A GAME-CHANGING APPROACH TO HELP OVERCOME CONTACT LENS DROPOUT How point-of-care testing can grow your contact lens practice by aiding in lens selection, treatment recommendations and patient education. By Paul Karpecki, OD, and Ian Benjamin Gaddie, OD C ontact lens dropout rates have not changed appreciably in nearly two decades. Although new materials and pre-servative-free products have helped, neither was the tipping point we hoped for in contact lens practice. What’s more, as clinicians, we now face even greater challenges than we once did. The explosion in digital device use has placed an unprece-dented burden on the ocular surface, erecting yet another hurdle to com-fort. If there is one thing we have learned about contact lens dropout, it is this: We are less likely than ever to overcome it using traditional strategies. It’s time to start thinking outside the box. In our clinical experience, and in that of many of our forward-think-ing colleagues, the most e ff ective way out of what is otherwise sure to be a downward spiral is to catch as many patients as we can as they come in for their annual exams. In other words, we need to identify which patients are at risk of drop-ping out prior to fi rst fi ttings and before re fi ts. In this three-part series, we will explore how osmolarity testing can be the catalyst for change that the contact lens industry has long sought. This surprisingly simple ap-proach is both practical and pro fi t-able. In this fi rst installment, we will make the case for how point-of-care osmolarity testing can bene fi t your contact lens practice. We will also explore di ff erent ways you can inte-grate it into your practice routine. In parts two and three, we will explain how osmolarity can help guide lens selection, setting the stage for better patient education, less dropout and a better bottom line in terms of reim-bursements. STRATEGIES FOR TESTING NEW WEARERS While many clinicians believe that osmolarity testing is most appropri-ate for monitoring disease progres-sion, an even better use of tear osmo-larity testing is to determine whether a patient has dry eye disease, espe-cially in its early stage when other dry eye signs may give con fl icting information. In a recent study by the National Health Service (Great Brit-ain, UK), osmolarity was shown to have the highest positive predictive value for dry eye disease compared to other routine dry eye diagnostic tests. 1 Furthermore, TearLab Osmo-larity testing is not only the most predictive test for dry eye, it’s also the fastest, requiring fewer than 30 seconds from test to result. There are several ways to approach dry eye diagnosis at an initial lens fi tting. Some practices fi nd that the best approach is to perform osmolar-ity testing on every new contact lens patient using the TearLab Osmolarity System while others wait to perform osmolarity testing pending other in-dicators, such as a poor score on a subjective questionnaire. If your decision to perform osmo-larity testing depends on subjective symptoms or surveys, bear in mind that dry eye disease is often asymp-tomatic—until the ocular surface is “challenged” by a contact lens, so adopting a protocol like this requires greater clinical diligence. In fact, re-search suggests that relying on symp-toms to diagnose dry eye would pro-duce a missed or incorrect diagnosis more than 40% of the time. 2-4 HOW TO APPROACH REFITS Have 50% of your current lens wearers mentioned that they have dry eye symptoms? Probably not. Yet dry eye a ff ects nearly 30 million 30 REVIEW OF OPTOMETRY MAY 15, 2016

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