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I could not live without...

My flipper

Contact lens optician at BBR Optometry, Nick Black, shares how his flipper adds efficiency and satisfaction for his contact lens and low vision patients

16 Dec 2018 by Emily McCormick

During my working week, I wear several different hats, but when I am a contact lens optician or low vision practitioner, my flipper is my best friend.

I do still hear some practitioners who question the choice to fit multifocals as a first fit for presbyopes. However, at BBR Optometry, 50% of the soft contact lenses that we dispense are one form of multifocal or another. Whether it is daily disposables, monthlies or other daily wear options, the goal is always to minimise the clinical time and optimise the processes to deliver the best results as cost effectively as possible for the patient.

My flipper is great as when determining maximum plus in the trial frame, I can binocular flip between powers to optimise the starting point. Although this is encouraged with Acuvue for presbyopia, I had not fully appreciated this step until the arrival of the Acuvue Moist Multifocal onto the market. I now use this technique with all of my multifocal fits in order to find first lens fit, and then I follow the fitting guides. This has definitely streamlined the route to endpoint.

Satisfaction rating

With so many contact lens follow-ups now being multifocals, it is important to be able to maintain patient satisfaction in lenses. Like many of my colleagues, I use a rating scale of one to 10 to understand the patient perspective for distance, near and comfort. How many times do we get tripped up by trying to attain 6/x or N? The rating system allows me to step into the patient’s world of how satisfied they are. Anything less than seven is likely to be an indicator of concern and therefore will need addressing unless there is a clear explanation and understanding for the patient as to why a seven, eight, nine or 10 rating is not attainable.

“During binocular over refraction, a flipper of 0.25 or 0.50 is speedy and slick”

The flipper difference

We all know that plus or minus 0.25 can make a real difference to the patient, so at BBR Optometry we aim to assess multifocal wearers on a six-monthly cycle.

During binocular over refraction, a flipper of 0.25 or 0.50 is speedy and slick. Patients want practitioners to be confident in managing their care. The flipper allows a transparent and immediate assessment of performance without the barrier of a trial frame, whether looking into the distance or at a near task.

Although subtle, the observation of the patient can provide crucial clues to the likelihood of success. Using my flipper means these are not hidden behind the trial frame.

Low vision rewards

When dealing in low vision, one of the questions that I get asked most regularly is ‘Can you give me stronger glasses?’ In Hereford we have a community low vision service, so I have patients who have either been seen by optometrists at BBR Optometry or been referred by peers following a recent examination.

Knowing my optometrist colleagues have explored prescription options, I can use my flipper to demonstrate the effects of changing the distance or supplying different reading adds.

If I have a patient who is receptive to a higher add, then I can explore this in more detail. However, as most people do not want to compromise, the working distance a 0.50D flipper is a fantastic indicator.

I am fortunate to work in a practice that has all wonder of clinical equipment and tools to optimise the patient experience and clinical decision making, but for me it’s the buzz of the personal interaction. My flipper allows me to be responsive and adaptive to the individual with simple demonstrative solutions. I mean, everyone likes a ‘better with one or two’ don’t they?

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