Fitting soft custom lenses – Seven steps to success
We spoke to Jim Dickson, mark’ennovy Professional Affairs Manager UK & Ireland, about the seven steps to successfully fityting soft custom lenses.
Patient retention and drop out from contact lenses has dominated many of our thoughts over the last few years. Even with an abundance of new materials, innovation and new products the market is still relatively stagnant. One area for consideration to help grow your contact lens business and to retain your patients is to consider offering custom made products. For some practitioners, the barrier to fitting custom lenses may be a lack of confidence, limited experience, equipment concerns or it not being a focus during their optical training. There may also be the belief that they are time consuming and not particularly worth the effort.
For those who are interested in starting to fit custom lenses or re-visiting them as a patient option, the process can be daunting. Below is a 7-step guide to identifying the patient and how to fit them.
Step 1 – Patient identification – our first thoughts on fitting custom lenses may be prompted by a high correction be it spherical or cylindrical, but this is only part of the opportunity.
There is the ever-increasing category of presbyopes with astigmatism who, while their correction may not be particularly high in any meridian, they still have limited options due to the sheer volume of SKUs required to facilitate successful lens wear. Mass produced lenses may not fulfil their requirements.
The next category are those wearers who are currently using multifocal contact lenses but not completely satisfied with them, ‘functional vision’ may not be enough for them, and a more individualised option may be better. Then there are those who struggle with haloes or ghosting and using an Extended Depth of Focus design may solve these issues.
Finally, we have the often-overlooked group of patients who may have a simple enough correction (which would usually result in them being fitted with a standard off the shelf product) but these patients have a smaller or larger corneal diameter than the average or their cornea is flatter or steeper than normal.
Step 2 – Measurements
Start with an up-to-date refraction, a corneal assessment, and the biometric measurements of k- readings and HVID. These measurements will contribute to identifying the patient who should be fitted with a custom lens.
A Topographer will give us more information such as the amount of flattening towards the periphery of the cornea (eccentricity) but for those without, a keratometer will suffice and a PD rule to take the HVID. If we are fitting a multifocal then the ocular dominance is required as well. Though this is not required when fitting mark’ennovys’ EDOF lens.
Step 3 – Ordering the lens
We should consider what is the best material for the patient and modality, the patient who requires part time wear may be best suited to a hydrogel whereas those who want extensive wear may benefit from a Silicon Hydrogel. Also, consider the material choice for presbyopic patients who are more inclined to have dry eye symptoms.
At this point we should have all the information we require to order the lens. Refer to the manufacturers fitting guide which may be supplemented by an online calculator. If you are unsure, then many manufacturers will have a technical support desk to help you with the initial selection of material and specifications. Mark’ennovy employ 20 customer care operatives who are qualified opticians.
Step 4 – Collection of lenses
Allow a short time after insertion to allow the lens to settle then assess the fit.
Only when the ECP is content with how the lens fits on eye should the over refraction be performed.
If fit and vision is satisfactory then proceed with a suitable trial period of wear.
Step 5 – Making an adjustment
If the lens fit is unsatisfactorily, then we need to make an alteration to the lens specifications.
Excessive movement can be improved with an increased diameter and or a reduction in the base curve, whereas insufficient movement can be improved with a reduction in diameter and or an increase in base curve.
For guidance, if the lens is rotating over 20 degrees, when the over refraction is considerably higher than normal expectations or the VA doesn’t improve with over refraction then the fit is unlikely to be optimal.
Step 6 – When to seek help?
If you are unsure of the amount of adjustment, then a call to the manufacturers technical support would be the next step.
Step 7 – Dispense the lenses
When you and the patient are satisfied then proceed with the dispense of the revenue lenses, ideally committing the patient to an ongoing service plan. For those unable to offer or join such a plan then a 3 monthly call to remind them to order will ensure good compliance with the recommended replacement schedule as well as minimising problems and subsequent drop out.
Learn more at our webinar: Mark’ennovy & SightCare exclusive webinar – Unlock the potential of custom soft lenses in just 1 hour! Discover why soft custom lenses are not just an option, but a game-changer for your business. Tues 15 April, 6.30 pm: https://buff.ly/ICm8OqY
