A Time to Refit - Challenges of replacing and refitting conventional soft lenses [ view all articles ]
Throughout the 1980’s, a “soft” contact lens meant a conventional yearly lens in a glass vial. The launch of disposable lenses 25 years ago1 brought about many new soft lens options throughout the 1990’s, even daily disposables. For those whose parameters were not yet available in a disposable, several annual replacement lenses were being offered as a quarterly or planned replacement. Soon disposable lenses expanded to include multifocal lenses as well as toric lenses, and more and more patients were able to convert to a frequent replacement lens.
Better hydrogel materials, followed by new high DK options in silicone hydrogel, meant even more patients being fit into disposable lenses. Today, about 99% of soft lens wearers in the US are in a disposable lens2.
Those patients remaining in conventional vial lenses are a small minority at about1%. However they represent some of the more challenging contact lens fits. Some practices may get more than their fair share of these patient. When the time comes to refit the conventional lens patient into a new product, there are many factors to consider.
Why were they in this lens?
Before refitting a patient who is currently wearing conventional lenses, determine why the patient is wearing this lens now. Knowing their history and their preferences can reduce chair time and facilitate the process. There are many reasons the patient may be in this lens:
· The patient prefers vialed lenses: Some patients are simply happy in the lenses they have been wearing for years. They don’t mind the modality, still get good vision, and like the price. If each yearly exam is just an update in Rx, and there are no signs of complications or over-wear, it is tempting to just prescribe the same lens in their updated powers. It is not until something changes (presbyopia, complications, discontinued product, etc.) that the patient is forced to be refit.
· They need custom range parameters: Many patients still in conventional lenses are those with high sphere powers, flat or steep corneas, or high cylinders who are beyond the parameters of most disposable lenses. They’ve been told they can’t wear an “off-the-rack” lens. If they have had satisfactory vision and no complications, it is not uncommon for the patient to stay in their conventional lenses with the assumption that there is nothing else available to them.
· Previous refits were unsuccessful: If in recent years a practitioner attempted to refit the patient, but they preferred the vision or comfort of their current lens, the patient may be hesitant to try again and go through the refitting process unless they are assured there are new options available. You may also find that some patients have not been offered the opportunity to change products because they haven’t had any issues.
The Time for Change
The most common reason a patient and a practitioner are faced with a refit is because a lens is being discontinued. Many excellent conventional lenses have been phased out over the past few years simply because of a lower demand. When a patient’s lens is discontinued, it can be a frustrating experience. The patient may be unhappy and resistant to change. Often it is only after the patient has purchased the lens and the practice tries to order it that they find out it is no longer available. This means the patient may have to come back in for a refit instead of a dispense. Before seeing the patient, a small amount of research can save you and the patient much trouble.
· Call the manufacturer: ask for a recommended replacement. There may be a newer or similar product of the same design with a different material. The design may have been sold to another manufacturer where it will soon be available. Otherwise, they may be able to recommend another product on the market with similar characteristics or another manufacturer that can replicate the design and parameters.3Call the manufacturer of the replacement product and ask for consultation. They may already be familiar with the discontinued product and recommend a product from their catalog than can serve as a replacement.
· Find out what made that product unique: Knowing what material, design and parameter the patient was wearing can help to find a replacement lens with that unique parameter. Were they in a small diameter? If it was toric, what type of stabilization design was it (prism ballast, thin zones…)? Did they need too high of a sphere power or cylinder power for disposables? If you know what made the lens unique, you will likely have the key to a successful refit. Search for a lens with those unique parameters and you may find several viable choices.
· Be prepared with a replacement lens: If possible, order the best replacement lens and have it in the office before the patient has to come back. The lens may be able to be refit in one sitting. If a patient is a candidate for a disposable lens, try to have one or two trial lenses also on reserve in case the patient is willing to switch.
· Know the patient’s limits: If you are unable to find a successful refit at the first follow-up, find out what your patient is willing to do. Are they open to a disposable or would they prefer to stay conventional? Are they open to trying a RGP (Rigid Gas Permeable) lens?Did they ever wear rigid lenses in the past? If so, why did they switch to soft lenses?4. Is their biggest concern pricing, comfort, modality, or vision?
New Products Available
Perhaps you’ve recently discovered a new product that can address the needs of a particular patient base that you previously would have fit into a conventional lens. A more frequent replacement or a newer material option may now be available to replace a conventional lens. Even if the patient is happy in their current product, a yearly checkup is a good time to offer to try something new. Many patients welcome a lens in a healthier material or a more frequent replacement provided they still get good vision. The availability of customizable silicone hydrogel lenses, as well as custom monthly lenses, has opened new doors for patientsthat were previously stuck in conventional lenses.5
If you have a successful refitting into a better product, be proactive and get ready to offer the new lens to similar patients. Being prepared with trial lens sets (when possible) and fitting/pricing information will make future refits of similar patients go smoothly. You may have only 7 or 8 patients in that particular lens, but those are all patients that will have to be refit in the future.
For the patient in a single vision conventional lens, the onset of presbyopia may be the first opportunity to discuss a change. It is tempting to simply start a monovision fit in the same lens. However, if the patient is willing, it may be better to introduce a multifocal product right away, even during pre-presbyopia6 (and prevent an inevitable refit once the monovision is no longer tolerable. Moving to a multifocal disposable may be an easy transition if the patient is motivated and has normal parameters. A more challenging fit may require a custom multifocal, but they are also available in frequent replacement options.
· More chair time: Most practitioners would say that additional chair time is the reason they might not offer to refit a patient in a conventional lens until they absolutely have to. Look at the refitting as something that will be inevitable, it comes down to a conversation with the patient.Do we do this now, or worry about it next year? Eventually the choice might be made for you.
· Refitting Fees:An unexpected need to refit a lens will certainly mean additional chair time. To be fair, this should mean an appropriate contact lens fitting fee. The patient may be unhappy about this if it was not expected. Some practitioners have found it helpful to not charge any additional and unexpected fitting fees until the follow-up visit when dispensing the replacement lens. The patient will appreciate the extra time to budget the unplanned expense. Explain that previous exam fees have only been a standard contact lens check, but now we need to re-evaluate. Refitting fee policies vary by practice, but the patients’ acceptance of the situation has much to do with your communication.7Establish your policy so that your staff can help to explain it and enforce it.
· Old Habits Die Hard: Even if the lens the patient is wearing is no longer available, some patients will be very unhappy if they have to change products. It is human nature to be resistant to change, and often a patient will want to place blame. Assure the patient that your goal is to find them a proper replacement lens if not an even better one.
The refitting process out of conventional lenses can be frustrating and time-consuming. However, there is a growing selection of parameters available in disposable, frequent replacement, and customized soft lenses to fill this need. Each refitting can result in a satisfied patient and potentially better future eye health.
1Heiting,Gary OD When Contact Lenses Were Invented All About Vision January 2010
2International Contact Lens Prescribing in 2011Contact Lens Spectrum, Volume: 27 , Issue: January 2012, page(s): 26 – 32
3 “Alden Optical Launches Phoenix Program” http://www.aldenoptical.com/news/20110210-expand-phoenix-program.phpJuly 23, 2010
4Phyllis Rakow, COMT, NCLE-AC, FCLSARefitting Soft Multifocal Patients Into GPsContact Lens Spectrum, Volume: 27 , Issue: March 2012, page(s): 40 - 42 44
5Neil Pence, OD, FAAO Replacing Discontinued Lenses Contact Lens Spectrum, Issue: September 2011
6Craig Norman, FCLSA Where Do We Go From Here? Contact Lens Spectrum January 2013
7Roxanna T. Potter, OD, FAAO Creating Policies for the Contact Lens Practice Contact Lens Spectrum, Issue: November 2011