent clinical study confirms that 74% of toric lenses remain misoriented even after 60 seconds.² 

For this reason, it’s essential to ask probing questions about patients’ experiences with their toric lenses and offer an alternative, such as the hybrid SynergEyes Duette. This lens delivers excellent vision that is not dependent on the position of the lens, so your patients’ vision will stay consistently clear—even when they blink.

Fifty nine percent of toric lens wearers are convinced that there must be a better lens for astigmatism¹. As their doctor, you want to make sure they find it at your practice. If you’re worried about sticker shock, research shows that 73% of toric wearers say they would pay more for a lens that eliminates toric issues¹.

Visually Sensitive Patients

The development of hybrid lenses marks one of the greatest advances in contact lens technology because these lenses provide the best of two worlds—the optical quality you’d expect from a gas permeable lens and the comfort patients desire in soft lens designs.

These are advanced, high-performing devices to be sure. While we know that, in theory, every patient deserves the best possible vision, many ECPs understandably yearn for an objective indication that signals the tipping point, indicating it’s time to go the extra mile and begin a discussion about this innovative category.

For Brian Brightman, OD, it all comes down to a process he calls “prescription analysis.” He asks patients “what is the most detailed thing you do in your day?“ If they have very detail-oriented tasks and have a history of being visually discriminating, he will suggest Duette versus a soft toric, even in low and moderate astigmatic patients.

Todd Pfeil, OD agrees: You can usually tell when patients are visually sensitive and want more stable optics. “These are the perfect Duette patients,” he says, because you can rest assured that you are going to meet their expectations.

Athletes

Athletes have exceedingly high visual demands and can be especially more discriminating with respect to their visual needs.  They require a stable lens and will typically invest in whatever specialized equipment is needed to excel at their sport. As such, Duette is the clear choice, says Alan Berman, OD. As an added bonus, the soft skirt of Duette prevents dirt and debris from getting under athletes’ lenses—and it has UV protection.

Patients with Visual Struggles

When patients can’t perform an essential activity with confidence due to an issue with contact lens optics, it is definitely time to explore specialty designs. This is often true with glare when driving at night; though some patients may even have trouble driving during the day if they are experiencing toric lens rotation.

Brooke Kaplan, OD, recalls a particularly memorable day in her career when Duette changed the life of one of her patients. The patient used to be a motorcyclist but had stopped riding because she felt unsafe due to lens rotation. At a recent visit, the patient showed up with three years’ worth of unopened custom toric lens vials. “We put her in the Duette and she was in tears, saying she could not remember a time where she saw this well,” recalls Dr. Kaplan. “This lens literally changed this patient’s life.”

Anyone Who Wants the Best

Some doctors look for signs that clearly indicate the tipping point, while others think Duette is a tipping point in its own right. These doctors don’t wait for patients to experience problems with traditional lenses before bringing up Duette. “I’m putting most of my patients in this lens,” says Golie Roshandel Keovan, OD, who calls Duette her number one, go-to lens. Her reason is simple: “Who wouldn’t want high-definition vision that doesn’t fluctuate?”

Likewise, Brian Dembo, O.D., PC, isn’t willing to compromise quality. “It is very hard for me to put up a sign in my office that says, ‘Today Mrs. Jones, our goal for you is so-so vision.’” Dr. Dembo wants to get his presbyopic patients away from disposable lenses and has a strong affinity for the Duette Progressive. He says moving to Duette Progressive is very easy to do in patients with low levels of astigmatism and gives a much better quality of comfort and vision.

An Easy Choice

While many patients enjoy moderate satisfaction with commodity designs, others are far less willing to compromise. The challenge for the ECP is to figure out which patients can get by with a commodity design and which ones would rather not.

Duette has made this choice much easier, so doctors aren’t forced to find out the hard way that their patient wasn’t happy. On the contrary, practices can use Duette to strengthen patient loyalty. “I would say, on average, I get two to four referrals from every successful Duette Progressive,” says Erin Sullivan, OD. “No other lens will do that for your practice.”

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.

1. Study of 400 Toric Wearers. Data on file.
2. Non-dispensing clinical study of 38 eyes (leading 4 toric brands). After lens is rotated 45 degrees temporally. Data on file.