Contact considerations: Choosing the right lens

Excerpted from page 46 March 2017 edition of AOA Focus.

Ease versus safety. Routine versus comfort. Cost versus convenience. These are patients' perceived trade-offs from monthly to daily contact lenses, but in reality, such concessions are only a matter of perspective.  

Although daily disposables have clear health and safety benefits, only about 30% of new contact lens patients wear dailies. Compare that to the 30% of patients wearing two-week disposables and nearly 40% wearing monthlies, and it's clear that there are a number of factors influencing patients' lens choices—not just the health and safety recommendations from their doctors.  

This past Optometry's Meeting ^® in Boston offered members of the AOA Contact Lens and Cornea Section (CLCS) Council an opportunity to initiate a round-table discussion on a range of topics related to the monthly contact lens modality for patients. Their detailed conversation is captured in a new supplement titled, "Through the Lens: Perspectives on Monthly Contact Lens Modalities," sponsored by Johnson & Johnson Vision Care, Inc.

Helping patients choose the best contact lens modality for their individual needs is part of an informed discussion with their doctor of optometry, and below are several points highlighted within the supplement that can aid that conversation.  

4 tips and considerations for discussing contact lenses  

1. Always be patient focused. Approach every patient with an attitude of "what's best for this particular patient?" says ThomasQuinn, O.D., past CLCS chair. Patients have different needs, lifestyle requirements and financial concerns, so it's important that doctors have an array of options available because no two people are alike.  
   
   "We can have a recommendation, but we always need to have a plan B, in case our initial recommendation isn't a good fit for that given patient's solution," Dr. Quinn notes.   
   
   Practitioners shouldn't hesitate to discuss other lens options with patients, otherwise the patient might never be the wiser.  
   
   "It looks good in that patient's eyes when you're actively trying to talk to them about different options and trying to help them," says Jeffrey Sonsino, O.D., CLCS chair. "The patient will say, 'That doctor is trying to fight for me.'"  
   
   And once you do have a clear understanding of that patient's needs, confidently recommend the best treatment, Dr. Quinn says.
    
2. Convince creatures of habit. In some cases, neither the newest lens materials nor the most compelling arguments can convince a patient to break routine and try a new contact lens. These monthly wearers are used to the convenience of wearing lenses all day, every day, and exchanging them on the first of the month. These are often the hardest patients to convert to dailies or weeklies, but that doesn't mean you can't make suggestions. Dr. Sonsino presents the benefits of daily disposables and often sends patients home with a strip of dailies to experience the comfort and convenience.  
   
   
3. Change up your delivery. "How are your contacts?" is a benign enough question to ask your contact lens patient, but it usually draws the same, insipid response: "fine."  
   
   But is it?  
   
   Dr. Quinn encourages doctors to dig a little during questioning as many patients are reluctant to "complain" about fit. Pamela Lowe, O.D., CLCS Council member, suggests trying a more open-ended question, such as, "How long are your lenses in before you feel them?"
   
   Patients who are truly fine might be confused by this question; however, if that patient can pinpoint a time of day when discomfort sets in, then you have a starting point. Dr. Sonsino has a more pointed technique: "the powerful pause."  
   
   If a patient answers with "fine," then ask, "really?" and pause. Silence gives way to the real answer, Dr. Sonsino says.
   
   4. Read the room. When discussing contact lens options with patients, get a feel for areas of need, including their familiarity with proper hygiene or propensity for bad habits. The patient who rubs his or her eyelids to increase tear production or frequently used the mouth to rewet likely needs a refresher on the do's and don'ts of contact lens wear, in addition to a conversation about lens options.  
   
   Jeffrey Walline, O.D., Ph.D., CLCS Council member, points out that one Johnson & Johnson Vision Care, Inc. survey found that over two-thirds of monthly wearers experienced comfort-related issues, and of those with problems, 84% either remove, clean and replace their lenses; take a break during the day; or use rewetting drops. However, three-fourths weren't planning on telling their eye care provider.  
   
   "I think every contact lens prescriber needs to do a better job of educating patients on best practices, things that we all know," Dr. Sonsino says.