Contact Lens Practice Pearls

It’s OK to Prescribe Glasses over Contact Lenses

BY JESSICA H. MATHEW, OD, PHD, FAAO

With new variations of contact lenses becoming available all the time, it’s possible to provide a lens option for almost every conceivable type of patient. Somewhere along the way, practitioners have adopted the idea that patients want to be completely spectacle free all of the time. But is this really the case? Is our goal as eyecare practitioners to simply provide our patients with 20/happy vision? There’s no doubt that a majority of contact lens patients are extremely happy with the vision that their lenses provide. However, certain groups of patients have learned to settle for almost-good vision, which can limit some of their functionality.

Here are some scenarios for which glasses over contact lenses are appropriate and appreciated.

Monovision

Monovision contact lenses work well for many patients most of the time, but there are always situations in which they are less than ideal (for instance, driving at night, complex reading, and certain hobbies). Binocularity and depth perception are typically to blame and can be easily fixed by offering spectacle corrections over the contact lenses for these few occasions.

By correcting the near eye fully for distance or the distance eye for their preferred near activity, additional spectacles can provide patients with better functionality for these specific tasks.

Multifocal

Often, too much add can interfere with distance vision. Subsequently, patients don’t quite get the magnification at near that they really want from their multifocal lenses. Because most patients forego near vision to maintain distance vision, this is the perfect opportunity to offer an additional pair of readers for extended amounts of reading, fine print, or the dreaded low-light conditions. For patients who have a small amount of astigmatism that wasn’t corrected, extra readers that include the astigmatic correction may be especially helpful for near.

Scleral

Scleral contact lenses tend to be used for irregular corneas as they do a great job of masking corneal surface distortions. However, there may sometimes be small amounts of residual astigmatism that the lens cannot correct. But because these lenses typically provide such superior vision in comparison to other types of correction, patients often do not complain about “minor” leftover distortions. Correcting this small amount of astigmatism may be useful for driving, especially at night. For presbyopic patients, who will inevitably require a pair of reading glasses, it makes sense to also include correction for the residual astigmatism. Progressive spectacles also tend to be a great option for scleral lens wearers.

Final Thoughts

Although patients come in asking for contact lenses, practitioners still need to make the appropriate recommendations, even if that means adding a pair of spectacles for improved distance or near vision. Demonstrate the improvement provided by spectacles while patients are in the office, as this will be the selling point. By going the extra step and providing these options, your patients will be satisfied, and you will have created a profitable optical opportunity for your practice. In addition, you are more likely to reduce dropout rates by creating a positive and successful contact lens experience for your patients. CLS

Dr. Mathew is a research assistant professor at the University of Houston College of Optometry. She manages patients who have severe corneal distortions and require specialty contact lenses, and she is also involved in basic science and clinical trial research with The Texas Eye Research and Technology Center and The Ocular Surface Institute. She has received research funding from Allergan, CooperVision, Clearlab, Essilor, Shire, Tearlab, Menicon, and Vistakon. You can reach her at jmathew@optometry.uh.edu.