Contact Lens Spectrum
Issue link: https://clssupplements.epubxp.com/i/740958
C O N T A C T L E N S S P E C T R U M S P E C I A L E D I T I O N 2 0 1 6 c l s p e c t r u m . c o m 10 GP INSIGHTS Dr. Woo practices at Havasu Eye Center in Lake Havasu, Ariz. She is also the trea- surer for the Scleral Lens Education Soci- ety and is an Advisory Board member for the GPLI. She is a consultant or advisor to Alcon, Blanchard, Bio-Tissue, B+L, Essilor, and X-Cel. vision is different when I wake up, compared to 1 hour later, and at the end of the day. My vision seems to fluctuate a lot." Doctor: "Well, I have great news. There is a special type of contact lens that might work for you. It is completely different from the con- tact lenses you wore before the RK surgery. This type of contact lens is custom fit to your eye, so you should have great vision, and it will also aid with the fluctuating vision. Would you like to try it?" Sally: "Sure. I would love to get back into contacts, but I want soft contacts. Those hard contacts were uncomfortable and they were always popping out. Can't I just wear soft contacts again?" Doctor: "Traditional soft contact lenses are created for patients who have a normal-shaped eye, and who have not undergone any surgery. Since your eyes had the RK surgery, they are no longer a normal shape, and thus you aren't the best candi- date for a soft lens. Don't worry, the lens I'm going to fit you with is com- fortable, and I think you're going to enjoy your new vision." Post-refractive surgery patients are typically very pleased with the reduction or elimination of fluctu- ating vision. A scleral lens with an oblate design would be most ap- propriate. Something else unique about Zenlens is SmartCurve, which allows practitioners to modify only the parameter they want, and leave all other parameters the same. One of the most frustrating and confusing issues with scleral lenses is modifying the parameters. Many scleral lens manufacturers require alterations to all parameters, even if only one small change is needed. SmartCurve makes it easy to navi- gate, so making changes to the lens is simple. Don't Forget Dry Eye Once I had success with scleral lenses, I began recommending them to patients with severe dry eye. To educate patients, I use photos to show the tear reservoir behind the scleral lens, which bathes the eye all day. Many patients are quite in- terested, especially if they've been suffering for a long time. Note that only the Boston Sight prosthetic device is indicated for treatment of severe dry eye. Astigmatism and More Most recently, scleral lenses have become a lens of choice for patients with astigmatism, high myopia/ hyperopia, aphakia, presbyopia, and regular astigmatism. Patients with normal corneas have become a huge part of my scleral lens prac- tice. Patients who have been wear- ing soft contact lenses for the afore- mentioned conditions may benefit from scleral lenses. Due to the crisp optics of the GP material, many patients actually see better (with less fluctuating vision from lens rotation) with scleral lenses com- pared to their soft lenses. Here is a conversation that you may have with a patient. Doctor: "You've been wearing soft lenses for astigmatism for a while now. How is your vision?" Jane: "Good." Doctor: "Is your vision clear all day every day, from the moment you apply the lenses to the moment you take them out? Do you ever have blurry vision during the day?" Jane: "Well, now that you men- tion it, my vision is pretty good in the morning but a few hours later, one of my eyes gets blurry. I have to blink a lot and move the contact lens around with my finger to get it to focus again. This happens a few times a day." Doctor: "It sounds like the lens is rotating on your eye during different parts of the day. There is a special weight in your lens that allows the lens to stay in place, but sometimes the weight moves into a different position, and that's when you experi- ence blurry vision. There is another type of contact lens you might con- sider, which is designed to better fit your eye. And if the lens rotates on your eye, it won't matter. Your vision will remain clear. Is that something you would like to try?" Let Patients Decide Many contact lens patients will tell you nothing is wrong with their contact lenses — unless you ask spe- cific, targeted questions. So, keep probing! Explaining a potentially better contact lens option may be enough to peak their interest. Don't limit scleral lens recom- mendations to patients with com- plaints. I learned from my mentor and partner, Dr. Stuart Adams, to explain all of the options to patients. Forget what they're currently wear- ing and how much money you think they want to spend. Just explain the benefits of each lens option and let the patients decide. Advancements in scleral lenses allow practitioners to fit normal corneas and have become a great option for patients desiring the best possible vision. Our practice now has more than 1,000 scleral lens patients. Scleral lenses can be inte- grated into any practice, if you have the desire and motivation. If patients are well educated about their options, they will often choose the lens that delivers the best vision. Like Dr. Adams has taught me: If you relate everything to the patients' vision, that is what they care about the most, and that is why they're seek- ing your help. If you take the time to educate patients about their eyes and why a scleral lens might benefit them, success will follow. CLS