RGP insights

Making An Educated Decision

BY EDWARD S. BENNETT, OD,MSED
July 1999

Important decisions are almost always made after careful deliberation. And just as we make decisions for our own benefit, patients want the right to make educated decisions for themselves. They want optimum vision without compromising their eye health.

Patients have the right to be provided with all of the information available on contact lenses, and as practitioners, we are obligated to uphold that right by providing them with the information they want. However, this right is being denied to an alarmingly high number of patients. Many times, they are hastily fit into soft contact lenses by their practitioner. Those who are satisfied RGP wearers are automatically refit into soft contact lenses because it's convenient for the practitioner, which often results in dissatisfied patients.

These new soft lens wearers are told how much better disposables are than other modalities. Perhaps they are even "fortunate" enough to benefit from the current discounted prices available. But unfortunately, if these patients question why their lens material is being changed, they're told that RGPs aren't as good, that they're uncomfortable and that they'll be better off in disposables. These patients are not being given the information they need to make an educated decision. Often, when patients are given the proper and necessary information required to compare the benefits of soft lenses to those of RGPs, many of them, if not the majority, especially the younger ones, select RGPs.

With success rates of 80 percent and higher, why aren't RGP bifocals being prescribed more often? The Acuvue Bifocal, from Vistakon, is bringing interested patients into our practices and some of them will benefit from this and other soft bifocal lens designs. But how many of these individuals would benefit more from an RGP design?

Just Give It a Try

Nevertheless, I admit that there's a purpose and a place for all lenses. Yes, RGPs do take time and expertise to fit, and no, not everyone can wear them, but they provide the best vision correction option for many. I have little empathy for practitioners who complain about the impact of mail-order companies and other alternative contact lens distribution sites, but who continually feed these outlets by fitting all of their patients with disposable contact lenses.

Many practitioners have successfully handled the mail-order issue, typically by offering competitive lens prices and replacement methods, but also by emphasizing RGPs and special design contact lenses.

RGP patients realize that their lenses are designed specifically for their eyes and that they require more expertise to fit than lenses provided by alternative distribution sites. Do soft lens patients have the same attitude toward their lenses and their practitioner? Perform an in-office study -- the results may surprise you.

If you have pride in the management of your eyecare patients; if you determine the best spectacle prescription; if you prescribe the optimum therapeutic drug for a given eye infection, how then can you justify fitting soft contact lenses on every patient? Are you meeting their individual needs and vision demands?

It's not ethical to fit every patient into soft contact lenses. It's not ethical to refit satisfied RGP wearers into soft lenses or to downplay RGP lenses to patients without even making the effort to determine their possibilities. In my educated opinion, when you fit every patient with your available lenses and not with the option that's best for them, your prescribing habits may be bordering on malpractice.

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