Article Date: 11/1/2005


The Only Constant Is Change
Recognizing subtle changes will make you a better — and sought-after — practitioner.

EVERY PRACTICING optometrist has a patient who simply refuses to believe age is causing his reading problems.
"But I've had trouble reading before!" is a typical response. This example demonstrates the one thing that's constant in all patients: Change.

When examining long-established patients, however, we can fail to recognize important changes. This is particularly true for our contact lens patients. By paying attention to subtle changes, you can proactively address vision problems before patients notice them. They'll thank you for it.

Here are some examples of contact-lens-related changes that are easily addressed and can make a big difference in patients' comfort and vision.

Contact Lens Solutions

We all know a few contact lens wearers can't tolerate certain preservatives in multipurpose solutions, but many of us forget that other patients can develop intolerances.

Just because Mrs. Jones has used the same contact lens solution for years without incident doesn't mean she'll be able to use it forever. One sign that a patient is becoming intolerant to her lens care product is the presence of persistent bilateral, diffuse superficial punctate keratitis. This red flag may indicate your patient needs to use a different lens care solution.

Fine-tuning Monovision

Successful monovision adaptation doesn't guarantee a lifetime of good near and far vision. As someone with monovision ages, his reading prescription changes more often than his distance prescription. The disparity between his near eye and his distance eye becomes greater with each passing year. It's not uncommon for a patient to have difficulty adapting when this difference becomes too great.

Educating your patients about this phenomenon and the availability of multifocal contact lenses that provide excellent bilateral vision accomplishes two goals. First, patients will recognize the changes they're experiencing are normal. Second, they'll be relieved to know they don't have to give up their contact lenses. They may even decide to try multifocal lenses before they have problems.

Base Curve/Topography

Practitioners rarely discuss the dynamic nature of the human cornea, but this factor can have a serious impact on continued contact lens wearing success. Corneal shape depends on several transient components, including the aqueous and mucin layers of the tear film. What's more, the process of replacing dying epithelial cells with fresh cells constantly reshapes the cornea. As a consequence, you may need to change a patient's contact lens base curve, even if he's worn the same lenses successfully for years.

Embrace Change

Change is inevitable. No matter how much we and our patients try to deny it, we're all aging. Yes, even you young, vibrant optometry students and recent grads get closer to the dreaded presbyopia every day.

Recognize that change always will be an integral part of your professional career. Embracing change will keep you from becoming old and obsolete before your time.

Optometric Management, Issue: November 2005