The contact lens magician
How do locums make contact lens fitting their superpower? Johnson & Johnson Vision professional affairs consultant, Marie-Therese Hall, gives her tips
14 April 2023
Each patient who enters an optometry practice comes with a different lifestyle, occupation and hobbies.
A contact lens that perfectly complements the daily activities of a young office worker may not work for their older neighbour who plays competitive tennis.
For locum optometrists, the magic of contact lens fitting comes when the practitioner can transform what they have uncovered in their consultation into a tailored contact lens solution.
OT approached Johnson & Johnson Vision professional affairs consultant, Marie-Therese Hall, for her advice on the considerations that locum optometrists should keep in mind when fitting different patient groups.
Hall highlighted the rewarding nature of fitting children with contact lenses.
“I’m sure most practitioners can recall an episode where a child fitted with contact lenses really came out of their shell, having more confidence at school or sports,” she said.
Hall observed that building trust with the child and their carer is important for locum optometrists.
“When suggesting contact lenses, look for cues from both the carer and child to ensure both understand the benefits, and that both are on board. Make sure you address any questions or concerns either may have,” she said.
The caregiver may have concerns that the child is too young, or lacks the responsibility to look after their contact lenses, while the child may be concerned about touching their eyes.
“Check if the practice has any written information leaflets you can let them take away to discuss at home,” Hall advised.
When it comes to students, Hall emphasised the importance of finding out the patient’s unique requirements.
“We might be stereotypical and presume that all students have a restricted budget, have lots of late nights and spend a lot of time on a computer screen. This might not always be the case, especially with more students taking vocational courses or apprenticeships,” Hall shared.
“Use any information on the patient’s anticipated wearing time, alongside their expectations, to recommend a contact lens material you feel will best meet their needs,” Hall advised.
If a student is budget-conscious, then it can be helpful to break the cost down to cost per wear – as well as being aware of any payment plans that the practice has in place.
Hall highlighted that four in 10 Europeans take part in sports or exercise at least once a week.
“Regardless of the type of sport, or level played, patients may be interested to know the visual benefits of contact lenses,” she emphasised.
Benefits of contact lenses for sports players include a wider field of view, freedom from glasses fogging up in the rain or dirt and enhanced depth perception.
Hall added that for those who play contact sports, contact lenses give patients the option of wearing protective headwear and reduce the risk of their glasses being broken.
Hall shared that screen time increased during the pandemic, with one study by Eyesafe Nielsen in 2020 estimating that the average person spent 13 hours each day on a screen.
She added that office workers are more likely to be above average in terms of daily screen time.
Screen use is associated with a decrease in blinking, as well as an increase in tear film break up and evaporation.
I’m sure most practitioners can recall an episode where a child fitted with contact lenses really came out of their shell
Hall highlighted that while this creates challenges for comfortable wear, lifestyle demands should not be a reason to avoid mentioning contact lenses.
“Some newer contact lens materials are shown to perform better than others,” she emphasised.
For example, Acuvue Oasys Max 1-Day with TearStable Technology uses a tear-like wetting agent that reduces evaporation and prolongs tear film stability.
“Being familiar with these technologies, and options available on the market, will help ensure the lens you recommend will match up to the patient’s needs,” Hall shared.
A common misconception that Hall comes across during consultations with presbyopes is that they do not think they can wear contact lenses.
“There are still a lot of patients who think presbyopia makes them unsuitable for contact lenses. Take time to discuss the option of contact lenses, managing expectations, and letting them know there are options to allow them to see clearly at all distances,” Hall advised.
She added that choosing a vision correction option that fits with both the patient’s visual and lifestyle needs will enhance success.
Locum optometrists should check which multifocal contact lenses the practice has available and ensure that they are familiar with the design of each contact lens.
Hall recommended keeping a fitting guide for each multifocal contact lens on hand.
“Manufacturers produce fitting guides specific for their design of multifocal contact lens which include the most effective ways to fit their specific design, and how to enhance vision if needed,” she said.
Fitting guides can be obtained by contacting the manufacturer, from the local account manager or online.
When talking with older patients, Hall will ask if there are any occasions where their glasses get in the way.
“It may be that the patient has a specific hobby where they would benefit from being glasses-free,” Hall shared.
Within this patient group, Hall also recommended looking for cues that the application and removal of contact lenses may be challenging from a dexterity point of view.
“If so, consider using a contact lens with a higher modulus that the patient may find easier to handle,” she said.
Time for a change?
Marie-Therese Hall outlines what to look out for when considering if a patient needs updated contact lenses – and how to navigate the conversation
Listen out for symptoms. Is the patient experiencing discomfort? Or are comfort levels declining over the day? When patients describe feelings of physical discomfort, they often use words like dryness, itchiness, grittiness. When describing visual discomfort, they may use words linked to eyestrain such as their eyes feeling heavy or tired.
Look out for a change in wearing pattern. For example, if the patient is choosing to take their contact lenses out earlier, or not wearing them as often.
Observe the contact lens on the eye. Look at how the tears are forming over the contact lens material.
Look at the eye once the contact lens has been removed. Are there any signs of dryness, or irritation caused by high friction such as contact lens induced papillary conjunctivitis or lid wiper epitheliopathy?
Explain your thoughts and any findings to the patient in simple terms. Let them know about any alternative contact lens materials you feel may perform better, and why. It can be useful to give the patient a trial of the new material, allowing them to experience any improvement first hand.
Record details of these conversations carefully in the patient’s clinical record so that it is seamless for another practitioner to follow up if required.