editor's perspective

Contact Lens Experts - Is There a Gap?

BY JOSEPH T. BARR, OD, MS, EDITOR
July 1999

In a Contact Lenses Today (www.cltoday.com) mini-editorial a few weeks ago, I said that I sensed a gap growing between typical eyecare practitioners who fit contact lenses and the more serious contact lens practitioners, or experts. Since it's not politically correct to say "specialists," I'll call them serious contact lens practitioners, or SCLPs. A number of years ago, I asked some SCLPs how they determine who is worthy of the distinction of this title. A good answer was whether or not they really knew how to modify an RGP lens to make it work better.

Bob Grohe, O.D., says that we are a society driven by convenience and that this influences how we practice. If lenses aren't easy to fit, many practitioners won't use them. He continues, "we are experiencing the dumbing down of contact lens fitting and the promotion of the auto/uni-fit." He comments that an example is the U.S. trend to prescribe RGPs in 0.1mm steps, while Europeans work with lenses that have different asphericities in different quadrants. You're getting my point, Bob, and I too think that the United States is generally less interested than it once was in contact lenses. This apathy is due to optometry's fascination with its expanded scope of practice and ophthalmology's fascination with refractive surgery.

At the recent British Contact Lens Association (BCLA) meeting, it was great to see standing-room-only crowds anxious to learn about new contact lens technology. One poster at this meeting described an increase of international articles on contact lenses with a reduction in the numbers from the USA. Perhaps this publishing trend is a wake-up call, or maybe it's just a natural evolution.

To me, one area of growth in the contact lens field is consultants -- the ones who work for the manufacturers and take Ks and refractions over the phone and answer n�ive questions from the practitioners who are getting the patients' fees. This is just one more example of the gap between SCLPs and average practitioners. I don't expect the presumed trend toward fewer sophisticated contact lens practitioners to slow, but for those young practitioners who want to carve out a niche like our mentors did -- make sure you possess these special skills. Know how to modify an RGP lens to make it perform better, even if you don't do the modification yourself. Know how lenticulars really work and what SPE and CPE are. Understand center of mass and specific gravity and their impact on fitting. Get a lens design program and know how to troubleshoot toric lens problems. Learn to fit bifocals too. Learn how to inspect lenses for defective optics, poor manufacturing and defects. Learn all you can about the cornea and anterior segment. Get a topographer, read Contact Lens Spectrum and go to the contact lens sessions at meetings. Our patients deserve more SCLPs. And if you have any good tips on what makes a SCLP, let us know.