09_05nOD_StreetSmartsRedesign
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