contact lens practice pearls
Incorporating Corneal Molding Into Your Practice
BY THOMAS G. QUINN, OD, MS, FAAO

Molding the cornea in a controlled fashion to correct refractive error is a powerful technique and a great addition to clinical practice. Here's how we put this technology to work in our office.

Introducing CRT

All patients who visit our office for a comprehensive vision examination complete a Patient Visual Needs Assessment Form that asks, among other things:

Are you interested in Corneal Refractive Therapy (wearing a gas permeable lens overnight to gently re-shape the eye, so when removed in the morning, uncorrected vision is clear)?

This introduces Paragon CRT (Paragon Vision Sciences), a relatively unknown corrective option, to patients before the exam. We also educate patients via our office newsletter, Web site and on-hold message system.

Figure 1. CRT often works great on kids.

Sizing Up Candidates

Before discussing CRT as a corrective option, I take a good history and perform a refraction, corneal shape measurement and slit lamp exam. The best CRT candidate has relatively moderate visual demands, a refractive error between ­1.00D and ­4.00D with a moderate corneal curvature, healthy lids, a malleable cornea and a good tear film.

Where will you find such a patient? Plenty exist, but you're most likely to find these characteristics in the younger population. Kids do great with CRT (Figure 1). And parents enjoy that they don't have to worry about how their child is treating his contact lenses when away from their supervision -- children wear CRT devices only when they're asleep at home.

It's a Device, Not a Lens

Note that I called it a CRT "device." This terminology distinguishes these appliances from standard contact lenses. Although it may look similar, I want patients to understand that a CRT device corrects vision in an entirely different way.

Setting Expectations

I tell prospective candidates that it takes about one week for the full CRT effect to take place. In reality, many return after the first night of wear seeing 20/20 following device removal. But, cases exist that require a full week.

I instruct candidates to wear the devices nightly, then tell them that they probably won't suffer any visual ill effects if they miss a night or two once in a while. I further inform them that they need to replace the devices at least annually.

I also tell patients up front that sometimes full correction isn't possible with CRT. Before beginning therapy, we provide patients with a handout outlining our refund policy. (To see a copy, click here to download a pdf version of our handout).* Patients must sign the form acknowledging that they understand the CRT process and refund policy.

Comparing Costs

Before we discuss specific fees, I tell prospective candidates that CRT is about half the cost of laser surgery and is reversible, should the cornea not respond as anticipated. Patients who are considering LASIK but are afraid of the surgery or the cost associated with it find this enticing.

I fit one to two patients each month with CRT and find it a valuable part of my practice. It's sometimes challenging, but always fun and it gives our bottom line a nice boost.

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

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