Contact Lens Practice Pearls

Don't Shy Away From Patients Who Have Failed Elsewhere

By John Mark Jackson, OD, MS, FAAO

In my contact lens course last week, I was discussing with my students the finer points of doing a contact lens pre-fitting exam. As with most types of exams, a good patient history helps tremendously. One thing I told them to be wary of was a patient who has been to numerous clinicians for contact lenses, yet was not satisfied with any of the results. Such patients, I said, were not likely to be satisfied by them, either.

But the more I thought about it, the more I realized that sometimes this just isn't true. I got to thinking about numerous patients over the years who were in this category, and we were able to find a solution for them. Often, it just takes a little bit of troubleshooting, creative thinking, and willingness to try new designs and technology.

A Few Examples

Case #1 A 50-year-old man had tried soft multifocals but had not been successful with them. He had gone to several clinicians who had used somewhat outdated lens designs. A few had even tried to refit him in the same lens with altered parameters when it clearly wasn't working. We fit him with a more modern silicone hydrogel multifocal lens design that provided him with very good distance and near vision.

Case #2 A 35-year-old woman suffered from dryness when wearing her soft lenses. Previous clinicians had tried different materials and lens care solutions, but had not really addressed the dry eye itself, as she had very mild symptoms when she wasn't wearing her lenses. We treated her meibomian gland dysfunction, and she was then able to wear her lenses for most of the day.

Case #3 A 30-year-old man who had keratoconus was referred to us by a surgeon for one more try with contact lenses before having a corneal transplant. He had tried standard corneal GP lenses, but he had problems with comfort and lens ejection, which led him to the surgical consult. We fit him with a scleral lens, which resolved both of his complaints, and he avoided the transplant for a few more years.

Case #4 A 24-year-old woman presented with more than −4.00DC of astigmatism. She had tried both soft torics and GP lenses, including a bitoric lens. She loved the vision with the GP lenses, but could never adapt. We fit her with a hybrid contact lens that gave her great vision and good comfort.

Case #5 A 32-year-old woman had dryness issues that we couldn't fully resolve with treatment, but she still wanted to avoid wearing her glasses. We treated her with orthokeratology, which provided her with clear vision throughout the day but eliminated daytime lens dryness.

Take up the Challenge

These kinds of cases can be challenging, fun, and practice-building. As I said, getting a thorough history of what the patient has tried before is extremely valuable. Don't keep offering the same types of contact lenses in the hope that they will somehow work. Albert Einstein said that insanity is doing the same thing over and over again and expecting different results. Do some creative thinking and it's likely you will find something to meet the patient's needs. CLS

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Dr. Jackson is an associate professor at Southern College of Optometry where he works in the Advanced Contact Lens Service, teaches courses in contact lenses, and performs clinical research. You can reach him at jjackson@sco.edu.