Speciality contact lenses have historically been associated with unusual conditions and extreme prescriptions but advances in technology and the emergence of myopia control is making practitioners think again.
A collaboration between SynergEyes, Menicon, UltraVision and Contamac was curated by Positive Impact resulting in a day of lectures and discussion on specialist contact lenses to raise awareness and educate. On offer were 8 CET points and presentations on Hybrids, ortho-k, scleral and soft lens options as well as a focus on myopia control. The day also provided information on the business opportunities specialist lenses present along with free products and offers worth £340.
The day’s keynote speaker was Leightons’ Indie Grewal who spoke about commercialising niche contact lenses. Grewal, the current holder of the Optician Contact Lens Practitioner of the Year Award, took delegates through his systematic approach to contact lens practice and how he invests time in understanding his patients’ needs to draw them in, and keep them on, contact lenses.
He demonstrated, through examples, how specialist and mainstream lenses can work together and how specialist lenses don’t have to be time consuming. He used the example of child brought in by his mother embarking on ortho-k.
While the lenses were settling in he struck up a conversation with the mother about multifocal lenses. This resulted in a fit, and direct debit, for Dailies Total1 Multifocal. The direct debit for the mother’s lenses was higher than that for the ortho-k.
Grewal also touched on the business rationale behind equipment. A show of hands revealed most in the room had OCT and topographers and Grewal contended that a £9,000 topographer was an easy investment to justify against £30-£50,000 spent on an OCT. Video imaging is also a great tool, he said, for highlighting non-compliance and backing up lens upgrades.
Data mining
Practice technology of a more general kind is also a powerful tool for building a contact lens business. Grewal explained how he had used his database to identify patients who might be suitable for specialist lens types having previously been drop outs from other types of lens wear. A classic example would be toric wearers who drop out with the onset of presbyopia. ‘We are hoping Duette will satisfy that,’ he said.
Other reasons for specialist wear may be more straightforward such as the link he has with the local swimming club. It sends members to him for ortho-k, a convenient option for swimmers. ‘There are a lot of people who would like to be spectacle-free and speciality lenses can help them do that,’ he added.
Another example of successful database use was provided when Grewal had the opportunity to try Coopervision’s Misight myopia control lens. From a database of 100 patients interested in myopia control 72 went on to try the lenses.
Keeping graphical forms of patient data can also be powerful. Grewal showed how a graphical representation of myopia progression can be a power tool when suggesting control options. Grewal’s practice has 29% of its business in contact lenses, half of which is multifocals, 30% myopia control and 15% RGPs.
Referring to Coopervision data presented at the BCLA conference Grewal showed how a practice with 8.2% of its business in contact lenses could increase its turnover from £250,000 to £380,000 by upping its contact lens activity to 21.8% of its business. ‘If you do more contact lenses you will be more profitable,’ why not try it, he said, all you have to lose is a little bit of time.
Hybrid lenses
Moving away from myopia control, Phil Thompson, professional services lead for Synergeyes, provided an update and round up of the latest on hybrid lenses. The theme was very much the best of both worlds offered by an RGP centre and a silicone hydrogel skirt, offering visual correction for corneal astigmats, high astigmats, multifocals. Innovative features such as the blink operated tear pump of the Ultra Health lens showed the versatility of a lens offering the visual benefits of a high Dk centre and the comfort of a silicone hydrogel skirt.
Perhaps the most medical talk of the day was from Contamac’s professionals services consultant Martin Conway who gave an update on sclerals. He said about seven years ago there had been a ‘little explosion’ in sclerals driven by the US insurance industry and its decision to classify sclerals as a prosthetic device.
This and ortho-k had created a mini-boom for RGP. As sclerals tend to be used for irregular cornea, post-graft, post-lasik and dry eye applications many are fitted in hospitals, said Conway. He went on to describe the benefits, fitting process and differences in attitudes to limbal landing in Europe and the US.
Soft lens advances
Delegates who were left thinking Specialist Club was all about RGPs, sclerals and hybrid lenses were put right by Lynn White, clinical director of Ultravision, who spoke to the topic: Can I fit a soft lens? Always say yes.
Lynn White: 95% of patients could be fitted with soft lenses
White went on to say that in theory about 95% of patients could be fitted with a soft lens. Modern technology meant bespoke lathe cutting of contact lenses was easily available to practices with clear benefits of better vision and better fit for the patient.
She said moulding was used for mass market geometries, due to its lower cost. Custom lathing the front and back surfaces was inherently more expensive but the fusing of those two techniques was on its way. ‘Moulding the front surface and lathing the back surface would bring the costs down,’ she said.
Myopia control was a reoccurring theme and Josie Barlow, professional services manager at Menicon, looked at ortho-k’s role in its management. She said myopia control wasn’t just about keeping people out of spectacles and outlined the association myopia has with a range of conditions from retinal detachment to maculopathies.
The increasing incidence of myopia means that by 2050 half the population of the world will be myopic. The rates of myopia in some Far East countries is already at 90% and while in Europe and the US that figure is between 20% and 50% the incidence in the UK has more than doubled since the 1950s. ‘This is not an evolutionary development, this isn’t genetic, it’s is about what we are doing to ourselves,’ said Barlow.
She went on to define myopia control and discuss the causes of myopia and the role of axial length and hyperopic defocus in the periphery. She said at present the known control methods are soft lenses, such as Coopervision’s Misight, Atropine, which has yet to be licensed and ortho-k, a widely available and known technique.
She outlined ortho-k, currently the only freely available option, before concluding that it was a safe and effective approach. The landscape is changing with MiSight becoming more available and Atropine due for licensing shortly. Returning to myopia control she suggested practitioners should be discussing options with patients. ‘If you are not having conversations with your patients start having them, myopia control is going to be talked about more and more.’