Reap the Benefits of
In-Office Lens Modification

BY JEFFREY J. WALLINE, O.D., & KARLA ZADNIK, O.D., Ph.D.
JAN. 1997

Today's fast-paced society demands that the services your office provides be efficient with respect to time and money. Returning rigid gas permeable lenses to the laboratory for small but important adjustments can be costly in both regards, not to mention the fact that the person who must make the modifications has never seen the lens on the eye. In-office modification units can provide you with greater flexibility and save both you and your patient time, effort and inconvenience.

NO DEPOSITS, NO RETURNS

A 24-year-old woman presents to your office with complaints of decreased comfortable wearing time with her RGPs and a slight decrease in vision, gradually worsening over the past month. She states that she has had the lenses for one year and that this typically happens each year. She reports that her previous eye doctor always seemed to alleviate the symptoms by prescribing new lenses.

Her vision is 20/20­ OU. Spherical overrefraction reveals +0.25D 20/20­ OD and plano 20/20­ OS. Slit lamp examination reveals a good contact lens fit with minimal apical clearance and an adequate peripheral system. Both lenses are heavily coated with protein and debris. A five-minute lens polish cleans the lenses thoroughly and provides comfortable, clear vision. The patient calls the office one week later, stating that she can now wear the lenses all day without discomfort and that her vision is very clear.

By providing sharp, comfortable vision with a quick, in-office procedure, you can avoid forcing patients to wear uncomfortable lenses for a week or more while you order another pair.

FIG. 1: A TIGHT FIT WITH MINIMAL PERIPHERAL CLEARANCE AND 3 AND 9 O'CLOCK STAINING.

DANGEROUS CURVES

An 18-year-old man presents to your office to pick up his first pair of RGP lenses. Fifteen minutes after inserting the lenses, he sees 20/20 OU, but complains of discomfort in the right eye. Slit lamp examination with fluorescein reveals an abrupt transition between the secondary and the peripheral systems. You determine the secondary and peripheral radii of curvature and blend the transition zone with an intermediate curvature between them.

Fifteen minutes after reinserting the right lens, the patient reports clear vision and good comfort. Once again, a quick procedure completed in the office saved time and money.

FLATTEN & CONQUER

A 34-year-old keratoconus patient returns to your office stating that his lenses are extremely uncomfortable after only two hours of wear, but that his vision is just fine.

Visual acuities are 20/25­ OD and 20/20­ OS. After three hours of wear, slit lamp examination reveals adequate central clearance, but almost no peripheral clearance, very little lens movement and moderate 3 and 9 o'clock staining (Fig. 1). You flatten the peripheral curve by two millimeters and blend the secondary and peripheral curves by modifying the lens with a modification tool one millimeter steeper than the periphery. After 15 minutes of wear, the lenses show adequate peripheral clearance and about 1.5mm movement with the blink. You prescribe artificial tears four times a day in both eyes and schedule a visit in one week.

One week later, the patient reports marked improvement of comfortable wearing time. After six hours of wear, the lenses show adequate peripheral clearance and 1.0mm to 1.5mm movement with the blink. The 3 and 9 o'clock staining has nearly resolved. You have alleviated the symptoms immediately and gained the confidence of yet another patient.

RAPID RETURN ON INVESTMENT

An RGP lens modification unit will help you create a very favorable impression as patients realize your special abilities as an eyecare practitioner. You will quickly recoup the cost of this tool in time, money, good-will and referrals. CLS

Dr. Walline is a graduate student in physiological optics at The Ohio State University College of Optometry in Columbus. Dr. Zadnik is an assistant professor at OSU.