How to Create an Evidence-Based Contact Lens Practice

In today’s market, it's easy to view contact lenses as a commodity that simply comes in a box and can be vended out using a one-size-fits-all approach. There is an ever-increasing pressure from patients seeking a cheap and speedy solution turning to big box stores and online retailers.

With these influences, fitting decisions can become dictated by revenue, price per box, and convenience. However, during optometry school, we spent a significant amount of our time learning how to prescribe the proper contact lens.

Doing so involves contemplating factors, including material properties, lens designs, and optics, as well as thoroughly assessing each individual patient to determine who might best benefit from a particular offering or require a specialty version, such as rigid gas permeable (RGP) or scleral soft contact lenses.

As with any medical device, it is imperative to marry the proper product to the proper patient, which requires using this evidence-based approach.

What is evidence-based care?

In an evidence-based practice, current research, trusted studies, case reports, clinical expertise, and individualized evaluation inform patient management decisions.^1,2

In evidence-based care:

Existing evidence is analyzed to guide treatment decisions and care.
Published evidence from ophthalmologists and optometrists has undergone a peer-review process prior to being integrated into clinical practice.
Every effort is taken to eliminate any bias and conflict of interest in decision-making.
Clinical recommendations from studies and research guide treatment.
New evidence is incorporated on an ongoing basis.
Existing evidence is reviewed every 2 to 5 years for accuracy.

Incorporating evidence into a contact lens practice

The key to contact lens success is to match the right lens to the right patient at the right time.

To do this, you must address several questions:

What is their prescription?
What is their overall ocular health?
What does the ocular surface and tear film look like?
What are their daily vision and lifestyle needs?
What does the latest research say?
What new proven products or innovations in design are now available?

Treatment based on these findings and the most relevant research constitutes evidence-based optometry. By looking beyond cost and revenue, and placing the impetus on individualized fitting and prescribing protocol, practitioners can ensure optimal outcomes.

3 top benefits of evidence-based contact lens fittings

The advantages of evidence-based fitting are essentially threefold: patient satisfaction, professional fulfillment, and practice success.

1. Patient satisfaction

As optometrists, there is a fiduciary responsibility to patients to provide them with the most appropriate evidence-based choice of products. Once the best options have been presented, patients should be included in the decision-making process to increase satisfaction and reduce dropout, leading to better overall results.³

2. Professional fulfillment

Being a contact lens vending machine is not the goal of most optometrists. Simply put, job fulfillment comes from utilizing your training, employing your experience, and seeing ever-improving results within your patient population. Engaging in evidence-based optometry promotes ongoing learning and career development.

3. Practice success

Whether you measure practice success by a full schedule, number of associate optometrists employed, or revenue, taking a patient-centric approach often leads to both word-of-mouth and online reviews—which are key to garnering more patients and growing a viable practice.

For example, in 2009, I opened a part-time practice. In 2024, we are hiring our fifth doctor and opening our fourth location. I attribute this expansion to maintaining a laser focus on the patient.

How to establish an evidence-based contact lens practice

The most critical aspect of establishing an evidence-based practice is education—for both the clinician and patient. The onus is on the optometrist to continually increase their knowledge.

1. Read and research

Set aside time each week to expand your comprehension of innovations in material and design. Read the latest peer-reviewed journals and review studies that are registered on ClinicalTrials.gov.

Marketing materials from contact lens companies can also be valuable resources, but make certain to vet the information for bias.

2. Network with key opinion leaders and industry professionals.

Attend meetings and conferences with colleagues—such as the American Academy of Optometry's (AAO’s) Academy to be held in 2024 from November 6 to 9 in Indianapolis and the Global Specialty Lens Symposium held in Las Vegas, Nevada each January.

At these conferences, optometrists can attend talks from industry professionals, have in-depth discussions with colleagues, and be the first to hear about design enhancements and product releases.

3. Value vendors

Instead of viewing vendor appointments as a necessary evil, take full advantage of the representative’s expertise and knowledge. Ask about design improvements, merits in materials, and, even more importantly, the documented pros and cons. An honest and well-informed rep should be prepared to discuss both a product’s strengths and shortfalls.

Establish the upsides—and downsides—by asking questions, such as:

What is this lens designed to optimize?
What benefit should my patient see from using it?
Where does that benefit apply (i.e., dryness/evaporation, comfort after 6 to 8 hours, night driving)?
Where is the shortfall with this lens?
Who is the ideal patient for this lens?
Which patients would be best served by a different product?

4. Make the most of mentorship

In the words of John F. Kennedy, “A rising tide lifts all boats.” I take personal responsibility in helping the profession as a whole rise and, therefore, am happy to serve as a mentor. I’ve found that many of my seasoned colleagues feel the same way.

The ultimate goal is to see the field of optometry grow and flourish—which is even more important considering the current shortage of eyecare professionals in certain underserved areas.

Finding a mentor whose core clinical values and philosophy of care align with your own is key.

5. Expand evaluation

When evaluating the patient, in addition to utilizing the tried-and-true questionnaires and diagnostics, employ all of the technologies available and take a holistic approach, thoroughly assessing overall ocular health.

A comprehensive ocular evaluation may include:

Performing a new refraction and not over-minusing.
Implementing lissamine and fluorescein dyes to analyze the ocular surface to determine if the patient suffers from underlying dry eye disease.
Checking for Demodex blepharitis.

6. Pivot with purpose

There is a fine balance between giving a lens an adequate chance and “failing fast” to mitigate problems and increase satisfaction. To the first point, there is no lens that is going to be perfect for every individual. However, just because a product does not work for one patient does not mean it will not be ideal for another.

With new products, use your acquired evidence to choose at least 10 patients who could benefit from the technology. If it works for 60 to 70% of those, I consider it a success. I also reevaluate those for whom it did not work and analyze why to avoid the same situation in the future.

And, as fitting failure is inevitable, it is important to understand that chair time is equally valuable for you and your patients who do not want to return again and again. When a dissatisfied patient revisits your chair, instead of resigning yourself to a trial-and-error approach, try to look at them with fresh eyes and use all of the knowledge at your disposal to choose the right lens based on the entire set of clinical and lifestyle factors.

Prioritize patient education

As mentioned, education is twofold. Don’t underestimate the patient’s desire to be actively involved in their own eyecare and the decision-making process. Openly share your product and prescribing knowledge, and be transparent about why you are choosing a particular lens for them. This also applies when switching a patient from one lens to another.

Sample patient conversation:

"When I look at you today, I see that, despite being in your twenties, you seem to have an early, middle-aged tear film. Our tear film decreases by 50% by the age of 50, and your contact lenses always interact with that. I also see there's some irritation on the base of your lashes, so I’d like to talk to you about lid scrubs.

Because of your tear film I’m going to put you in contact X, which is made to mimic your natural tear film. Also, since you’ve told me in your history that you spend a significant amount of time looking at a screen, this contact is going to give you that better comfort.

You see, our blink rate slows by more than half when we're on a screen, so this lens is going to help you maintain your tear film. As a result, I think you're going to experience less eye fatigue and better comfort at the end of the day in this product."

In conclusion

As conscientious clinicians, we must avoid the pitfall of profit first and instead put the patient first. To do this, it is imperative to commit to continued education, as it will increase both personal and patient satisfaction and, in turn, long-term growth and profitability.

Research-based knowledge is the cornerstone of evidence-based care. When an evidence-based approach informs all of our contact lens fitting decisions, we enhance the level of confidence our patients feel, reduce dropout, and influence better overall results.