Thank you to Johnson and Johnson Vision for their support of this podcast episode. Dr. Erin Rueff is a consultant for Johnson and Johnson Vision. 

When we prescribe a contact lens and our patient returns stating that they are unhappy with the performance, we often ask our patient to categorize their complaints into two separate buckets: vision or comfort? When a patient comes in and says that their eyes are uncomfortable at the end of the day with their contact lenses, we often think that must mean the lens is dry. But discomfort to a patient can be as driven by eye strain due to a vision clarity issue as it is by dryness or lens awareness. On this podcast episode, we discuss deciphering the patient contact lens experience with Dr. Erin Rueff, Chief of the Cornea and Contact Lens department at the Marshall B. Ketchum University Eye Center. 

It’s important to start a contact lens fit with a recipe to maximize success. As an optometrist a spot-on refraction is what a patient depends on – they might not remember that you caught that retinal tear, but if they can’t see well in their glasses, they will definitely judge you as a doctor based on that outcome. “I always am really careful to not over-minus, balance my refraction, and being very detailed oriented with my cylinder refraction,” Dr. Rueff explains about her refractive philosophy. Every year at their annual exam she makes sure that her patient’s new manifest refraction data is aligned with their contact lens prescription – for patients that have been coming for years and years, these prescriptions can start to drift away from each other and it’s important to always check the contact lens prescription even on a “happy” existing wearer. 

One of the most frequent mistakes that doctors make when transitioning from refraction to contact lens selection is ignoring even low amounts of cyl in favor of spherical equivalent. Studies have shown that low amounts of astigmatism (even just -0.75 DC) can greatly impact a patient’s clarity and subjective comfort. An estimated 47% of patients of patients have at least 0.75 DC of astigmatism in at least one eye, but toric contact lenses are only fit on approximately 25% of soft contact lens wearers. Fitting patients with toric lenses compared to spherical equivalent lenses have been shown to improve high and low-contrast visual acuity as well as subjective, patient-reported comfort (judged by a Convergence Insufficiency Symptom Score) in even mild and moderate astigmats. 

When it comes to multifocal contact lenses, Dr. Rueff encourages doctors to consider that “presbyopia doesn’t happen overnight.” She checks near vision on every single patient, and she finds that even in their 30s, many of her patients start benefitting from a low amount of plus at near. Dr. Rueff recently published a study looking at the effect of multifocal contact lens prescribing on the comfort of patients in even younger wearers.  Researchers found that many 35- to 40-year-old wearers preferred multifocal contact lenses for vision and/or comfort, suggesting that early and emerging presbyopes may benefit from multifocal lenses before they experience sustained blur. 

When it comes to add selection, it’s important to determine functional add and not over-plus patients at near. That’s where utilizing the fitting guide is so important to multifocal contact lens success. “I always say lose your pride, follow the fitting guide!” jokes Dr. Rueff about how she educates her students about successful contact lens fitting st...