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CONTACT
LENSES:
The Optician's Role |
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In year’s past, Opticians played a major role in the fitting and dispensing of contact lenses in most places in the US. Clearly some of the nation’s best contact lens practitioners are Opticians.
Professional journals are filled with Opticians articles, and many of the country’s best lecturers on contact lenses are Opticians. Why then do Opticians in most places around the country not fit contact lenses on a regular basis? This article addresses contact lenses as an opportunity for Opticians, and will attempt to objectively describe how Opticians can reclaim some of the contact lens marketplace relinquished to ODs in the 1970s. |
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Demand
Is there still a demand for contact lenses? Many see the market as declining or at best remaining static, so why even be concerned about it? Many practitioners see Lasik as a cash cow, and limit their involvement in contact lenses to easy, simple fits and even tell patients they cannot wear lenses if the first attempt does not go as planned. This leaves a huge void. There are thousands of patients who still are fearful of surgical correction and want to wear contact lenses. They may now be presbyopic, which in the past was a concern, but today there are many different varieties of lens choices to meet their needs, if the savvy practitioner simply takes the time to work with each patient as an individual. It will take chair time to find the appropriate design, but it can be done. Opticians can provide those services.
Many people are not aware of gas permeable designs today. In many schools and colleges of Optometry, we understand from colleagues that they are not gaining experience in the fitting of gas permeable lenses. For that reason, soft lenses are recommended as the best alternative. In reality a more rigid (I know….not a pc term today, but I felt this term would provide emphasis for descriptive purposes) design would actually provide the best vision.
These are but two examples; there are others. The point is that there is a demand, and as our OD colleagues move to a more medical model, Opticians can work to fill the void in contact lenses.
Lens Designs
Specifically, there are a number of lens designs that provide tremendous opportunities in the opinion of this author. Let’s take a look at several of those.
Multifocal/Bifocal Designs
There are a plethora of multifocal/bifocal designs on the market today, so a specific lens design will not be mentioned. They include Soft lenses, Gas Permeable lenses, Silicone-hydrogel lenses, all with the ability to correct presbyopia. The baby boomers, many of whom grew up wearing contact lenses, do not want to hear that they must now wear spectacles because of presbyopia and they do not have to any longer. Opticians can help these people solve their visual problems.
A caution, fitting these, and any specialty design, takes time. If you cannot commit to spending significant time with these patients, then do not undertake the case. Also, do not think one size fits all. You would be wary if a contractor came to build your house with only a hammer and nails, and you must have a number of lens designs and types in your “tool kit,”
CRT/Advanced Ortho-K
Corneal Refractive Therapy (CRT) www.paragoncrt.com is an alternative to refractive surgery. It is a lens that is worn during sleep that gently reduces myopic correction and has proven itself over the last several years as safe and effective. In fairness, this author served as a consultant to Paragon Vision Sciences, the developer of CRT, but has not had an involvement with them for several years. Paragon has a certification program that is a requirement to fit and dispense these devices. Take the course, and see what a great addition CRT can be to your practice.
There are other advanced Ortho-K designs as well. The WAVE system is an example
www.wavecontactlenses.com. The computer-assisted lenses utilize existing materials to provide a similar alternative to refractive surgery.
Bausch and Lomb www.bausch.com/en_US/ecp/visioncare/product/general/ortho_ecp.aspx also has a number of select lens designs that combine to form their Vision Shaping Treatment. You will find their system works equally well, and is time proven.
All of these lenses/devices allow for reduction of myopia, and soon will be utilized for the correction of additional optical anomalies. They can be fit by Opticians with the specific equipment required, and in the correct clinical environment.
Post-Refractive Surgery/Irregular Corneas
The post-refractive surgery contact lens is something we need to learn more about. Many lens designs are now readily available from a variety of sources, and provide excellent opportunities to assist those who are not pleased with their refractive surgery outcomes, or with irregular corneas. I know the surgeon on your block is probably the latest and greatest, but according to a variety of sources, there are a percentage of patients we can help with these lens designs.
Examples:
SynergEyes www.synergeyes.com is a hybrid lens design with a gas permeable center, and a soft lens skirt. It allows for fitting of many complications including corneal scars, grafts, PMD, Kerataconus and others.
Lens Dynamics www.lensdynamics.com offers the Dyna-Z Intra-Limbal lens for irregular corneas. It is an example of the mini-scleral lens mentioned above, and is one that is well recognized for great comfort and has a proven history.
Education and Training Requirements
Here is lies the problem. Opticians must undertake more advanced education and training requirements to successfully and safely fit contact lenses on a large scale. Great understanding of the technical aspects of fitting is important, and must include course work on anatomy and physiology. Most of the schools of Opticianry include those courses today, but unfortunately most Opticians do not attend a school, but are trained in woefully inadequate “apprenticeship” programs that in reality provide little training and education to these future “professionals” We must do better!
In a study conducted by this author, only 40% of respondents (n= 200) fit contact lenses actively, but in reality many of those on dispense boxes of disposable to patients, or help do insertion and removal. The true number is left unknown, but is suspected to be small. It can grow, however!
The study population indicated that they felt Opticians should assume a greater role in the fitting of contact lenses. 69.5% strongly supported the idea, while 9% felt Opticians should not fit contact lenses at all. 20.5% were neutral. This indicates that Opticians do want to do more in the area of contact lenses.
Nest Steps
What do we do? It appears there is not one out there seeking to review and advance the professional activities of Opticians. What needs to happen is two-fold. First, we must educate and train Opticians to assume a larger role as a contact lens practitioner. It will not happen overnight, but one thing I can tell you, it will never happen if we do not take the initiative.
Second, we must develop leaders in professional organizations who respect education themselves and will seek to expand the role of Opticians beyond the boundaries that currently exist.
Conclusion
It is imperative that we, as a community of professionals, step up to the plate. We must strive to do more, and reach for greater heights. Contact Lenses are a part of our past, and we must make them a larger part of our future. I encourage you to investigate how you can play a role in contact lens advancement.
References on request
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