GP FITTING SUCCESS

Lab Consultants Can Boost Your Success

Utilizing their expertise can help your fitting success and get more patients wearing GP lenses.

By Mary Coupe Bekker

GP lenses can offer many benefits to your patients: crisp vision, durability and good eye health. But to some practitioners, GP lenses also represent more chair time. If this is the case in your practice, it may be time to refine your fitting process.

Lab consultants can be a great resource for helping you find the right lens material, troubleshoot a difficult lens fit and in some cases even fit patients who desperately want to stay in GP lenses.

Here we'll look at the different ways your lab consultants can make your GP fitting more successful and also how working as a team can help you fit more patients in GP lenses.

Are You Prepared?

Fitting more patients in GP lenses may seem like a time-consuming and costly proposition to some. But the lab consultants we spoke with emphasize that the chances for a successful fit improve tremendously based on the initial information they receive from the practice.

Keith Parker of Advanced Vision Technologies, a specialty lab in Golden, Colo., says that sometimes very basic information is missing. Having that information up front can save time and money later.

"First is it a new patient or an existing patient? If it's an existing lens patient, what are they currently wearing and how is it performing? Are they updating a current prescription? How long has the patient worn lenses? All of this information is important," he says.

"We often face situations that are very confusing," says Daniel Bell, president, Corneal Design Corporation. "Practitioners call with a description of a problem that was given to them by an associate who isn't available to speak, or it was given to them by the patient over the phone. Success is based upon good information, and actually seeing the lens on the eye can be a critical part of getting good information."

Examining the lens on the eye is important. "I ask about lid position. The comfort of a GP lens comes from how the lid interacts with that lens. So that's how I decide what diameter I'm going to make the lens," Keith Parker says.

"A key piece of information is what the fluorescein pattern looks like and where the lens is positioning," says Janice Schramm of Valley Contax and president of the Contact Lens Manufacturers Association. The lens might be positioning inferiorly or superiorly. "Did the practitioner check the parameters of the current lens? We don't have a baseline if they didn't verify the parameters. The lens might be positioning inferiorly or superiorly. We will address the specific gravity, which may result in a need to change the center thickness of the lens. Changing the material, in terms of its weight, can also reposition the lens."

She says the company's consultants also ask if the patient has any special needs. For example, if the patient is trying to increase wear time, the consultants address that issue.

Another important detail is whether the lenses are for a post-surgical cornea. With many patients looking to GPs for improved vision after refractive surgery, this information is increasingly important.

Troubleshooting a refit also can be difficult with cryptic information. "Eighty percent of the time a tech calls in the information, and that information is minimal. We get wording very similar to, 'The patient can't see well,' or "Patient is unhappy with vision, please remake,'" Keith Parker says.

"Sometimes we get calls from technicians who've never seen lenses on the eyes, and the doctor is out of the office so he or she can't be reached about the fit. This happens often with chain stores where practitioners work one or two days a week," Daniel Bell says. "The patient will come back when the doctor isn't there and say the lenses don't work. Then the original doctor will call and say 'I didn't actually see the patient, I was off that day.' That means We've lost a fundamental rung in our problem-solving ladder."

Keith Parker suggests making a checklist to use for each call to the lab with details on previous lens wear, current lens wear, etc.

The Right Tools

Keith Parker is a proponent of corneal topography for lens design. He says that while K readings contain only four data points, a topography map contains several thousand.

Some of his clients e-mail their topography results, while others send them by express delivery or regular mail. His lab also has a color fax, and he will supply practices with a color fax machine to avoid trying to decipher the black and white faxes of scans he sometimes still receives.

While some practitioners are still hesitant to take the time to use corneal topography, he stresses that it will save time in the long run. "The machine does nothing for you if you don't use it," he says. "It delivers a tremendous amount of information. A picture is worth 1,000 words. It's definitely better than three office visits."

Good exam information is important to a successful fit, and sometimes practitioners miss the basics in this process. "I would suggest that practitioners obtain recent K readings using equipment that has been calibrated at some point in time," Daniel Bell says. "Very often we see one practice that is consistently off in design success, and we can trace that problem to a lack of instrument maintenance."

Calibrating keratometers and all of your equipment is an easy way to prevent fitting mistakes. He also points out that if your basic information is incorrect, the inaccuracies compound until it's very difficult to discover the true fitting problem.

Using Their Expertise

Lab consultants are a valuable resource when choosing designs and materials. Daniel Bell says that at least 50 percent to 75 percent of calls to his lab concern toric, multifocal and keratoconus fits. His lab even gets calls about soft lenses, at which point he refers the caller to the manufacturer.

"Material selection is in some cases determined by the practitioner and is sometimes left to the lab consultant to decide," Keith Parker says. "I try to recommend a material that I trust is stable for the type of prescription needed. For example, if the prescription is a toric design, stability of the plastic is quite important. If it's for a keratoconus or traumatized cornea of some kind, a high-oxygen material is of importance. I try to always recommend to practitioners to upgrade the GP material into a more advanced plastic."

"Many practitioners look at Dk as a very important ingredient in a successful fit. I feel that the use of higher-Dk materials is necessary but greatly overstated," Daniel Bell says. "Most patients are healthy and happy with very wettable mid-range Dk materials that are properly fit."

Consultants also can offer advice on how many lenses to order.

"Most practitioners feel comfortable ordering replacement lenses that the patient has previously worn successfully on a per lens, non-warranted basis," Keith Parker says. "For new prescription patients, meaning the first time the patient is being fit at their office, the security of a warranted lens is more logical and common.

"I recommend per case warranty plans on new orders for new patients and on all multifocal, post-surgical and keratoconus lens orders due to the complexity of these designs," he adds.

"For proficient fitters, I recommend a lens bank that is non-warranted," Daniel Bell says. "It's the least expensive option and is a reward for knowing how to fit specialty lenses. They can maintain a small trial lens set with the lenses that they don't need or simply throw them away. Warranted lenses have become more expensive in the past few years and they may be necessary for the more complicated designs. Manufacturing has improved to the point that a trial lens set can save thousands of dollars each year for a typical practice."

Adaptation Advice

Of course, all the consultants' expertise is wasted if patients aren't interested in GPs. Patients see advertising for soft contact lenses in many different mediums, but it's up to practitioners to discuss GP lenses.

"One of the selling points for us is that GPs get more comfortable as time goes on," Janice Schramm says. "A soft lens gets more uncomfortable the longer a patient wears it." She adds, "The presentation for GPs is key. If practitioners use words like hurt, rigid, hard or uncomfortable, it's more than likely that patients will sense that they're not 100 percent in favor of fitting gas perms."

Education is part of the process. Keith Parker says that when a patient comes in wanting soft lenses but is a good candidate for GPs, practitioners should present the option, stressing better vision and fewer complications. "Talk about the benefits, but mention that initial comfort isn't one of them."

Daniel Bell advises practitioners to tell patients, "Yes, you will feel GPs in your eyes for a few days. Then that will go away and you'll find that you don't even notice the lenses are there." He adds, "A confident statement from a trusted professional will do more for the patient than any other advice. Patients sense apprehension on the part of the fitter and reflect that opinion on the first return visit. If the practitioner is confident, the patient will work with the lens to achieve success. Without trust and confidence in the first recommendation, we usually find a rapid search for another option and a decline in patient confidence that results in failure."

A topical anesthetic also helps the adaptation process for fitter and patient, Keith Parker says. An anesthetic helps fitters assess the fit better because it reduces patient tearing. He also advises patients to shut their eyes initially, because the awareness comes from the upper lid reacting to the lens. When the patient's eyes are open, he asks them to look down at first to ease the transition.

If a patient is complaining a lot, he suggests taking out the lens and putting in an eye drop. "Don't make the patient struggle," he says. He adds that 99 percent of the time when the lens is reapplied the patient says it feels better.

Another way to increase initial comfort is to use plasma-treated lenses. "Laboratories are beginning to use plasma treatment, which will create the comfort initially," Janice Schramm says.

"Plasma treatment should be considered an advantage to offer to the practitioner for any new lens sold," Daniel Bell says. "The treatment may not last forever but it can help to support the necessary transition into a new lens. Be careful not to believe all of the marketing that surrounds this treatment."

By finding ways to ease the adaptation period, practitioners can focus more on GPs' benefits. "The best thing We've got going for us is the safety issue," he says. "In a study done at Johns Hopkins in 2004, of all the vision correction options GPs were the safest."

Crisp vision for wearers who may have struggled in soft lenses is another bonus. Daniel Bell, who fits patients in his lab near Washington, D.C., says that the economy of GPs is also a surprise to some.

"Parents are especially shocked to find that their child can take care of lenses at a much, much lower cost than that of their own lenses," he says. "We've had a few instances in which the parents became GP wearers after their kids starting wearing them."

With many patients interested in the environment and conservation, they may also be interested in the less-disposable aspects of GP lenses. He points out that if all the packaging from the annual use of soft disposable lenses was combined in one place, we would have 159,388,646 pounds of plastic foil covering 15 acres of area. GP use would cut that waste to under 75,000 pounds.

Economics of GPs

While some say GPs are too costly to fit because of time and refits, the consultants we spoke with have seen practice-boosting results with GP fitters.

Daniel Bell mentions one practitioner who worried when a warehouse discount club moved into his small town. He feared losing all his patients to the store's discount optical. Many of his patients wore GPs, and when they visited the new optical they found that the chain didn't want to bother with GPs, so they faced higher costs and poor fits. The practitioner didn't lose one patient, Bell says, and in fact added patients because of good service and expertise.

"Some of the students coming out of optometry schools don't feel compelled to fit GPs," Janice Schramm says. "However, those seeking to apply their knowledge and skills will find their profitable niche in fitting specialty GP lenses."

"The economics of GP lenses and the relative safety of the product are under-appreciated in the industry," Daniel Bell says. And while there's still apprehension from patients and practitioners, he's encouraged by the growth in orthokeratology.

"GP lenses will show continued growth in multifocal sales as practitioners accept the fact that patients are willing to try new products to improve their quality of vision," he says.

Focusing on Teamwork

Some labs, like Daniel Bell's, will fit difficult patients and then send them back to their practitioner for follow-up. The benefits of fitting patients who may have given up hope for normal vision goes beyond monetary measures.

He talks about fitting a boy in bitoric lenses while the boys' parents cried with happiness that their son would be able to participate in everyday childhood activities. "It's a great thing to be able to do," he says. "I feel it's more than just getting paid to make lenses. It's a gratifying part of my job."

Working together on difficult cases is just one way practitioners can work as a team with the labs to benefit their patients and practices. Lab consultants also are tireless proponents of GP lenses, and utilizing their expertise will help create loyal GP wearers and will ultimately boost your practice. CLS

To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #139.