Specialty Lenses and Corneal Disease: Part II

By Ashley Tucker, OD, FAAO, FSLS, Dipl ABO

Specialty contact lenses (ie, rigid gas permeable [RGP] lenses, scleral lenses, and hybrid lenses) are a great option for patients who cannot refract well or see well out of spectacles. The goal behind fitting specialty lenses is twofold: 1) to not cause additional harm or compromise to the patient’s cornea, and 2) to provide better vision. Part two of this article by Ashley Tucker, OD, FAAO, FSLS, DIPL ABO, offers insights on patient goals, education, and follow-up.

THE PATIENT COMPONENT
Patient Goals
Many of my patients are defeated because they’ve lost their independence and they’re trying to get it back. They want to be able to drive safely at night. Sometimes it can be challenging as a practitioner because patients come in with lofty goals, and many times we can achieve them, but sometimes we can’t, so we have to temper their expectations and goals.

Age
We have many older patients with corneal dystrophies and degenerations who could benefit from a specialty contact lens, but dexterity issues caused by rheumatoid arthritis or another ailment prevent them from successful wear. There are some tools and strategies available that can help get a motivated patient into a specialty lens.

Education
My team and staff members have concentrated time with each patient to teach them how to insert, remove, clean, and store their lenses. We then send the patient home with a document I put together that restates everything my technician discussed with them. (We also have a QR code the patient can scan that offers a video version of what we did in the office and reviews everything in the written document.) We try to leave no room for mistakes, and we provide three different opportunities to learn, because patients are not going to remember everything you tell them on day 1.

Follow-Up Care
After the initial lens fitting, patients should be seen within 1 to 2 weeks to assess the fit and troubleshoot any issues. While some minor discomforts may resolve with time, it’s important to monitor and adjust the fit as needed. I generally have patients come back at the 2-week mark to troubleshoot any potential issues, but if they are anxious or I sense they need some handholding, I have them return after 1 week, then schedule them back every 2 weeks until we are all happy with the lens fit. Once we get to a lens that everyone feels good about, I’ll push them out for a month. At this visit, maybe another 30% of patients need an additional change or tweak, but most patients are good at this point, so I schedule to see them back every 6 months. I always leave a window open for them to see me at any time.

Most manufacturers offer a 90- to 120-day warranty period, and I tell patients they can see me as often as they need to during that timeframe.

SUPPORTING PATIENT SUCCESS
The patient’s experience with specialty lenses involves much more than just selecting the right lens type. Understanding their goals, providing proper education, and offering thorough follow-up care are also essential components of the fitting process. By considering these factors, optometrists can enhance the likelihood of a successful outcome and significantly improve the quality of life for patients with corneal disease.

ASHLEY TUCKER, OD, FAAO, FSLS, DIPL ABO

• Optometrist, Bellaire Family Eye Care, Bellaire, Texas
• Adjunct Faculty, University of Houston College of Optometry, Houston, Texas
• ashley.w.tucker@gmail.com
• Financial disclosure: None acknowledged 

Editorially independent content supported with advertising by CooperVision and Glaukos