contact lens practice pearls
Making Time for the CL Fitting During the Exam Process
BY THOMAS G. QUINN, OD, MS, FAAO

The patient in your chair is enthusiastically interested in contact lens correction and your history, refractive testing and anterior segment exam tell you that he's a great candidate. But you've only scheduled enough time for a vision examination. You still need to perform a dilated fundus examination and a visual field test. To add on a lens fitting would send your schedule into chaos. What do you do?

Look at the Choices

You can take your exam in one of the following three directions:

1. Complete the comprehensive exam, including dilated fundus exam (DFE), and have the patient return for a contact lens fitting.

2. Stop the vision exam, institute contact lens fitting procedures and perform the balance of the exam at a future visit.

3. Proceed with your exam by instilling dilating drops, and as the patient's pupils dilate, undertake contact lens fitting.

Strike While the Iron's Hot

Asking a patient to return for fitting opens the door for him to pursue contact lens services elsewhere. But how do you meet his contact lens needs without putting his eye health at risk by delaying an internal ocular exam?

Make your decision on which direction to take your exam by reviewing two key pieces of data:

1.The patient's chief reason for the exam.

2. The patient's case history.

If the patient's chief reason for getting an exam is related to internal eye health or he reports symptoms suggestive of internal ocular pathology (for example, he complains of a recent onset of floaters and photopsia), then move health tests to the top of your priority list. Exercise greater caution when working with new patients.

On the other hand, if you're working with an established patient whose health and case history are good and whose chief purpose for seeking your care is solely for you to fit him with contact lenses, then proceed with the contact lens fitting.

At this point, the question becomes, "Can I perform the fitting and the DFE simultaneously?"

Can You Fit it All in One Visit?

The key here is how important the patient's subjective visual input is to the fitting process. For example, if you're undertaking a multifocal contact lens fitting, then assessing the patient's visual performance is critical to your lens power selection. Dilating the pupil would prevent you from acquiring this vital information in any reliable form. Therefore it makes the most sense to perform the remainder of the health checks at a follow-up visit.

One word of caution when taking this approach: It's important to set up a system that will ensure you actually complete the health exam at a follow-up visit. When we schedule the patient for a return visit, we enter a note in the computer, "and DFE," that prints out with the schedule on the day of follow-up exam.

Meeting the Patient's Needs

If you are confident of the contact lens power and the physical fit of the lens is the primary concern, then consider fitting a lens while the pupil dilates. It's important to prepare the patient by stating, "You'll have slightly blurry vision because your pupils are dilated." Explore the vision in greater detail at the follow-up visit when the patient's eyes are in their natural state.

When unsure about how to proceed, always default to what will most efficiently and effectively meet the patient's needs. This way, you'll always be heading in the right direction. And most often, following the patient's needs means fitting him with lenses while he's in your chair.

Dr. Quinn is in group practice in Athens, Ohio, and has served as a faculty member at The Ohio State University College of Optometry.