RGP insights

RGP Comfort Drops

BY EDWARD S. BENNETT, OD, MSED
JANUARY 1999

Although experienced RGP practitioners don't have problems with initial lens comfort, many inexperienced practitioners bias patients away from RGP lenses during the initial presentation of lens types. Keep in mind that patients can be influenced by the their practitioner's terminology.

Speak No Evil

By using such statements as "discomfort," "pain" and "feels like there is something on your eye" to describe RGPs, and by emphasizing "the exciting new disposable lens programs in our office," you may turn patients off to the idea of wearing RGP lenses.

I always assume that every new patient has been given the impression that rigid lenses are uncomfortable, so I describe RGP lenses in the following way. "RGP lenses typically provide excellent vision and eye health. They're also wettable and durable, but they don't feel the same way a soft lens does initially. Because they're smaller, they move more on the eye. The eyelids sense this movement, but gradually adapt, typically resulting in comfortable lens wear."

A recent one-month study (Bennett ES, Stulc S, Bassi CJ, et al., Optom Vis Sci, July, 1998) confirmed the impact of presentation methods. Non-contact lens wearers were divided into one of three groups: 1) Fear-Arousing (subjects observed a video of a doctor discussing RGPs with a new wearer during the diagnostic fitting process using terms such as "discomfort," "possible pain," "intolerance" and "failure"); 2) Neutral Content, Non-Enthused (subjects observed a video of a doctor using terms such as "lens awareness" and "initial lid sensation" to describe RGPs, and the doctor's attitude was less than enthusiastic about this option); and 3) Neutral Content, Enthusiastic (the doctor used the same terminology as the second group, but exhibited a positive attitude toward RGPs). A total of eight subjects discontinued lens wear, six of whom were in group one; the other two were in group two. The subjects in the third group were significantly more compliant in returning daily questionnaires than the other two groups.

You Won't Feel a Thing

All patients are at least mildly apprehensive about the initial application of contact lenses. If the first few minutes of lens wear are not unpleasant, patient satisfaction and the potential for long-term successful wear will be good. Using a topical anesthetic during the diagnostic fitting process is just as important as properly presenting RGPs for patient comfort and satisfaction. The topical anesthetic wears off, and the patient gradually experiences lens awareness. Some clinicians are concerned that topical anesthetic use softens the epithelium, resulting in more potential for staining, and possibly misleads patients, since lens awareness will occur during the adaptation process.

An 80-subject, multicenter study recently evaluated the effect of topical anesthetic use on initial comfort and patient satisfaction for first-time RGP wearers (Bennett ES, Smythe J, Henry VA, et al., Optom Vis Sci, Nov., 1998). Twenty non-RGP-wearing subjects were selected from four educational institutions (University of Missouri-St. Louis, Pacific University, The Ohio State University and Southern College of Optometry). Half of the subjects received a placebo at the fitting visit, and the other half received a topical anesthetic. Eight of 10 who discontinued lens wear were in the placebo group. At the study completion, anesthetized subjects perceived their adaptation time, long-term wear, fit experience and overall satisfaction to be significantly higher than subjects who had a placebo. No significant difference in corneal staining between these two groups was found at consequent visits.

Topical anesthetic use is not a requirement for RGP lens fitting. For apprehensive practitioners and patients, however, these "comfort drops" can mean the difference between failure and success, and can help you build your practice with RGPs.

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