Changing lives with specialist lenses

Within this field, some manufacturers have noted an increased level of interest in training for fitting scleral contact lenses in recent years.

Ian Sexton, professional services manager for No7 Contact Lenses, shared that between 2017-2018 mini scleral lens sales saw an increase of almost 25% on the previous year. While sales seemed to slow a little in 2019, at the time of writing, the company has seen a 10-15% increase so far this year.

This is reflected in his own experience. Within the hospital where he runs a specialist contact lens clinic, Sexton said: “I’ve certainly seen a large increase in the number of scleral lenses that are being fitted to patients. That seems to be being mirrored in hospitals across the country.”

“But we’re also seeing a real demand for training in these lenses in independent practices,” he continued, adding that “it expands their options as practitioners.”

Scott Brown, clinical director of custom-fit specialist lens company, Scotlens, suggested that comfort has been a factor in the increase in popularity of scleral lenses: “From an independent practice point of view, the prevalence that these lenses have had almost normalises them as a go-to option for patients that you are struggling with. The fact you can fit them, and patients don’t have to manage comfort, was a big thing.”

As modern scleral lenses have become thinner and more breathable, with a DK/T acceptable for daily wear and costs coming down, Brown suggested there is less inhibition around opting for scleral lenses.

Josie Barlow, Menicon professional services manager, agreed that there is more interest in fitting scleral lenses. She explained: “From a clinical standpoint, these lenses are really good problem solvers. They are not just for the patients who have irregular corneas; they are great for high astigmats or dry eye patients who have fallen out of contact lens wear because they just can’t cope with standard soft lenses and gas permeable lenses.”

Hansraj Sunassee, hospital business development manager, for Menicon’s speciality division, added: “I think sclerals have a stigma of only being for the irregular cornea or for the hospital clinics, but it’s becoming more mainstream.”

Some of this demand is led by patients, he suggested, with a lot of information now available for patients to educate themselves on the options available.

Perception of challenge

Suppliers agreed that a key barrier when it comes to fitting specialist lenses, and scleral lenses in particular, has been the perception of challenges or complexities involved.

Barlow suggested that, although fitting has simplified over time: “There are still practitioners who are a bit hesitant of fitting scleral lenses because they think it is going to be quite complex and difficult to do, and that’s not the case.”

Manufacturers have evolved too, she added, with more control over the production and as a greater range of equipment has become available to measure more of the eye, making lenses easier to fit as a result.

Sunassee identified: “I think the biggest problem is the unknown. Once the practitioners get their hands on these lenses, they understand it is not as hard as it was.

“It is an exciting time,” he continued. “I think we’re at a pivotal point because there is so much great technology out there, not just physical technology but lens fitting technology as well that is driving this side of specialist lenses forward.”

Brown, too, suggested that expectations of the lenses can be a barrier to fitting, commenting: “I think there’s a perception optometrists have that there is a whole level of knowledge hospital optometrists have that they don’t, and a worry that they are going to do something badly.”

He notes that following the fitting guides is key, adding: “As long as you’ve got the basic skills of putting a lens into the eye, assessing it and refining based on your assessment, you can fit complex contact lenses onto irregular eyes.”

While practitioners might find they haven’t got the right lens for a patient, Brown shared: “That’s where scleral lenses really help, because it can reveal the potential that any gas permeable contact lens will have on that eye.”

There’s a perception optometrists have that there is a whole level of knowledge hospital optometrists have that they don’t, and a worry that they are going to do something badly

There are downsides to scleral lenses, Brown acknowledges: “They’re not the ideal first lenses for the patient, because there is no tear exchange and because you’ve got plastic in a large area, they are prone to drying out and getting lipid deposits.”

This is something Lynn White, clinical director of Ultravision, a provider of specialist contact lenses noted, adding that while scleral lenses can be comfortable and worn all day, others can encounter problems like fogging.

White suggested that finding a lens that is acceptable and comfortable is the priority for the patient and their quality of life, suggesting that it can be worth trying disposable lenses first, “because the simplest option is the best option for your patient.”

A further concern for practices around fitting specialist contact lenses can be around chair time, White shared, particularly for those practices with shorter appointment times.

Lengthening waiting lists

Manufacturers were enthusiastic about the field of specialist lenses, both for the impact it can have for patients, and for the professional development and practice benefits it can bring.

Sexton told OT: “I think the thing about specialist lenses and scleral lenses in particular is that it is a really interesting topic and they are fascinating lenses to use.

“We all have patients that come into our consulting room and we’re not sure what to do to help them. Specialist lenses will be able to solve a lot of patients’ problems and create really great results for everybody,” he continued.

The waiting list challenges faced within hospital clinics and compounded by the impact of the pandemic, also contributing to the reasons for community optometrists and contact lens opticians to fit specialist lenses.

Manufacturers highlighted that, with the waiting lists growing, there would be patients who would prefer to be seen by an optometrist rather than move through the hospital appointment structure.

I think the thing about specialist lenses and scleral lenses in particular is that it is a really interesting topic and they are fascinating lenses to use

Sexton noted: “Patients who are struggling and would rather pay privately will be looking to their local optometrist and someone they have been seeing for a long time.”

Reflecting on the challenges faced in hospital clinics, Sunassee suggested this could lead to further collaboration with primary care: “A lot of hospitals, ophthalmologists and corneal consultants are looking for practitioners in the field that they can refer to because they know it’s just a massive waitlist.”

This is something Brown sees continuing into the future: “There’s going to be even more need I think, in five or 10 years time. If you want your patients to have the optimum solution to their eye problem, you’ve got control to be able to do that.”

Specialisation and differentiation

White suggested that now is a particularly good time to get involved in specialist contact lens fitting, noting that many practices have found over the past few years that “having that extra time with the patient has proved to be more profitable.”

The skill is a good practice builder, White continues: “Specialisation is the only way the High Street is going to differentiate itself, I think. Not only with specialist contact lenses – it leads into myopia control and presbyopia, and it’s not difficult to pick up quite a wide range of specialities.”

It can also be beneficial for patient loyalty, White continued: “if you take the time to fit a really complicated case, you tend to pull the rest of the family relations and friends in as well.”

This is something Barlow also highlighted: “They are very loyal patients. You can’t buy scleral lenses from a store online; you are going to buy them from a qualified practitioner. It is great for building your business, your patient base, and for patient loyalty.”

Over the past year, Sunassee shared, direct debit schemes have helped practices to see the value of contact lenses within their practices, “showing them that it is something they possibly need to build on.”

“But it also helps them understand they need to differentiate; they need to be standing out because there is so much competition on the High Street,” he added.

Skills and equipment

When it comes to the fitting of specialist contact lenses, there are a range of tools that could support practices in providing the service, from training and resources to devices – with topography top of the list for key equipment.

Topography machines were among key recommendations from several manufacturers as useful for making it easier to identify the right lens for each patient. White suggested that without the device, “It is a bit like trying to be specialists in glaucoma but not having any way of measuring the pressure. It’s an integral part.”

For those thinking of fitting specialist lenses, she recommends getting experience in a range of lenses, noting: “You need to understand the full range of lenses available, and if you don’t want to fit a certain type, make contact with a colleague who can so you can always refer people on.”

Patients come to see you, not what is on your shelves

A range of fitting sets, able to be obtained from suppliers, would also set practices up to fit specialist lenses. Brown shared: “The more sets you’ve got, the more options you’ve got that are going to suit your patients.”

Education would also be beneficial, with training and support available from manufacturers.

No7 Contact Lenses recently launched the Irregular Cornea (IC) Specialist website. Freely accessible to account holders, the website includes presentations for optometrists to learn about the lenses, how they work, how they fit, and problem solving.

Menicon’s Sunassee highlighted that practitioners should seek “a reliable lab that can support them – not just with the lens supply – but with hands-on-fitting, the training they need and after-support, so all the technical advice of making the adjustments and changes.”

To make fitting specialist contact lenses part of practice, experts emphasised the importance of appropriately pricing services.

“I think practices are scared to charge more,” Brown noted. “It is a really bespoke service that you are providing for patients, and therefore the service that goes with that is what you need to value charging for.”

Sunassee also identified this issue and the importance of incorporating chair time into the equation, adding: “Patients come to see you, not what is on your shelves.”