The concept of lifestyle dispensing in eye care practices is not new. It is a tactic you can use to identify a patient's occupational and visual needs, and then offer the best options and materials to meet those needs. Most eye care professionals will agree these techniques can help boost sales and profits while delivering real lens benefits. Lifestyle dispensing helps to build patient loyalty too.

As an eye care professional, it is important to consider a variety of factors when recommending the right contact lens to your patients. Asking your patient questions such as whether or not he or she has an active lifestyle, works long hours, or even considering a patient’s age are all part of the contact lens selection process.

Your patients may want to become more involved in the process as well. So how do you take all of these factors into consideration and relay that information clearly to your patients? Here are some lifestyle questions that can help:

Does your patient have special needs?

First, make sure that you tell your eye care patients about their special needs. Does your patient have astigmatism? Is your patient a candidate for multifocal lenses? Since these special needs require special lenses such as toric lenses or multifocal lenses, having your patient understand what their needs are will help you guide them to the right contact lenses. CooperVision has a great YouTube channel resource that can help your patients learn more about astigmatism, presbyopia, and multifocal lenses if they want to learn more about their special needs.

What are your patient’s lifestyle habits?

Learning about how your patient spends a typical day, how long your patient expects to wear contact lenses through the course of the day, or even lifestyle activities can help you recommend a contact lens that is a good fit for your patient. For example, if you learn that a patient may occasionally sleep with his or her contact lenses in, then your recommendation may differ from a patient who will remove the lenses daily before bed. Once your patient has had his or her eye exam, having your patient take this Find A Lens quiz can also help with the contact lens selection process.

Daily disposable lenses have many advantages over other contact lens modalities. Whether its ocular health, convenience, or compliance, there are a variety of reasons that eye care professionals should consider making daily disposable contact lenses an integral part of their practice. Are you ready to embrace this growing modality in your practice?

CooperVision will hold a webinar on making daily disposables a significant part of your practice on March 27, 2013 at 9:00 PM (EST).

This webinar, hosted by Dr. Keith Wan, offers clear and practical advice on how to make daily disposables a big part of your contact lens practice.

Dr. Wan will talk about:

• Advantages of 1 Days for Patients
• Trends in Market Share & Growth and How to Leverage These in your Eye Care Practice
• Patient Compliance with 1 Days vs. Other Modalities
• Talking Points On Financial Concerns of Patients About 1 Days
• The Growing Popularity of the 1 Day Modality

Click here to register!

Dr. Keith Wan specializes in fitting contact lenses and medically indicated contact lenses for conditions such as keratoconus, high myopia, and anisometropia. Dr. Wan is board certified in the treatment of ocular disease, such as glaucoma and diabetic retinopathy. Therapeutic privileges are utilized with the ability to prescribe topical steroids, glaucoma, and systemic medications. He also participates in laser refractive surgery co-management and post refractive surgical care for patients. Dr. Wan was named America's Top Optometrist for 2006 and 2007 by the Consumers Research Council of America.

As an eye doctor, you care about your patient’s eye health. One important factor to consider when you have a patient in the chair is whether to sell a patient an annual supply of contact lenses. Selling your contact lens patients an annual supply is not only convenient, it can save them money, help keep them compliant, and is a great way for you to build your practice too.

Some of the benefits of selling an annual supply of contact lenses to your patients are:

Setting up patients to remember their annual eye exam

When you offer your patients the option to purchase an annual supply of contact lenses, you are giving your patient a chance to plan out their next eye exam. It is simple. Once the patient runs out of contact lenses, they can come back to your practice for an annual eye exam and get their next annual supply.

Saves your practice time:

By selling your patients an annual supply of contact lenses, you save your staff the hassle of having to take the time to dispense a partial order midyear. It also saves shipping costs too.

Increases revenue and cash flow:

When you sell an annual supply, you increase cash flow at once because you are collecting revenue in one complete transaction instead of delaying part of the sale.

Helps keep patients compliant:

When patients have an annual supply, they are more likely to be compliant with sticking to their replacement schedules.

These are just a few reasons why selling an annual supply of contact lenses is good for both your patient and your practice. If you are looking for more resources to help you and your practice, make sure to visit our Build Your Practice section on our site.

By Desmond Fonn

Introduction

Patients with refractive astigmatism who would rather wear contact lenses than spectacles should be fitted with toric soft lenses. This is a sweeping statement as some would argue that for visual reasons spherical rigid gas permeable (RGP) lenses will correct astigmatism resulting in visual acuity that would closely match their vision with spectacle lenses.

The argument is flawed if the refractive astigmatism is not all corneal, resulting in residual astigmatism induced by the RGP lens. Plus, there is always approximately 10% residual of the corneal astigmatism with a spherical RGP lens, but it is dependent on the refractive index of the RGP lens material. The range of astigmatism that I am referring to is 0.75 – 3.00D, and if vertexed to the corneal plane might be closer to 2.75D.

The reason for my bold statement is that the current inventory of toric soft contact lens designs would cater for that power range and manufacturing capability is so good that practitioners and patients can be assured of a predictable correction. There is little doubt as well about the vastly superior comfort of soft lenses [1]. In the low astigmatic range, masking of astigmatism with spherical soft lenses does not provide the level of vision of toric soft lenses [2-4], and the visual performance with aspheric lenses is also worse than soft toric lenses. [5]

Prevalence of Astigmatism

In an Australian study of 179 patients in the 1970s, Holden reported that 45% of the prospective contact lens patients exhibited 0.75 D or more of astigmatism and if the astigmatism of 1.00D or greater was corrected, 35% of the patients would require toric lenses but only 25% of the cohort exhibited 1.25 D or more.[6]

Young et al’s paper on the prevalence of astigmatism in relation to soft lens fitting included a summary table of 8 papers and showed that in a large age range, the prevalence ranged from 16 - 45% with astigmatism of 0.75 D or greater. [7] Young et al worked from a database of 11,624 patients (age range 8 to 70 years) and the prevalence of astigmatism of 0.75D group was 24.1% and 1.00 D or greater in both eyes was 15.0%.

The prevalence of astigmatism of 0.75 D or greater in myopes was almost twice that of hyperopes and the prevalence of with-the-rule (WTR) astigmatism was higher than against-the-rule (32.9% vs. 29.1%). Their summary showed approximately 33% of potential contact lens wearers require astigmatic correction based on the spectacle prescription from the database.

Cho et al’s paper on spherical and toric daily disposable lenses for low astigmatic corrections included a prevalence of astigmatism summary of 4 papers [9-12]. They wrote 46 to 63% of adults had astigmatism, but the percentage was dependent on the magnitude used as the threshold.

Percentage of the correctable population fitted with toric lenses

Quite appropriately the number and percentage of patients wearing toric lenses has grown quite substantially.

Here are some examples: In 1991, Pearson estimated that only 9% of all soft lens fits in the UK were soft torics [8]. Morgan et al reported that the proportion of toric soft lenses prescribed has grown from approximately 12% to 30% [13,14], and the trends in North America are very similar, perhaps as high as 38% [15,16]. Efron has stated that toric soft lenses now represent over 35% of all soft lenses prescribed, but this survey was restricted to seven countries with the exception of Japan where the percentage there is considerably lower.

Lens designs that stabilize the axis/orientation on the eye

The diameter and posterior surface shape or base curve of toric soft lenses are very similar to spherical lens dimensions, but the thickness profile will be substantially different in order to position the correcting cylinder in the correct meridian and to maintain it in that position. The methods include prism “ballast”, periballast, eccentric lenticulation, back-surface toricity, thin/thick zones, and various combinations of these designs.

Most of the recent design developments have incorporated the latter thickness differential designs, where the top and bottom lids govern the orientation of the lens and therefore the astigmatic correction and they seem to be working very well. In a study recently conducted at the CCLR (data on file), more than 60% of the silicone hydrogel toric lenses dispensed (three currently marketed toric silicone hydrogel lenses) had the same axis as the manifest spectacle correction and the axis of the remainder were within 10 degrees of the spectacle correction.

Reorientation or recovery refers to the toric lens’ ability to speedily relocate to the proper axis after the axis is misaligned, for example when physically misaligning the lens.

A number of terms to have been used to describe the lens recovery performance e.g., “reorientation speed”, or “rotational recovery”, Young et al. used “lens reorientation” to determine whether gravity affects the lens orientation or axis mis-location.

They found that the three prism-ballast design lenses rotated away from their baseline position “significantly more” than the accelerated stabilization lens design [18] and concluded that gravity does affect prism ballasted or peri-ballasted lenses rather than the thin/thick zone lenses when patients adopted a recumbent position. The four lens designs showed similar re-orientation speeds.

Fitting toric lenses

On the basis that inventory toric lenses will be used, the majority of practitioners’ inventory will be less than the 3000 lenses that Young has suggested will be needed for 90% of patients but this method of fitting and prescribing is the best. Even if the exact prescription isn’t within stock, a close approximation will with a high degree of certainty, confirm the lens that is required. The three elements that are necessary to fulfill the correct prescription, assuming that the lens fits symmetrically and centrally over the cornea without excessive movement, are:

• 1. The refractive correction at the corneal plane
• 2. The degree of rotation (if any) of the lens
• 3. The rotational stability of the lens

If the refractive correction is known, the only function of the trial lens should be to ascertain if it fits correctly and to measure the amount of rotation of the lens and to compensate for the rotation when determining the final prescription. There are numerous texts and descriptive papers on when and how an over-refraction should be conducted, but that should not be necessary with the method that I have described.

Summary

As the average thickness of toric lenses is influenced by the by prism ballast or periballast and therefore increased thickness in parts of the lens, the oxygen transmissibility may be compromised and this will almost always be negated by the use of silicone hydrogel materials.

As silicone hydrogels,as a category, represent at least 60% of prescribed soft lenses there is every reason to believe that the same statistic applies to toric soft lenses. Fitting and prescribing should no longer be considered as specialty lenses except for those prescriptions that require custom designs.

As toric silicone hydrogel lenses are more expensive than spherical lenses practitioners should guard against non-compliance of exceeding the manufacturers recommended replacement frequency as this habit has been demonstrated in two studies [19,20].

References

1.      Fonn D, Gauthier CA, Pritchard N.Patient preferences and comparative ocular responses to rigid and soft contactlenses. Optom Vis Sci 1995; 72:857-863

2.      Snyder C, Talley DK: Masking of astigmatism withselected spherical soft contact lenses. J Am Optom Assoc 1989; 60:728-31.

3.       Richdale K,Bersten D, Mack K et al. Visual Acuity with Spherical and Toric Soft Contact Lenses in Low- to Moderate-Astigmatic Eyes. OptomVis Sci 2007; 84: 969-75.

4.       Cho P, Cheung SW, Charm J. Visualoutcome of Soflens Daily Disposable and Soflens Daily Disposable forAstigmatism in subjects with low astigmatism. Clin Exp Optom. 2012; 95: 43–47.

5.       Morgan PB,Efron SE, Efron N, Hill EA: Inefficacy of aspheric soft contact lenses for thecorrection of low levels of astigmatism. Optom Vis Sci 2005; 82: 823-8.

6.      Holden BA. The principles and practiceof correcting astigmatism with soft contact lenses.Aust J Optom 1975;58: 279–99.

7.      Young G, Sully A, Hunt C. Prevalenceof astigmatism in relation to soft contact lens fitting. Eye Contact Lens2011;37: 20 -25

8.      Pearson R. Contact lens trends in the UnitedKingdom in 1991. J Brit Contact Lens Assoc 1992; 15:17 - 23.9.      Anstice J. Astigmatism–its componentsand their changes with age. Am J Optom Arch Am Acad Optom 1971; 48: 1001–1006.

10.  Fledelius HC, Stubgaard M. Changes inrefraction and corneal curvature during growth and adult life. Across-sectional study. Acta Ophthalmol Copenh 1986; 64: 487–491.

11.  Satterfield DS. Prevalence andvariation of astigmatism in a military population. J Am Optom Assoc 1989;60: 14–18

12.  Read SA, Collins MJ, Carney LG. Areview of astigmatism and its possible genesis. Clin Exp Optom 2007; 90:5–19.

13.  Morgan PB, Efron N. Prescribing softcontact lenses for astigmatism. Cont Lens Ant Eye 2009;32: 97–98.

14.  Morgan P. Trends in UK contact lensprescribing 2010. Optician 2010; 239: 34–35.

15.  Barr JT. Contact lenses 2001. ContLens Spectrum 2002; 17:22–28.

16.  Nichols JJ. Contact lenses 2009. ContLens Spectrum 2010; 25:20–27.

17.  Efron N, Morgan P, Helland M et al.Soft toric contact lens prescribing in different countries. Contact Lens & Anterior Eye. 2011; 34: 36–38

18.   Young G, McIlraith R, Hunt C. Clinical Evaluation of Factors Affecting SoftToric Lens Orientation Optom Vis Sci 2009;86: E1259- E1266

19.  Richter D, Dumbleton K, Guthrie S, Woods C, JonesL, Fonn D: Patient and practitioner compliance with silicone hydrogel and dailydisposable lens replacement in Canada. Can J Optom 2010;72: 10-19

20.  Dumbleton K, Woods C, Jones L, Fonn D: Comfort andvision with silicone hydrogel lenses: Effects of compliance. Optom VisSci 2010; 

As an eye care professional, you know that not all patients are the same with the same needs. Some patients may need a little extra time when it comes to fitting them with the right contact lenses. These include patients who have astigmatism that may need to be fit with toric contact lenses. As a world leader of toric contact lenses, CooperVision has the products and the expertise to help you successfully fit toric lenses.

Here are some helpful tips that you can use when you want to fit toric contact lenses:

Ask yourself the right questions:

• Is this patient a candidate for toric soft contact lenses?
• What material best meets the patient's vision and lifestyle needs?
• Which lens is available for the parameters that are necessary to fit the patient?

Make sure that you know what tools are available to you.

CooperVision offers a variety of support when it comes to fitting toric contact lenses. In fact, we have an entire section devoted to you on our practitioner website that gives you easy access to a variety of helpful toric fitting information, including procedures for diagnostic and empirical fitting, helpful case studies, and much more.

Use the fitting guides offered by contact lens manufacturers.

It is essential to fit your patient correctly with a toric contact lens if you want a successful practice. So why not use the tools offered to you by contact lens manufacturers that can help you do that? CooperVision offers a great tool called the ToriTrak Calculator that is the most accurate method of fitting our toric contact lenses and is designed to eliminate errors in estimating lens rotation.

No matter what your fitting needs may be, CooperVision is able to provide you with the tools to fit your toric patients.

The holiday season is in full swing, and as an eye doctor with a practice to maintain, you may be wondering how to use social media without getting lost in the holiday shuffle. Here are some tips on how to use social media during the holidays that any eye care practice can easily pull off:

• Write social media content in advance: This is a piece of advice that will get any eyecare practice through the holidays. Since employees are going to want to take time off, may get busy with other tasks in the office during the season, or just may have writer’s block, stocking up on future posts is always a good way to just ensure that your social media pages are still active and engaged with patients. As you write these posts, make sure they are relevant for the holiday season and optimized (for example use helpful hashtags in Twitter)
• Make sure your content is engaging: Writing content that is worth reading and sharing with patients is essential. During the holiday season, patients will want to know important things such as spending their FSA dollars before the year’s end, how to look good for holiday parties, driving at night, and other relevant eye related information. The more engaging your content is, the more likely a patient will share that content with their own friends and family.
• Showcase your practice’s charitable side: The holidays are all about giving, so why not show how your eyecare practice gives back? It allows patients to see how your practice is invested in the local or even global community. From doing a food drive, to volunteering in a soup kitchen with your staff, there are so many ways for your eye care practice to get involved.
• Offer exclusive deals: Reward your fans and followers with an exclusive offer that only they can redeem. This tip works year round, but holiday deals are a great way to get patients excited about coming to your eye care practice.

These tips should help your practice on how to use social media for holidays. For more great tips on how to create a web presence with your practice, make sure to read CooperVision’s CV+ blog.

November is American Diabetes Month. A lot of diabetic eye conditions do not have early warning signs, so it helps to be aware of what can affect a diabetic patient. However, with early detection and treatment with an eye doctor, diabetic eye patients can control diabetic eye disease. But what eye conditions can affect diabetic patients? Here is a helpful list that patients can look over and discuss with their eye doctor:

Diabetic Retinopathy

Diabetic retinopathy is a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina. In some patients with diabetic retinopathy, retinal blood vessels may swell and leak fluid. In others, abnormal new blood vessels grow on the surface of the retina. Both can lead to vision loss or blindness.

Glaucoma

Glaucoma is an increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. It is sometimes referred to as the "sneak thief of sight" as there are generally no symptoms or warning signals in the early stages of the disease. Annual eye exams are important for adults as they may help detect diseases such as glaucoma and diabetes in the early stages.

Cataracts

A cataract is when the lens of the eye becomes cloudy. It typically occurs in aging patients, but cataracts can occur in patients after an eye trauma, eye surgery, or even exposure to some types of radiation. One of the major risk factors is diabetes. Diabetic patients should have an eye exam by an eye doctor if they have symptoms like cloudy or blurry vision, colors that look dull, double vision, glare, or poor night vision.

How often do you replace your contact lenses? Your replacement schedule is the length of time your contact lenses can be worn before they need to be replaced with new lenses. Do you know what replacement schedule your eye doctor recommended for you? Typically an eye doctor prescribes a specific contact lens replacement schedule based on lifestyle and vision correction needs. As we have written about in a previous post, there are different replacement schedule options that you can discuss with your eye doctor.

However, no matter that your replacement schedule is, it is important for you to be consistent about replacing your contact lenses. Some of the benefits of being compliant with your replacement schedule include:

• Comfort: Compliance with a replacement schedule, regardless of modality, is associated with better comfort and vision at the end of the day and at the end of the wear cycle. When you replace your contact lens according to its replacement schedule, you are less likely to encounter discomfort due to build up from lipids, proteins, and microorganisms.
• Lowers Infection Risks: Poor contact lens hygiene, including not being compliant about contact lens replacement may contribute to infections such as microbial keratitis
• Better Vision: If a patient sticks to a regular contact lens replacement schedule, there is less likelihood of contact lens build up which can affect visual acuity.

No matter what your replacement schedule is, always follow it to keep your eyes healthy, unless otherwise directed by your eye care practitioner.

As the days get shorter during these winter months, eye care patients will have to drive in the dark earlier. Driving at night can be a challenge because the human eye’s field of vision is much smaller without the help of natural light. There are also patients such as older patients, patients with dry eye, and patients who have higher order aberrations (optical imperfections that can’t be corrected with contact lenses or glasses) that may have a more challenging time driving when it is dark out. Here are a few important things that patients should know about their vision and night driving:

• Make Sure Your Prescription Is Up to Date: One way motorists can overcome visual challenges while driving at night safely is making sure their prescription is current. Getting regular eye exams is one way to ensure that. An eye doctor can also check and let patients know if fading night vision could be a problem.
• Older Patients Should Get Tested More Often: Older patients may struggle to focus on the road at night, where lighting is poor and more complex visual tasks are required. There are also eye conditions that can cause vision loss as patients age. These conditions include: cataracts, age-related macular degeneration, glaucoma, and diabetic retinopathy. By getting regular eye exams, older patients can check with their eye doctor about the risks of driving at night.
• Be Prepared: Before patients go for a drive, it can help to check and see if the windshield and mirrors are clear of any debris.
• Talk To Your Eye Doctor: If a patient notices that his or her vision seems to be worse at night, talking to your eye doctor can help. An eye doctor can recommend tips and steps that a patient can take in order to stay safe on the road at night.

Patients with diabetes have an increased risk for glaucoma, cataracts, and other eye problems. While people with diabetes do have a higher risk of blindness than people without diabetes, most patients who have diabetes have nothing more than minor eye conditions. With regular checkups, patients can work with their eye doctor to keep their eyes healthy. And if diabetic patients develop a major problem, there are treatments that often work well if you begin them right away. Here are some tips for patients to keep their eyes healthy:

Get Regular Eye Exams: Diabetic patients should get an annual eye exam by an eye doctor. Patients can even find eye doctors who specifically treat diabetic patients. Eye exams may include dilating the eye so that the eye doctor can see the blood vessels in the entire retina. This will allow an eye doctor to see if there is diabetic retinopathy, a condition where diabetes damages the blood vessels in the retina.

Work With A Doctor To Control Blood Sugar: Patients who work with their doctor to control blood sugar levels may lower their risk of having eye problems. According to the American Diabetes Association, having high blood sugar can make your vision blurry temporarily.

Maintain a Healthy Blood Pressure: High blood pressure can make eye problems worse.

Quit Smoking: Patients can ask their physician for help if they need it.

Know When To Call An Eye Doctor: If patients have any issues like blurry vision, trouble reading, seeing double, eye pressure, or any other vision problems, they should make sure to see an eye doctor immediately.