Reviews Supplements FITTING WITH CONFIDENCE : Page 1

FITTING WITH CONFIDENCE How osmolarity testing can help guide contact lens selection and make patients feel good about choosing healthier options—even when they cost more. By David Geff en, OD and Paul Karpecki, OD W hile switching materials and solutions can’t solve every pa-tient’s contact lens woes, making a change is not without virtue in many cases. The key to success lies in making educated de-cisions that can be measured versus following the well-tread trial-and-er-ror path. Part of the reason why 16% of contact lens wearers drop out every year 1,2 is because patients and doctors hesitate to move into a more appro-priate lens. More often than not, such wavering is driven primarily by fear of the increased expense with little re-gard to the long-term consequences of discomfort. Similarly, it’s equally precarious to switch patients into new lenses if we’re not quite sure whether the new lenses can o ff er any meaning-ful improvement. TearLab osmolar-ity testing can directly address these challenges by providing an objective measure that o ff ers peace of mind to both patient and doctor alike. BE DIRECT If you ask a patient how he’s doing with his contact lenses, he will likely say he’s doing “ fi ne”—even if he’s taking his lenses out as soon as he gets home from work. Patients are afraid that you will either tell them they can’t wear their lenses anymore or you will try to prescribe a more expensive lens. To combat this, it’s important to ask speci fi c targeted questions such as, “Do you feel like you need to take your lenses out when you get home from work?” Any patient who says “yes” is a dropout waiting to happen. Or ask how the comfort compares when fi rst inserting the lenses to when removing them at the end of the day on a 1 to 10 scale. What’s more, these patients don’t merely drop out of lenses, they tend to drop out of the practice as well. Missed annual exams are a common byproduct of contact lens dropout with consequences that can far outweigh a conversation about pricier contacts. STAY ONE STEP AHEAD Dry eye a ff ects nearly 30 million Americans—including 50% of all contact lens wearers. 3-7 Therefore, even if a patient is asymptomatic, we must be diligent about address-ing the ocular surface before it’s too late. Indeed, research suggests that relying on symptoms to diagnose dry eye would produce a missed or incorrect diagnosis more than 40% of the time. 8-10 Without the use of mea-surable clinical indicators, these pa-tients are at risk of one day dropping out of contact lenses. For this reason, anytime a contact lens patient shows a sign or symp-tom of dry eyes, we test their osmlar-CASE #1 A 36 year-old female presents wearing Acuvue 2 monthly replacement (OD -2.75, OS -3.00). The patient reports that her eyes are irritated and she needs to take out her contact lenses when she gets home from work. She also reports that her wearing time has diminished and comfort has decreased. Slit-lamp exam reveals clear corneas and grade 1 GPC OU, with all other fi ndings normal. Osmolarity scores are 308 OD and 311 OS. We recommended switching to a daily replacement lens, but the patient was wary of the increased cost. The patient agreed to try Dailies Total One for one week to see how her eyes would feel. At the one-week visit, the patient commented on how much better her eyes feel, adding that she now has to remember to take the contacts out before going to bed. Slit-lamp exam showed minor GPC with no in-jection. Osmolarity scores were lowered to 299 OD and 300 OS. Convinced, the patient is currently wearing the new lenses. 18 REVIEW OF OPTOMETRY JULY 15, 2016

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