We all learned in optometry school about the amazing benefits of gas permeable (GP) lenses. Durable and affordable, they provide significantly crisp, clear vision, especially for patients with irregular corneas who otherwise may be unable to wear contact lenses. However, many practitioners stop fitting GP lenses after they graduate optometry school, in part because of the intimidation factor. This is the result of a variety of issues, including lack of real-world fitting experience, patient expectations—with soft lenses the norm, they need education about GP lens benefits and the wearing experience differs—and increased chair time. Some of these problems can be alleviated with in-office alterations; others may require the help of lens manufacturers. What resources do manufacturers offer, and how should a practitioner go about selecting one?
Contact lens laboratories that are members of the Contact Lens Manufacturer’s Association (CLMA) have high standards to ensure quality products and support practitioner success. Their goal is to produce contact lenses that serve the needs of practitioners and patients. The CLMA has a code of ethics to encourage confidence in practitioners who use their products; as such, place the use of sophisticated and advanced manufacturing technology at the top of the checklist when selecting a laboratory.
The next step is to consider contacting a consultant. Contact lens consultants are one of the best resources that a fitter can use: they routinely design lenses, co-analyze the fit and assist with the process of problem-solving when a fit is not correct. Consultants know of different lens designs and fitting characteristics that are available, and can assist the practitioner in making the best selection for the patient during the lens design consultation.
As such, there are a number of benefits when partnering with a laboratory that has invested in the latest technology and who has a team of consultants available. Such a partnership can reduce chair time; educate practitioners on fitting techniques and unfamiliar lens designs; make the practice more efficient and the patient more satisfied; and increase patient confidence in the practitioner’s abilities.
Keep In Mind
Different manufacturers offer varying services depending on the size and scope of operation. Some will come directly to the office to train both the practitioner and staff on fitting specialty lenses—including insertion, removal and evaluation of fit of scleral lenses. Additionally, many laboratories offer free online educational resources such as webinars or fitting guides; some have also created social media pages to encourage practitioners to discuss and ask questions about their products.
I asked the current president of the CLMA, Jan Svochak of TruForm Optics, to make a few statements about how labs and consultants can help practitioners with specialty lens fittings. In particular, I wanted to know what he wishes practitioners would understand.
Here are his thoughts:
There are no dumb questions. We want you to be comfortable using our lenses, so ask away. Don’t cut yourself short by not calling and asking for consultant help. Many of your colleagues most certainly are.
Consultants live and breathe challenging issues. It is rare that we haven’t already run across a similar situation to the one you may be experiencing.
We learn from you, too. There is a lot of give-and-take in a practitioner/consultant relationship. The better the exchange of information, the better the relationship.
Having patient history readily available is a huge help. Knowing what has or hasn’t worked in the past in given situations helps us better determine where to go next with lens design.
Ask a Consultant
“Consultants have a vision to see every fitter become an optometric superhero—a fitter who changes lives,” say consultants Kelsey Roberts and Janice Adams from Valley Contax. “Each of the consultants view themselves as a partner as well as a friend to all of the fitters that they consult with throughout the day. Whether it is a discussion about fitting a challenging patient or simply discussing decisions already made regarding a contact lens fit, the consultants want fitters to know that they are ready to share their knowledge and experience in designing lenses and problem solving to achieve a successful fit for a happy patient.”
Having multiple consultants with fitting experience can be invaluable, says Tom Shone of Alden Optical, because together they may be able to solve more complicated cases that a single consultant could not. “I’d encourage ECPs to find great consultants and then develop mutual trust. Great things can happen that way. I’d say the best portal into the lab is a good consultant. They are best able to translate ECPs’ fitting challenges into solutions, both obvious and sometimes not so obvious.”
“Specialty lens manufacturers usually have deep benches for consultation, with many years of contact lens application experience for all sorts of indications,” says Mark Parker from X-cel Contacts. “In our own case, we have 13 National Contact Lens Examiner (NCLE)-certified consultants with more than 250 years of consultation experience.”
Cassandra Gordon from Visionary Optics points out that giving consultants certain information can help improve results. “In order for a consultant to be the most effective in providing the best resolution to successfully fit your patient, detailed comprehensive information relating to central and limbal clearance—or lack thereof—peripheral impingement/compression or edge lift, and signs such as debris in the lens-cornea interface, is very much appreciated. Inclusion of pictures, videos and/or OCT is even better.”
Keith Parker from Advanced Vision Technologies also has a few tips for practitioners. “When sending topographical maps, use an axial map and an elevation map,” he says. “When working with corneal reshaping patients, using tangential maps to assess the overnight treatment is recommended. Also, please remember the basics: HVID, pupil size and lid positions along with Ks and Rx. Use photos and video whenever possible. Perform spherical overrefractions and always compare to spherocylinder overrefractions, as the cylinder might not be worth the trouble.”
Pick a Treatment
Plasma treating is suitable for most gas permeable lenses, says Valley Contax. An often-misunderstood process, plasma treatment is a ‘super cleaning’ of the lenses in which they are treated with ions in a vacuum, imbuing them with a hydrophilic surface. The coating lasts for an average of two weeks depending on the patient’s care and handling regimen and significantly increases initial comfort and wettability for up to a year. Note, plasma-treated lenses should be cleaned with clear, non-milky cleaners; more abrasive cleaners will affect the length of treatment. Most laboratories, however, can re-treat a lens as needed.
Another common point of discussion is the use of diagnostic lens fitting sets. Diagnostic sets save a large amount of chair time and reduce the number of lenses ordered by at least half. Most laboratories offer them either for loan or sale, so if you do not want to invest money in a fitting set, ask the laboratory to borrow one. Generally, sets are loaned out for 90 days to give practitioners enough time to try them out on patients. When ordering lenses, communication between the doctor and the staff member processing the order is extremely important, says Corey Reynolds from Advanced Vision Technology. Often, technicians don’t know the basics of the lens designs they are ordering, and many doctors don’t pass on effective notes to them about what they want to change. This can lead to a lot of mistakes due to incorrect or missing information.
A Click Away
The Gas Permeable Lens Institute (GPLI) is the go-to website for many practitioners and patients. The GPLI has everything you need to become more comfortable with fitting GP lenses. One of the greatest features of the website is “Ask an Expert,” a free question-and-answer section with access to some of the best experts in the world on different subjects—for example, orthokeratology. Several experts are GPLI advisory board members, who offer their advice for free. The website also hosts archived webinars ranging in subject from gas permeable lens fittings and specialty lens tips to common GP problems and billing and coding issues.
Another online resource, the Scleral Lens Education Society (SLS), teaches contact lens practitioners the science and art of prescribing sclerals. SLS supports public education that highlights the benefits and availability of scleral contact lenses. This website is a great resource for practitioners and patients. Embedded within the website is an area to email questions to experts in the scleral lens field. A unique feature to this organization is the Scleral Lens Fellowship (FSLS), in which a practitioner demonstrates extensive knowledge of scleral lenses though case reports, posters, papers and lectures. The “Find a Fitter” tab helps patients and practitioners locate scleral lens experts throughout the world. The SLS is a fantastic site for patients and practitioners looking for any and all information related to scleral lenses.
I-site is an educational newsletter that is distributed on a monthly basis and provides an update on GP-related topics (i.e., scientific research, case reports and other publications worldwide). I-site is objective and non-political. Its editor, Eef van der Worp, is a lecturer and a consultant for a variety of industry partners, but is not related to any specific company.
With such a plethora of knowledge and assistance from a variety of sources, all practitioners should embrace the power of GP lenses! Manufacturers and consultants are some of the greatest resources for contact lens practitioners. Their ultimate goal is to help you succeed with all of your contact lens patients. They help you look like a superhero and will assist you and your office in any way possible to ensure that your patient is happy and healthy. GP lenses can help provide tremendous benefits to your patients and can aid practice growth. Set yourself apart from other practitioners while improving patient lives.
I would like to thank all of the laboratories and consultants for their advice and comments in the development of this article.