WHAT DO PLAYING tennis and contact lens fitting have in common? While seemingly unrelated, both activities utilize core principles coupled with mental resilience to achieve success.

What makes specialty contact lenses unique is not solely the nature of the lenses themselves. Using specialty lenses to their fullest potential is also an exercise in mental preparedness and strategy by practitioners.

For most practitioners, the reluctance to prescribe these unique contact lenses is often caused by the misnomer “specialty.” It has inadvertently become a roadblock for some, translating to “technically challenging” or “time-consuming.” In a survey of contact lens practitioners in the U.K., GP lens fitting was reported to be declining because most respondents believed that it inherently took additional chair time and required more advanced technical skills compared to fitting conventional soft contact lenses (Gill et al, 2010).

Clinicians should not be deterred merely because specialty lenses seem “remote” or “impractical” for their practices. With the right mindset and preparation, these lenses can become every practitioner’s forte, accelerating their practices to an unprecedented level.

While specialty lenses are yet to become a mainstay, the fitting process and user experience have changed remarkably. They no longer rely on monolithic factors or rules. Recently, the algorithm-guided fitting approach has largely done away with trial-and-error methods. The enhanced precision and validity during the lens design process also eases practitioners’ uncertainty about lens selection and helps make the process more cost-effective.

The mentality of excelling in the specialty lens field involves more than clinical acumen alone. Indeed, a practitioner’s indecisiveness surrounding the initial investment, which instrumentation to invest in, or when the return on investment will be met is often a symptom of the belief that one must “know everything.” This is often termed “bounded rationality” (i.e., our rationality is limited by our thinking capacity, the information that is available to us, and time) (Smith et al, 2020). When practitioners assume that knowing everything is a prerequisite for starting a specialty lens practice, they are falling prey to bounded rationality and unable to make decisions, and ultimately end up with no decision at all.

Innovation has helped us overcome the dilemma of bounded rationality. For instance, corneal characteristics measured by Placido-based corneal topography can offer more than just two-dimensional contours; data have shown that it can also be directly associated with the sagittal height in healthy eyes (Bandlitz et al, 2022).

Optical coherence tomography has gained importance and versatility in terms of assessing vault thickness and tear reservoir for scleral lens fitting (Valdes et al, 2022). To optimize scleral lens performance, it was found that unique limbal and scleral contours are often asymmetrical and can directly influence lens design and treatment outcomes (Fadel, 2018).

For the latest paradigm shift in orthokeratology lens technology, the classic well-centered “bull’s-eye” appearance merits second thoughts. Decentration of the treatment zone was found to be associated with a larger summation of the relative corneal refractive power profile, which in turn helps slow axial length elongation (Lin et al, 2022). In addition, among post-orthokeratology patients, correlations were observed between quadrant-specific corneal epithelial thickness variations and annual axial length changes (Kuo et al, 2022). This may be used as a novel guide for treatment prognosis in myopia management.

Just as elite athletes incorporate the power of creativity and mental resilience in their games, clinicians are urged to stay creative and mentally agile regarding the nuances of specialty lenses. Boldness and adaptability in this realm can help overcome the “know-it-all” stigma and help the practice reach a clinical oasis. CLS

References

1. Gill FR, Murphy PJ, Purslow C. A survey of UK practitioner attitudes to the fitting of rigid gas permeable lenses. Ophthal Physiol Opt. 2010 Nov;30:731-739.
2. Smith C, Babich C, Lubrick M. Leadership and Management in Learning Organizations. 2020 Sept. Available at ecampusontario.pressbooks.pub/educationleadershipmanagement . Accessed June 14, 2023.
3. Bandlitz S, Lagodny M, Kurz C, Wolffsohn JS. Prediction of anterior ocular surface sagittal heights using Placido-based corneal topography in healthy eyes. Ophthalmic Physiol Opt. 2022 Sep;42:1023-1031.
4. Valdes G, Romaguera M, Serramito M, Cerviño A, Gonzalo Carracedo G. OCT applications in contact lens fitting. Cont Lens Anterior Eye. 2022 Aug;45:101540.
5. Fadel D. The influence of limbal and scleral shape on scleral lens design. Cont Lens Anterior Eye. 2018 Aug;41:321-328.
6. Lin W, Gu T, Bi H, Du B, Zhang B, Wei R. The treatment zone decentration and corneal refractive profile changes in children undergoing orthokeratology treatment. BMC Ophthalmol. 2022 Apr;22:177.
7. Kuo YK, Chen YT, Chen HM, et al. Efficacy of Myopia Control and Distribution of Corneal Epithelial Thickness in Children Treated with Orthokeratology Assessed Using Optical Coherence Tomography. J Pers Med. 2022 Feb;12:278.