Contact Lens Business
Working With Disposable Torics
The current generation of lenses is better than ever. Make a note of these tips for satisfying patients.

BY DIANE BROE, FCLSA

Despite some initial skepticism on my part (about patient acceptance), disposable lenses have had a positive impact on our practice. Their health benefits and convenience are unbeatable. However, toric disposables have always seemed problematic, and many doctors have been slow to offer them.

Now, with the advent of better manufacturing techniques (from lathe processes to cast molding) toric disposables have become a valuable part of our practice. And our patients need them: Researchers estimate that 35 to 45% of the individuals who are eligible for contact lens wear have enough astigmatism that they'd benefit from a toric lens.

Here, I'd like to share some strategies for dispensing the new toric disposables.

CHOOSING THE RIGHT LENS

Issues worth considering when fitting these lenses include:

Corneal vs. lenticular astigmatism. Be sure to take into account the type of astigmatism your patient has.

• If the patient has a lot of corneal cylinder, you may want to consider prescribing a back-surface lens design. This will improve lens orientation and stability, thus providing better acuity.
• If the patient has lenticular astigmatism, look at the lid anatomy to decide whether a prism ballast or double slab-off design would work better. (Generally speaking, patients with small or tight apertures will do much better with a double slab-off design.)

FDA classification. Toric disposable lenses are available in all four FDA classifications, so choose the lens that will best suit your patient's needs. For example, if your patient has a dry eye problem, you may want to consider an FDA Classification I lens. The low water content of this type of lens will mean less evaporation, and the nonionic (more deposit-resistant) surface will avoid exacerbating the patient's problem.

Also, take the patient's condition into account when choosing a care system. For a dry eye patient, I recommend a hydrogen peroxide care system to spare the patient the chemicals and preservatives in multipurpose solutions (which can contribute to dry eye).

Small amounts of astigmatism. Don't be afraid to put patients who only have .50D to .75D of astigmatism into toric lenses instead of spherical disposables. Give them a chance to experience their vision with and without the cylinder correction. Many patients with only .50D of astigmatism will really appreciate the difference the toric lens makes.

Some doctors have avoided this option in the past because of the likelihood that patients would return with complaints and require further fitting. However, today's lenses are much easier to fit and more comfortable than those available in the past. (They're also more affordable for your patients.)

Diagnostic lenses. Diagnostic lenses are available in toric as well as spherical sets. Using them will increase your patients' success and enhance your practice efficiency. (I find it helpful to have a diagnostic set that falls into each of the four FDA classifications.)

Fitting fees. One last thought: As with any contact lenses, if a patient brings in a coupon for a free trial pair, make sure you charge a fee for your time and effort. Because toric lenses require more chair time and expertise, the fee you charge should be correspondingly higher for fitting them.

IT'S A BRAND NEW DAY

Disposable toric contact lenses have become more reproducible and dependable in the past few years than many of us ever expected. As a result, the current generation of lenses can be a wonderful addition to your contact lens practice. Offer them to your patients -- you just may be surprised at the results!

Diane Broe is president of the Contact Lens Society of America and has also served on the board of the Minnesota Contact Lens Society. She's been employed at Park Nicollet Clinic in Minneapolis for 15 years and is currently supervisor of the contact lens department.