Lifestyle Dispensing

Posted by CooperVision on Thursday, March 28, 2013

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.

Webinar on 1 Day Lenses: Realizing The Potential In Your Practice

Posted by CooperVision on Wednesday, March 20, 2013

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.

The Convenience of an Annual Supply

Posted by CooperVision on Tuesday, March 19, 2013

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.

Astigmatism and Toric Soft Contact Lenses: Now Mainstream?

Posted by CooperVision on Friday, March 8, 2013

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; 

About On Eye

On Eye is the contact lens blog from CooperVision. On this site, you will find insights about fitting, technology, and the business of contact lenses. The On Eye blog is designed to meet the needs of both Eye Care Practitioners and consumers. ECP and medical professional-specific portions of the blog will be password protected in order to protect and reserve the privacy of the profession. To read more about our terms of use, please see the Legal tab.

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