Article Date: 12/1/2000

This month, I'll present you with the last five of my truths about prescribing contact lenses. I hope you find them as useful in your practice as I find them in mine.

Final truths

Try to remember these concepts:

         Patients want extended wear. Patients want "functional normalcy." They want to behave as if they don't need correction when they really do. For the contact lens patient, functional normalcy can be found only in extended wear � it�s what they want.
We know what makes it safer � high oxygen permeability, decreased dehydration and decreased bacterial protein binding. The newer high Dk materials, both rigid and silicone hydrogel, are the wave of the future, so use them.

         A reading addition isn't a microscope. I'm convinced that most people can get by with a much lower add. Lowering the reading add in a bifocal contact lens improves distance acuity. If a patient can see at distance, then depth of focus, accommodative reserve and relative distance magnification will usually carry the day at near for him.
I worry more about distance acuity because it usually involves dynamic acuity, while near acuity is usually a static task. Visual compromise degrades dynamic acuity faster than static acuity.
Also, the new bifocal patient walks in the door with good distance acuity but bad near acuity. Any gain at near will be a relative improvement; any damage to distance acuity will be a relative loss. However, if a patient has a near task that demands a certain acuity, you'd better give him the ability to perform that task, or he'll give you back the bifocal lenses.

         The more specialized the lens, the more reward I get. Although I make the bulk of my money on routine patients, I earn more per minute working with bifocal, toric, keratoconic, post-surgical, and prosthetic lens patients. This kind of work is technically more demanding, requiring advanced skills and advanced patience, but it's a lot more rewarding.

         Contact lenses and refractive surgery feed off each other. Contact lens patients have been my best source of refractive surgical patients. Conversely, those seeking refractive surgery who aren't good candidates, are great contact lens prospects. Build your practice by actively promoting both contact lenses and refractive surgery.

         We're in the vision correction business, not the contact lens business. Some people are surprised that I'm an ardent supporter of refractive surgery when I prescribe contact lenses all day.
The truth is, both are viable methods of correcting ametropia. To cling to one while ignoring the other is to do a disservice to your patients and your practice. Remember, the guy who made buckets was in the water transportation business, not the bucket business. The public water works killed his business, no matter how much he improved his buckets.
The same thing will happen to us if we think that we're just in the glasses business or the contact lens business. Remembering why we do what we do is more important to our success � and to our patients' satisfaction with us � than remembering what we do.

Share your Zen

There you have it. I've shared my Zen of contact lens practice with you. I've tried to use some humor, a few mixed metaphors and some stilted phrases � all in the hopes that some of what I've discovered will stick in your mind.

The good part is that your Zen and my Zen might be different. So, now it's your turn to share your particular Zen with your colleagues.

Dr. Newman is in solo practice at the Plaza Vision Center in Dallas, Texas. He's a diplomate in the Cornea and Contact Lens Section of the AAO.

Optometric Management, Issue: December 2000