PREPPING YOURSELF FOR PATIENT QUERIES

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Because patients want to better understand their condition as well as hear about available treatment options, ECPs need to take time out for questions.

Here are some commonly asked questions—and answers—on irregular corneas.

We regularly see patients who have irregular corneas, mostly from keratoconus, corneal transplants, and post-LASIK ectasia. And that means answering a lot of questions, especially among those who have early stage ectasia. Everyone wants to better understand their condition as well as hear about available treatment options. To help you help your patients, we’ve culled some of the most commonly asked queries from patients, along with how we go about answering them.

Q: Did I do anything to cause this condition?
A: In the case of keratoconus, there appears to be some evidence that points to genetics being the primary contributor to the development of the irregular cornea. In some people this may be exacerbated by excessive eye rubbing. For keratoconus and other corneal ectasias, we want to diminish further damage by educating patients to avoid rubbing their eyes. We therefore recommend that those with atopic disease or ocular allergies leave the office with a prescription for topical allergy medication and a recommendation for regular artificial tear use.

Q: Why can’t I use regular contact lenses or glasses to make my vision better?
A: The shape of the eye is normally round. As such, the top and bottom, right side and left side of the eye are symmetrical to each other; contact lenses and glasses can be created to fix the prescription. In a patient with an irregular cornea, the shape of the eye has no symmetry and so glasses and/or contact lenses that have a standard prescription will not correct the entirety of the prescription. Instead, a custom contact lens needs to be designed to fit that patient’s eye shape and create a unified prescription.

Q:  Can’t I just get LASIK surgery to help this situation?
A: No. In the case of keratoconus, the eye shape is distorted as a result of a thinning of the corneal tissue. Having LASIK surgery will only make the condition worse. For patients who have had a corneal transplant, the situation may be a little different.  Depending on the graft-host interface, some patients may be candidates to have LASIK surgery. Usually LASIK is best done to correct any residual myopia, hyperopia, or regular astigmatism. If a patient has a significant irregular shape following transplant surgery, his irregular shape may be managed by strategic stitch removal or through the use of a custom contact lens.

Q: Why are the contact lenses for my eyes so much more expensive?
A: The contact lenses for patients with irregular astigmatism have to be custom made through a custom laboratory. Here’s the “but:” Even with all of the measurements and fitting process, the contact lens may not work after it is initially fit. Modifications to the lens may need to be made in order to create the optimal fit and vision. Because of its customized nature and special laboratory for creation, these lenses are usually more expensive than traditional contact lenses.

Having a basic perception of the kinds of questions your irregular cornea population may ask will help you help your patients better understand their lens options and be more amenable to their challenges and solutions.

Mile Brujic practices at Premier Vision Group in Bowling Green, OH; David Kading practices at Specialty Eyecare Group with locations in Seattle and Kirkland, WA.

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