editor's perspective
Who Chooses the Prescription?

I've heard many good eyecare practitioners say that they recommend a certain contact lens, for a certain replacement cycle, with a certain lens care system as their customary prescription and treatment for contact lens patients. For example, they will say that Brand X contact lenses have good results in a monthly replacement regimen when cared for with Brand Y solution, because the combination is generally problem-free. These are often leading brands, and the approach is hard to argue with. Modern practices need to be efficacious, consistent, as problem-free as possible and cost effective.

But how many of your patients are the same? How many have the same health history, the same schedule, the same work or leisure habits? We certainly don't know what their corneal oxygen demands are. So why don't practitioners customize treatment plans to each patient? Do practitioners sometimes or most often determine treatment plans according to their perception of patients' price point concerns? Or should we determine what is the best treatment option for each patient and then use that fact to justify the costs?

Just two cases in point include simple myopes who've been wearing low-Dk/t soft contact lenses and sleeping in them occasionally, but think they're doing fine despite the beginning of limbal neovascularization; and allergy patients who can't quite make it through a few weeks of wear with the same pair of lenses despite attempts at more rigorous lens cleaning. Wouldn't the first patient really be better off with a modern higher-Dk/t lens, replaced on a rigid two-week replacement schedule while using modern lens care? Many options exist in this case. Doesn't the second patient deserve daily disposable lenses to minimize the issue of deposit buildup? Numerous options are available in this case as well.

Do astigmatic patients always get a soft toric in your office? What about the benefits of a GP? Do you automatically fit presbyopes with monovision? Or do you consider the benefits of a modern multifocal contact lens or GP alternating bifocal?

We have an inventory of contact lens and lens care treatment options like never before. Sure it's hard to have a fee schedule for every product, and sure it's hard to remain up-to-date and experienced with every product on the market, but getting into a rut by providing so many patients with the same plan that may be best only for so few does not best serve your patients and may not best serve your practice.

I'd like your comments on this topic. Please feel free to contact me at clspectrum@lwwvisioncare.com.