What's Your Excuse For Not Fitting RGP Multifocals?

BY DAVID W. HANSEN, O.D.
OCT. 1996

RGP bifocal contact lenses don't work! They're uncomfortable, difficult to fit and there's no money in them. You've probably heard all these excuses, but now it's time to review the literature and dispel these wimpy, unfounded myths.

LITERATURE SUPPORTS SUCCESS

Van Meter, Gussler and Litteral (1990) found a 93 percent success rate for prism ballasted RGP bifocals, 74 percent for center near soft lenses and 67 percent for annular and concave RGP translating lenses. They also found that 75 percent of successful wearers did not have prior contact lens wearing experience. Kirman and Kirman (1988) reported a 91 percent success rate in a retrospective analysis of 100 aphakia and keratoconus patients wearing the Tangent Streak bifocal contact lens. Remba (1988) described a Tangent Streak bifocal study achieving 80 percent success. A 1993 clinical study by Bridgewater, Hansen, Kame, Rigel and Shaw of 75 patients who used the FluoroPerm ST translating design revealed 77 percent success, with modification of the lenses to achieve success.

INDUSTRY SUPPORTS SUCCESS

Are these studies representative of the real world? The answer is yes, thanks to sophisticated manufacturing techniques, innovative designs, physiologically compatible materials, conscientious consultants and talented practitioners. Together, these elements represent the foundation of a strong RGP multifocal market. Then what is the real reason we don't suggest RGP multifocals to our patients?

CLINICAL BENEFITS

In a managed care world where we have less control of our professional fees, specialty contact lenses, especially bifocals, provide the best opportunity to enhance practice growth. Clinically, RGP multifocals enable our presbyopic patients to experience binocularity, comfort, less risk of infection, sharp visual acuity and the potential for modification with advancing presbyopic refractive changes. Presbyopic patients refer more often than any other category of patients in our office and truly are the most enthusiastic heartbeat of the practice. These specialty lenses do require chair time, but we can assure ample compensation by setting appropriate professional fees.

PROFESSIONAL FEE SCHEDULE

Multifocal contact lenses require extra practice time, so an expanded fee schedule is appropriate. Explain all services and fees to the patient at the initial presentation. Table 1 illustrates an effective breakdown of services.

It's extremely important to add value to the services we perform in the specialty contact lens practice. Our expert services in the multifocal arena should command elevated fees. If a surgeon takes 10-15 minutes to remove a cataract for thousands of dollars, then we should be compensated for a few hours of expertise to enable the patient to see his world more clearly. CLS

Dr. Hansen, a cornea and contact lens diplomate and fellow of the American Academy of Optometry, is in private practive in Des Moines, Iowa.