The Great Barrier Relief
contact lens management
The Great Barrier Relief
Grow your practice by incorporating bandage contact lenses.
MILE BRUJIC, O.D.
Ask any consumer the purpose of a contact lens, and they'll answer: “To correct vision,” nothing more. For this reason, showing patients you possess the skills to use contact lenses therapeutically can be clinically rewarding and a real practice builder.
Here, I discuss when to employ specific types of bandage contact lenses and the rewards of doing so.
Scratching the surface
The three instances in which you should use a bandage contact lens:
1. Corneal abrasions. Any type of trauma to the cornea may result in a corneal abrasion. Examples include athletes suffering ocular trauma, a foreign body embedded in the conjunctiva overlying the super tarsal plate, and the inadvertent scratching of the corneal surface upon contact lens removal.
Further, you may induce a corneal abrasion by removing a foreign body embedded in the cornea. In addition to removing the foreign body, an abrasion along with any other epithelium inadvertently removed when dislodging the foreign body can result in the area previously occupied by the foreign body. In all these cases, I employ a silicone hydrogel bandage contact lens. This is because the lens promotes healing and alleviates pain by covering the abraded area and acting as a barrier against the friction of the upper lid's blink, while optimizing oxygen delivery to the cornea beneath the lens.
2. Surgically induced corneal abrasions. Some refractive surgeons and co-managing optometrists use silicone hydrogel bandage contact lenses post-photo refractive keratectomy, LASIK and LASEK to promote corneal re-epithelialization and alleviate discomfort or pain.
(NOTE: When dealing with corneal abrasions, prescribing a topical antibiotic t.i.d. to q.i.d. as a prophylactic is warranted to protect against opportunistic infection. Some practitioners use topical non-steroidal anti-inflammatory (NSAID) agents to help with much of the pain and inflammation associated with corneal abrasions until the condition resolves. Further, some practitioners actually soak the lens in the NSAID drop prior to placing it in the patient's eye. So, a multitude of options exist to help these patients.)
3. Persistent epithelial defects. If severe enough, these cases may require a scleral contact lens. For example, patients who have severe dry eye with keratopathy require constant lubrication. A scleral lens that contains saline and placed on the eye vaults the cornea, bearing much of the pressure of the lens on the sclera while creating a reservoir of fluid that meets these patients' needs for lubrication. The result: The promotion of a healthy healing environment for the cornea.
Note the pattern of corneal epithelial migration to fill in the braded area in this healing cornea.
(NOTE: You can prescribe an antibiotic, such as a fluoroquinolone, in the liquid reservoir as prophylaxis against infection. You should monitor these patients daily until the cornea heals. Then, you can discontinue the antibiotic.)
In addition to the personal satisfaction you achieve from helping these patients, incorporating bandage contact lenses in your practice garners you financial rewards as well. The immediate rewards include reimbursement for the initial and follow-up office visits, anterior segment photography and fitting services for the lens itself. (See “Commonly Used Codes For Abrasions,” below.)
Commonly Used Codes For Abrasions
OFFICE VISIT: 99212, 99213, 99214
ANTERIOR SEGMENT PHOTOGRAPHY: 92285
THERAPEUTIC CONTACT LENS: 92070
The peripheral reward is a new crop of patients that will result from referrals. Keep in mind that many of these patients are emergency patients, who will immediately recount to their friends and family how you helped them in their time of need — excellent public relations for your practice!
Bandage contact lenses not only provide our patients with a means of reducing pain and promoting corneal re-epithelialization, they also provide our practices with a means of additional revenues from the services rendered and the word-of-mouth referrals that result. OM
Special thanks to Lynette Johns, O.D. of the Boston Foundation for Sight, for her assistance with the scleral contact lens section of this article.
DR. BRUJIC IS A PARTNER OF PREMIER VISION GROUP, A FOUR-LOCATION OPTOMETRIC PRACTICE IN NORTHWEST, OHIO. HE HAS ASPECIAL INTEREST IN GLAUCOMA AND CONTACT LENSES AND OCULAR DISEASE MANAGEMENT OF THE ANTERIOR SEGMENT. E-MAIL HIM AT BRUJIC@PRODIGY.NET.
Optometric Management, Issue: May 2010