Making the Practitioner Comfortable

By Edward S. Bennett, O.D., M.S. Ed.

Recently, I evaluated M.L., a 12-year-old girl who was interested in contact lenses. As with most of my young contact lens patients, I wanted to prescribe rigid gas permeable lenses -- for all the right reasons -- vision, ocular health, durability and to slow myopia progression. In this case, however, the patient's mother wore soft lenses, and her aunt had already told her that rigid lenses are uncomfortable. Is this situation rare? No! Would most practitioners prescribe soft lenses? No question about it.

The following information explains what it takes to make patients like M.L. successful and satisfied RGP wearers.

OVERCOMING AN IMAGE PROBLEM

Many prospective RGP patients seem to have formed a negative opinion of them before they ever arrive in our offices. We should assume this and deal with it accordingly. Patients still follow our recommendations for contact lens wear. M.L. did and she's quite happy with her RGP lenses.

The key to successful adaptation of a new RGP wearer isn't lens design, fitting relationship or lens care regimen. In my opinion, these components combined account for no more than 20 percent of a patient's initial comfort with RGPs. The other 80 percent directly relates to the practitioner's attitude -- how we present RGPs -- and the steps we take to make the initial fitting a positive experience.

Studies at the University of Missouri-St. Louis School of Optometry reveal that what we say to a potential RGP patient can have a powerful impact (using the term "lens awareness" instead of "discomfort" or "pain," for example). With M.L., this was very important. I explained all the benefits of RGPs to her and her mother and described adaptation in a realistic but not anxiety-inducing manner.

THE PROS & CONS OF TOPICAL ANESTHETIC

Instilling a topical anesthetic at the fitting visit helps patients such as M.L. overcome the initial psychological hurdle while helping us to evaluate the fitting relationship more naturally and efficiently. However, this practice is controversial. We are aware of the potential negative effects of topical anesthetics such as corneal staining, although clinical studies at Pacific University and UMSL refute this.

Some practitioners also argue that we're misleading patients who will ultimately experience complete edge awareness. However, if we inform patients that we apply an anesthetic at the fitting visit only, their expectations will be realistic. Remember too, that the effect of the anesthetic, while minimizing the potential trauma of the first few minutes of lens wear, gradually decreases, allowing patients to experience sensation.

As RGP proponent Cristina Schnider, O.D., has frequently said: "Topical anesthetic is primarily for the practitioner, not the patient." Practitioners who are apprehensive about fitting RGPs, busy practitioners who must limit the time they spend evaluating the fit, and practitioners who have apprehensive patients all benefit from topical anesthetic use.

CHOOSE RGPs FOR ALL
THE RIGHT REASONS

As many respected RGP prescribers have commented, fitting RGP lenses is fun and represents one of the most rewarding parts of everyday practice. Children, astigmats, presbyopes, keratoconus patients and others benefit from RGP lenses, and patients respect the practitioner who prescribes the best lens material for their needs. Typically, retention is quite good among RGP patients, as these individuals are less likely to use alternative distribution sources for replacement lenses.

We have effective methods to overcome the initial comfort challenge, so it's our responsibility to use these techniques to experience -- and allow patients to experience -- the benefits of RGP contact lenses. I challenge every contact lens practitioner to employ a positive approach to prescribing RGPs. You won't regret it. CLS

Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis. He is executive director of the RGP Lens Institute.