zen of contact lens prescribing, part II, The

Optometric Management, Sep 2000 by Newman, Clarke D

Five more "truths" for you to practice by.

In last month's issue, I explained five "truths" I've discovered in my 14 years of practice. Here are five more truths that I've learned about - mostly the hard way. Remembering them may help you in your practice and save you some painful learning experiences of your own.

Words of wisdom

Here is this month's zen of contact lens prescribing. Optometrists like RGPs more than patients do. I said it; it had to be said. I can see the Academy's Section on Cornea and Contact Lenses and the Contact Lens Manufacturers Association burning me at the stake in Orlando. But before they do, remember: I like RGPs a lot - definitely more than my patients do.

So, if an RGP is indicated, as it frequently is, the patient must be told why. You should also take advantage of all new technologies and lens designs to make the lenses comfortable. If you make an RGP more comfortable, what's not to like?

The #1 cause of con tact lens complications is not owning a pair of glasses. I'm convinced that 99% of all contact lens complications can be prevented, or solved, if the patient would just switch to a pair of glasses when he experiences the first hint of trouble.

Encourage all of your patients to get back-up glasses. As Dr. Richard Kattouf says, "Use the power of the doctor." Tell the patient to get glasses, and give him a discount if he buys contact lenses and glasses. He and your optician will thank you.

You can't drive a car without oil, and you can't prescribe a contact lens without a tear film. I think the fundamental, overriding element in successful contact lens wear is a robust and stable tear film.

Of course, we've all seen patients who've been sleeping in 1,000-yearold daily wear lenses and their eyes and lenses look pristine. You almost have to invent a reason to yell at them. But we've also seen the patient who stumbles in the day after you prescribe lenses suffering with a major problem.

The difference lies in the tear film. Some people just have what I call "magic tear films." However train wrecks are far more common. Endeavor to evaluate the tear film properly, and prescribe accordingly Also, address the underlying causes of tear film abnormalities.

Patients don't care about what doesn't affect their vision or their comfort. I've never known a patient who cared about polymegathism or microcystic edema, and I'm not sure that I want to.

One of the hardest tasks we face in practice is telling an asymptomatic patient that he or she has a problem. You have to get the patient's problem down to his or her level - it has to affect him, not in the abstract, but in the concrete. But always remember that your concrete may be the patient's abstract.

Patients are non compliant, and the benefits of noncompliance far outweigh the risks. We hate to admit it, but it's true. An Australian study once found a near zero compliance rate for all aspects of contact lens wear and care - and many of the study subjects were optometrists and optometry students.

I'm not advocating depraved indifference to noncompliance; I'm just trying to illuminate the terrain in which we currently find ourselves deployed. Reinforce the necessity of compliance, but don't hold your breath until you actually get it.

Headache relief

I've taken a light-hearted look at this second set of five truths, but I live by them nonetheless. Some of you will scoff, but you would do well to remember them instead, and to follow them as I do. Your patients will thank you, and you'll avoid a lot of headaches. OM

Dr. Newman is a diplomats in the Academy's Section on Cornea and Contact Lenses, and he is in solo practice at Plaza Vision Center in Dallas, Texas.