How To Fit Contact Lenses like a Boss
Kiddos, spring has sprung!
We’re in the final quarter of optometry school, little ones. And as Commencement approaches, it’s time to learn about contact lenses. These are my last credit hours before the wings are clipped and I fall out of the tree.
First, there is an art to the contact lens.
Yes, it may appear to be a small cast-molded or lathe-cut piece of plastic to every John and Jane on the street–but if you look more closely, between those silicone and hydrogel moieties, it really is magic.
Imagine a life where you had to wear your dorky glasses everyday.
How on earth could 75 percent of romantic comedies gain traction if the tragic ugly duckling didn’t dispose of her gawky frames and wear contacts in order to warrant the attention of the loveable, albeit shallow, leading man?
(And you thought optometry was just about helping people see.)
Anyway, that’s neither here nor there.
Let’s get into the thick of things. (Or for the more technical amongst you, the Dk/t of things.) See what I did there? Don’t lie, you laughed.
Below are some tips and tricks I’ve amassed thus far. As always, it’s advisable to take these with a large grain of salt.
Your patients will lie to you. It’s okay, I lie to myself every day. But keep in mind that this time the lies have repercussions. Their ocular health may be at stake.
Solution: Assume that whatever they are telling you is only a third of the truth.
“I never sleep in my lenses” translates into “I nap in them accidentally.” This isn’t the worst thing in the world but it’s not advisable if their lenses aren’t designed for that. Don’t berate them, but reiterate the rules before you send them off.
“I sometimes sleep in them” translates into “I took them out last night for the first time in two weeks.” Gently reprimand them after you’ve seen their neovascularized corneas behind the slit lamp. Fit them into a breathable, FDA-approved lens for overnight extended wear.
“Yes, I sleep in them every night. I haven’t taken them out in a few months. I don’t know what solution I use because I never use solution. And yes, I know these are dailies and I’m supposed to discard them after one day.” These are the worst ones. As I said earlier, everyone lies. If they are giving you that much truth right off the bat, check the trunk of their car. Alert the appropriate authorities.
Irregular corneas are your friends. Sure, we all love a 43.00/43.50@ 090 cornea. That baby can wear anything. Throw a dart at your fitting set and whatever lens it lands on will fit like a custom designer gown. With each blink it’ll glide effortlessly, no conjunctival drag, no blanching, and a nice easy push up worthy of Victoria’s Secret.
But like all things in life, it’s easy to fall for the simple ones. The complicated ones are way more fun. (PS, this applies to people too). First of all, keratometry is your friend. Whip out that barrel, dust off the knobs, and focus that sucker. I’ll be the first to admit that keratometry and I weren’t BFFs at first, but we are now. Accurate K readings are the place to start with your irregular peeps.
Keratoconus is a progressive disease marked by the thinning of the cornea, resulting in a steepening of the surface and irregular astigmatism. Keratoconus used to scare the lights out of me–the first time I swiped a “kone” cornea with my optic section I pushed back from the machine in confusion. Um… why was it so pointy?! Now I’m a touch less dramatic. For these patients, the possibilities are endless. There are your regular gas-permeable lenses that center over the cone in a three point touch, hybrid lenses with a GP center and a soft skirt, piggyback lenses with the GP on top of the soft lens, and stiffer soft lenses called KeraSoft. These patients rely on contacts. In fact, my last kone patient told me he invited his optometrist to his wedding, that’s how critical a role she played in his life.
I got to fit a post-LASIK induced posterior ectasia patient the other day. Her extremely thinned and irregular surface was flat below, steep above, with hills in the between. Her refractive error was all over the place. The post-graft GP lens that she was fit in allowed her to achieve vision she could hardly have imagined before. She left the office a completely different personality then when she came in.
I’m telling you: Fit specialty contacts like a boss and become lucrative not only in the world of romantic comedies, but tap into that wedding market as well.
Multifocals are game changers I’m quite convinced my plight into presbyopia is nearing, despite my youthful appearance. I think multifocal contacts are my favorites. I think this is the lens that will change the profession for newbies like us because the technology has finally caught up with the demand of the baby boomers. Firstly, it’s become more expected to have a multifocal lens wearer see 20/20 at distance and near, whereas before the word “compromise” got thrown around a lot. Get comfortable with the different brands (near center, distance center, dominant vs. non-dominant, ranging adds), pick a favorite, and go to town.
Tip: Be the doctor that let that 50-something cosmopolitan jet-setter stay in contacts instead of reaching for god-forsaken readers–be famous for life. Seriously. Their spouse will come to you, their kids will come to you, and their presbyopic friends will come to you. Build a fountain of youth in your lobby with all that extra cash flow.
You’ll hear things that make you roll your eyes a lot. Resist the urge. Personal favorites I’ve heard this year:
“I want ones that are blue in the morning, green at night,”
“My cousin rolled her eyes back and the lens got stuck in behind her eyeball socket! Can that happen to me?”
“If I don’t have re-wetting drops, I just put it in my mouth for a second. Saliva is sterile.”
“Do I have the stigma in my contacts?!”
“Oh, I didn’t know I was supposed to wear my contacts to the contact lens check-up.”
And this gem:
“I lost the trials you gave me so I’m wearing my girlfriend’s.”
Contacts are fun. Get good at them and you’ll reap the rewards. Get excellent at them and expand your scope of practice. It is well within your abilities, even LARS (left add right subtract) can do it. And if you ever have a patient like the last one, congratulate them on the shared intimacy he has with his girlfriend and their apparent lack of boundaries, but gently suggest that medical devices should be where they draw the line.