Continuously evolving contact lens technology is providing practitioners with opportunities to change their patients’ quality of life by offering emerging fitting techniques. As a result of innovations in multifocal, orthokeratology, and scleral lens designs as well as in irregular cornea contact lens strategies, it makes perfect sense to incorporate GP lenses as the foundation of your clinical practice. If you are interested in specializing in contact lenses, this article will discuss the most important aspects in a specialty practice, how and why GP lenses are essential, and where you can turn to for help in both establishing a specialty lens practice and for assistance with achieving expertise with GPs.
WHY SHOULD GP LENSES REPRESENT THE FOUNDATION?
The hallmark or foundation of a specialty lens practice is GP lenses. Although a recent survey reported that about one in nine new fits and refits in the United States are with GP and hybrid lenses,1 we would argue that— for optimum patient care—that value should be much higher. It certainly is in our respective practices.
As mentioned earlier, advances in manufacturing technology have resulted in a number of new lens designs as well as in improvements to current designs, resulting in an increased number of individuals who can benefit from these designs. Specifically, these advancements have led to improvements in lens centration and initial lens comfort.
Patients who have astigmatism have always benefitted from the quality of vision achieved from a spherical GP for low-to-moderate corneal astigmatism (often < 2.50D) or from a bitoric GP for high astigmatism; the latter should always represent a viable alternative to soft toric contact lenses in specialty lens practice. Likewise, new aspheric and segmented/translating multifocal designs represent excellent options for presbyopes desiring good quality of vision at all distances. GPs are most certainly the go-to lens for the contact lens correction of irregular corneas, with sclerals leading the way.2 For ocular surface protection (i.e., Sjögren’s, keratoconjunctivitis sicca, exposure keratitis, etc.), scleral lenses have been life-changing. For practices emphasizing myopia management, orthokeratology is essential. More orthokeratology lens designs are becoming available, and as the area of myopia management is literally exploding, this option is becoming increasingly important as well as an integral component of the myopia management platform in specialty contact lens practice. The good news is that most GP designs—including spherical, bitoric, aspheric multifocal, hybrid, and orthokeratology—can be fit empirically.
WHAT ELSE IS IMPORTANT IN A SPECIALTY CONTACT LENS PRACTICE?
- Passion, Motivation, and Knowledge Success with a specialty lens practice begins with having a true passion for contact lenses, which includes a commitment to a lifetime of learning and to continuous improvement in meeting the needs of a particular patient base. The foundation of any endeavor is a sound, didactic knowledge base. The demand to continually “go back to school” is so important, because the field of specialty lenses—and in particular GPs—is ever-changing in terms of both our knowledge base and technologies. Managing a specialty contact lens practice is a lever that can only be pulled when the knowledge base is there. Just as you cannot practice clinical optometry without attending optometry school, you cannot effectively and profitably run a specialty lens practice without this foundation. It is truly defined by a focus and experience. Just like for a dry eye practice or a glaucoma practice, practitioners of specialty lens practices require a much more in-depth knowledge base complemented by extensive clinical experience. That said, having that passion is made easier by the fact that there is so much to love about contact lenses and how they can change a person’s life. Experiencing this in practice (or in some cases via optometry school or residency training) can inspire an interest in lifelong learning. Certainly, it has for all of us.
- An Understanding that the Treatments Are Practitioner-Driven While patients in a general eyecare practice may ask for a specific brand of colored contact lens, it would be unusual for patients to ask for a front-surface toric scleral contact lens. Because the mass-marketed, mass-produced lenses are highly commoditized, the role of prescribers may diminish in value. However, in the realm of specialty contact lens services, the practitioners’ skill and expertise are front and center—and are more important compared to the brand of the lens. In other words, specialty contact lens patients would attribute success to their physician rather than to the lens brand.
- Willingness to Try Multiple Designs on a Patient Understanding all of the contact lens options available and investigating each lens design’s strengths and weaknesses are essential to having the tools necessary to achieve successful outcomes. This is especially relevant in the area of GP lenses. Leaving one design out of your list of options restricts the possibility of satisfying a patient’s requirements. Nothing replaces the experience of fitting multiple patients into each contact lens design to understand the advantages and disadvantages of each product. If there was one best design, then no other lens design would exist. Understand that it is a patient’s perspective that ultimately identifies success and not the individual lens design.
- Welcome Complex Contact Lens Cases One way to participate in lifelong learning is to welcome complex contact lens cases into your practice. A specialty contact lens practice emphasizes niche contact lens treatments when mass-market treatments fail—and the niche treatments often pertain to GP lenses. There are a number of resources to assist you in managing challenging cases that you have not encountered before (see “Beneficial Resources and Organizations” sidebar on page 24), and you can build your practice on your willingness to fit patients who have either not been fit or have been fit unsuccessfully elsewhere. This is all part of an individual practitioner’s personal commitment to being the best specialty contact lens fitter that he or she can possibly be.
- Consider Specializing Within a Specialty All of us take great pride in having specialty contact lens practices in which we fit a wide variety of complex cases, often via referral from other eyecare practitioners (ECPs). This can include not only fitting high-astigmatic and presbyopic patients but also all forms of irregular cornea/corneal disease, dry eye syndrome, and myopia progression. Just as there are ECPs who specialize in contact lens medical management (e.g., corneal disease, post-surgical, and dry eye) and others who focus on orthokeratology or other forms of managing myopia progression, you can decide to specialize in any of these specific areas. These singularly focused facilities are very different from a specialty lens practice that offers all contact lens options, and often they exist as referral centers.
- Invest in Technology This is very important if you want to comprehensively evaluate patients prior to fitting them and, with the ability to empirically fit most GP lenses today, to optimize the first-fit success. Dry eye technology is booming, and having it is the hallmark of a dry eye center. Corneal topography evaluation is essential to a specialty contact lens practice, and scleral profilometry is becoming increasingly popular in scleral lens fitting practices to both optimize first-fit success and encourage empirical fitting of these designs. When fitting scleral lenses, anterior segment optical coherence tomography has become the gold standard for evaluating settled vault and haptic alignment.
WHERE CAN YOU GO FOR HELP?
General Organizations and Resources There are a number of organizations that deal with various aspects of the contact lens industry that can be invaluable to practitioners.
Organizations Becoming a Fellow of the American Academy of Optometry (AAO) is important. However, becoming a Diplomate in its Cornea, Contact Lenses and Refractive Technologies section is invaluable in the learning process necessary to grow as a specialty lens fitter. Additionally, it is important to interact with the very knowledgeable group of distinguished colleagues who are also Diplomates. Likewise, membership in the American Optometric Association’s (AOA) Contact Lens & Cornea Section can provide practitioners with beneficial resources. The National Keratoconus Foundation (NKCF) also has useful resources to benefit patients and practitioners as well as a list of potential referral practitioners. Finally, the International Keratoconus Academy (IKA) is practitioner-based and has several resources including a blog for ECPs to discuss cases with IKA experts.
Meetings There are several educational meetings, including an increasing number of online symposia, that are beneficial to emerging specialty contact lens specialists. Conferences of note include the Global Specialty Lens Symposium, Optometry’s Meeting from the AOA, the Annual Meeting of the AAO, and the Global Myopia Symposium, among others.
Publications Contact Lens Spectrum and its comprehensive archived article base is a great place to start when trying to learn more about specialty contact lenses. Clinical Manual of Contact Lenses, 5th ed. is a comprehensive text with an emphasis on specialty lens applications. Contemporary Scleral Lenses: Theory and Applications is another text that extensively covers all areas of scleral lens application and care. In addition, most publications offer practitioners the ability to read either the print versions or a digital version on their preferred device.
Interact with Colleagues As contact lens specialists, we are often contacted via email for advice. Sometimes as an emerging specialist, you may even ask to visit a practice. We encourage you to make these efforts, as you will be rewarded by the knowledge learned, guidance provided from those who specialize, and the relationships formed, all of which can be advantageous in the long-term.
Expand Your Specialty Lens Patient Base It is imperative to inform the ECPs (both OD and MD) in your community that you provide specialty contact lens services and also to use social media and an informational brochure to help in promoting these services. The best place to start with specialty contact lens practice may simply be to look at your existing patient base for underserved opportunities in which you can potentially upgrade existing patients into customized contact lens designs. One such example would be refitting a high astigmat who experiences fluctuating vision in mass-produced toric contact lenses into a GP. Once practitioners build sufficient confidence working within their own patient base, they will have the foundation to seek these patients outside of their practice. With momentum, practitioners can increasingly move the direction of the practice toward managing specialty contact lens cases.
GP-Specific Organizations and Resources In addition to the aforementioned resources, the following are beneficial organizations and resources pertaining almost exclusively to GP lenses.
Organizations The GP Lens Institute (GPLI) has a large number of GP resources including video-based programs, calculators, online books, consumer brochures, and a very large archived library on all types of GP lenses and their applications. In addition, almost 3,000 ECPs are listed in its “Find a GP Specialist” resource. The Scleral Lens Education Society (SLS) is an organization that can guide practitioners regarding scleral lenses via resources, webinars, and patient care and handling videos. In addition, several of us have taken advantage of the SLS fellowship program, which also serves the purpose of being an effective referral source. The International Academy of Orthokeratology and Myopia Control focuses on orthokeratology and has both an annual meeting and a fellowship program.
Laboratory Consultants Perhaps the most invaluable GP resource is laboratory consultants. These individuals can assist in every step of the process including lens selection, fitting, and problem-solving. Certainly, any successful contact lens specialist communicates—via online sources, phone, or both—frequently with them on a regular basis because of their extensive experience with their specific GP lens designs. Today, we can easily provide them with corneal topographies, videos, and photos to help consultants make the necessary design changes to optimize success. They can also refer you to beneficial resources on their websites including guides, calculators, and videos.
BENEFICIAL RESOURCES AND ORGANIZATIONS
- GP Lens Institute: www.gpli.info
- Scleral Lens Education Society: www.sclerallens.org
- International Keratoconus Academy: www.keratoconusacademy.com
- National Keratoconus Foundation: www.nkcf.org
- International Academy of Orthokeratology and Myopia Control: https://aaomc.org
- American Academy of Optometry Section on Cornea, Contact Lenses and Refractive Technologies: https://www.aaopt.org/membership/sections-sigs/fellows-sections/section-on-cornea-contact-lenses-and-refractive-technologies
- American Optometric Association Cornea & Contact Lens Section: https://www.aoa.org/practice/specialties/contact-lens-and-cornea?sso=y
- Contact Lens Spectrum: www.clspectrum.com
- Bennett ES, Henry VA. Clinical Manual of Contact Lenses (5th ed.), Philadelphia, Wolters Kluwer, 2020. https://shop.lww.com/Clinical-Manual-of-Contact-Lenses/p/9781496397799
- Barnett M, Johns L. Contemporary Scleral Lenses: Theory and Applications. https://benthambooks.com/book/9781681085661/
- reticule magnifier
- Laboratory Consultants: provide with photos/video and topography if possible
- Website Resources (fitting and problem-solving information, calculators, and videos)
The art and science required for specialty contact lens fitting is more apparent than with routine eye care. It is this intangible that will take patients who have been told by multiple practitioners that they cannot wear contact lenses to success. In the care of such specialists, patients can have a life-changing experience by being able to function when they otherwise could not. More often than not, this change has been the result of some form of GP contact lens. The quality of vision achieved with these lenses alone makes them the foundation of every specialty contact lens practice. CLS
- Nichols JJ, Fisher D. Contact Lenses 2020. Contact Lens Spectrum. 2021 Jan;36:24-29,51.
- Bennett ES. GP and Custom Soft Annual Report 2021. Contact Lens Spectrum. 2021 Oct;36:20-27.Beneficial Resources and OrganizationsOrganizations