Committing to Corneal Reshaping
This vision-correction option is a great area in which to specialize, but it requires your involvement.
Is it a good match for your practice?
BY BRUCE T. WILLIAMS, O.D., Seattle, Wash.
Even though this article focuses on incorporating corneal reshaping into your practice, I feel that I should really be telling you how to keep it out of your practice. Now, you're probably wondering why I would say such a thing, and the answer is that by incorporating this vision correction option into your practice, patients will start flooding you with questions about it.
That's really a good thing though, because it demonstrates the tremendous interest patients have in this new modality. But despite my inclinations, I'll give you an idea of what it's like to actively involve yourself in the fitting of corneal reshaping contact lenses.
What patients "know"
Many patients are under the impression that corneal reshaping doesn't work or that experts need to study it more because their previous eyecare practitioner was kind enough to tell them so. And quite a few patients know that corneal reshaping involves all of the hassles of contact lenses (e.g., cleaning, using storage solutions, requiring replacement lenses, biannual to annual exams, etc.). They probably also know that it's safe and reversible. They may want to return to a little myopia when they reach early presbyopia.
Creating interest is easy
Whatever the reason -- be it cost, safety, reversibility, ability to adjust for prescription changes, effective reduction of myopia progression, no age limitations or change to monovision for presbyopia -- patients will pay you for a relatively simple procedure that you accomplish with lenses that you probably already have in your fitting set.
My patients have a tendency to sneak behind my back and ask my staff questions -- questions that I could easily answer if I wasn't so busy fitting corneal reshaping lenses. My receptionist wanted to try corneal reshaping two years ago and now wears her lenses every other night and won't stop talking about it.
The staff leaves brochures all over the place and they send out newsletters, put together inserts with manufacturer-supplied compact discs for college campus newspapers and they even put little messages on statements and mailings.
One patient was so happy with the outcome that he, being an ad man, put together a short, public service-type statement for me that we ran on our local national public radio station during drive times. Boy, that stirred things up. People are still telling me that they heard about it there and that was a year ago!
Have I piqued your interest yet? If so, then the first step for you is to get certified.
Obtaining certification to fit these lenses is easy. You can do it online, at any number of conventions or, if you prefer, at what's called Web Training Seminars (live, online and interactive seminars). You can receive basic training and certification in two hours. Advanced clinical training and practice management seminars are available on a monthly basis.
Even if you're not sure you want to actually start fitting these lenses in your practice, you should still get certified. It will be a learning experience that will help you in your everyday understanding of GP contact lenses. Certification will also give you a little greater satisfaction in knowing that contact lens corneal reshaping works well, so when you tell a patient that corneal reshaping doesn't work or that it needs more study, what you're really doing is sending them to someone like me. I'm the one who will "suffer" the consequences. (Incidentally, when a patient asks me directly whether corneal reshaping works, I tell him that corneal refractive therapy is a science that's backed by unequivocal mathematical calculation and indisputable clinical results.)
Fitting with finesse
Fitting these lenses is a compilation of everything you've ever learned about GPs -- just simpler. You're still dealing with sagittal depths and cord diameters, but now you're just adding a proximity control factor. The manufacturer's consultation team is knowledgeable and accessible. Although corneal reshaping is some of the easiest GP fitting you'll ever do, it can prove time-consuming in the early stages of the learning process. Pace yourself and build your CRT practice slowly. As you develop your clinical skills with this fitting technique, you'll find that you're able to become efficient at managing several patients at a time and you'll become more profitable as a result.
It really is easy
The principles are straightforward and easy to comprehend. Too loose or too tight. Simple. Too much or too little edge lift. Easy. Sagittal depth too great or too shallow.
Something that really bothers me is when a patient says, "I think I could see one or two letters on the bottom line with my contact lenses in" when they're not wearing their contact lenses or their glasses. These patients don't understand the improvement that corneal reshaping lenses has made in their vision after I decreased the return zone depth by 25 µm and increased the landing zone angle by one degree for a total change of 12 µm and about .25D.
Did I mention the subtle near effect that you get from the steepness in the midperiphery under the return zone of these lenses? It's like a plus one add. One redeeming grace for you, as a fitter of corneal reshaping lenses, is that it's a lucrative program that's self-sustaining in terms of patient referrals. The more you fit, the more you fit. Believe me, when you get two or three hundred of these happy CRT patients out there, more people are going to know your name.
You have nothing to lose
Time is like money -- it's no fun until you spend it. So spend some time getting to know corneal reshaping and have some fun in the process. You just may find it rewarding.
is a member of the American Optometric Association, the Orthokeratology Academy of America, the British Contact Lens Association and the British Orthokeratology Society. He practices in a contact lens-focused general practice.
Optometric Management, Issue: May 2005