Contact Lens Spectrum Supplements

Special Edition 2016

Contact Lens Spectrum

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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 8 GP INSIGHTS S T E P H A N I E L . WO O, O D, FA AO, FS L S INTEGRATING SCLERAL LENS INNOVATION INTO YOUR PRACTICE S cleral lenses have been a very hot topic for the past few years — and for good reason. Scleral lenses have given us the opportunity to fit the most challenging patients, as well as the ability to provide patients with excellent vision and comfort. When scleral lenses first made their re-appearance a few years ago, they were mainly used to fit train wreck corneas, when all other lenses failed. Many other lens de- signs were often tried first, leaving scleral lenses as a last option. As scleral lens designs have improved, practitioners have learned to reach for scleral lenses as a first choice lens, instead of a last resort. Scleral lenses are easy to incorpo- rate into any practice. The keys are to recognize good candidates and educate those patients about their options. Four years ago, I joined a private practice that primarily handled comprehensive eye exams, eyeglass and soft contact prescrip- tions, and ocular disease treatment. Specialty contact lenses were non- existent, but I was determined to build our specialty lens base. Building a New Lens Niche I began by recommending scleral lenses to patients I knew would see an improvement in the quality of vision. If a patient had an ectatic cornea with a good deal of corneal irregularity, my goal was to educate him on his vision correction op- tions. Patients with highly irregular astigmatism, such as keratoconus, pellucid marginal degeneration, and corneal transplants, were easy to convince, and I was confident scleral lenses would improve their vision. Here is an example of a typi- cal conversation: Doctor: "Mr. Smith, you have been wearing eyeglasses for a long time to correct the vision in your right eye, but you also have very blurry vision in your left eye due to your corneal transplant. There might be a contact set. The top row of lenses is designed for prolate corneas (think of normal cornea shapes, keratoconus, dry eye, and proud graft). The prolate lenses are split into 16.00-mm and 17.00-mm diameters. The bot- tom row of lenses is designed for oblate corneas (such as post-refrac- tive surgery, and certain corneal transplants). The oblate lenses are also split up into 16.00-mm and 17.00-mm diameters. With the wide array of shapes and diameters, it is easy to fit. Broadening Your Scope Next, I branched out to patients with other corneal irregularities, such as post-refractive surgery pa- tients and patients with corneal scarring due to trauma, and herpes. I have found post-refractive surgery patients are motivated to try scleral lenses because they dislike their eye- glasses; many of these patients had refractive surgery in the first place because they didn't like wearing eyeglasses. Here is an example of a typical conversation: Doctor: "Sally, I see you had Radial Keratotomy (RK) surgery about 25 years ago and, when it started to regress, you began to wear eyeglasses again. Are there times you would like to reduce your dependency on eyeglasses? Do you ever experi- ence fluctuating vision? Do you feel your vision is different during differ- ent parts of the day?" Sally: "The RK surgery was great for about 10 years, but after that, my vision started to get blurry. So I had to wear eyeglasses again. I would love to get back into contacts, but my last doctor told me I could never wear them after the surgery. I do feel my lens that can improve the vision in your left eye. Is that something in which you would be interested?" Mr. Smith: "Yes, I would like to know more." Doctor: "There is a new, specialty contact lens that is very comfort- able and can be fit over your cor- neal transplant, and it might give you functional vision. We would need to schedule a fitting for you, so I can spend time trying different lenses until I identify the best fit. Then, we will check to see what your potential vision is. After that, I send all of the information to a lab and they create a custom lens just for you." Addressing patients with irregular corneas can be a great way to start in- corporating scleral lenses into your practice. These patients will usually see very clearly due to the GP optics, and these are some of the most excit- ed and appreciative patients. Once you see how gratifying scleral lenses are, you will begin to identify other patients who are good candidates. One easy fitting set I use is the Zenlens scleral lens (Alden Optical). Before fitting Zenlens, practitioners must complete an online certifica- tion to ensure their knowledge of the lens and the fitting philosophy. Zenlens has four distinct mini sets built into one large, comprehensive U F P. 0 2 5 4 . U S A . 1 6

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