Developing thoughts

PRACTICE MATTERS

Developing thoughts

In a seemingly mad world, it’s crucial to take time out to recharge, writes Phil Mullins

This way, that way, over there

Have you ever had the feeling that you have been invited to the Mad Hatter’s tea party? Where time seems to stand still and everyone around you is stark raving mad and talking absolute gibberish? Then you sit there and think: is it me? Not wanting to be too deep nor too flippant, I believe we have been stuck in a time warp for the last 18 months of the pandemic. The rates of Covid remain high across the world, restrictions keep changing, sometimes without rhyme or reason, and the politicians seem to all be talking at cross purposes. So how are we meant to make sense of it all and keep our focus?

I have to declare that I’m not an expert, but from a personal stance we have to make sure that our family, friends and those we work with are all looked after. Not only to keep safe from the virus itself, but to make sure you offer support for those who are struggling. Mental health, thankfully, is no longer stuffed in a cupboard out of the way, so keep an eye and see who may be struggling. This is particularly important if you have staff who have been affected by the virus, who may have had to handle illness, death, self-isolation and much more. There is plenty of help out there, so make sure that no-one is left behind.

TAKING TIME TO RECHARGE You also need to take time for yourself. I know many of you have worked tirelessly through the last 18 months to keep your business afloat and although some businesses have sadly gone, the majority of independent practices are still here and are now doing well. For years, it has been accepted in this country that working long, hard hours is a good thing but in reality, burning yourself out doesn’t do anyone any good – least of all you.

I recently took a week’s break to a lovely cottage near Barnard Castle (I was very good and avoided posting Dominic Cummings sight test jokes all over social media) but it was great to take time away, ignoring all emails and phone calls and recharging the batteries. Taking that time out means I’m refreshed and more focused and in a better place, which is good for me and the business. So make sure you take the time you need to recharge.

MOVE TOWARDS HYBRID MODEL But how do you move away from the feeling of being stuck in time? In my July article, I spoke about being flexible in practice, be that opening hours, clinic times or products offered – and that certainly will help. But you may need to fundamentally change something or even your entire business model. Much talk in the last year has been around moving independent practice towards a more private model, and that would certainly move you forwards. However, it’s not for everyone and my personal view is that a hybrid structure is where most independents will end up; with payment plans and a focus on private, but still offering some NHS work at set times.

More realistic is to focus on expanding one area of your business, such as dry eye clinics, or introducing a new area. This could be behavioural eyecare, independent prescribing or myopia control. There are some truly great products coming to the market in all of these areas. Just take myopia control, which is such an important area for the future vision of our children. New products are coming online all the time and with both contact lens and spectacle lens options, you can offer your patients real choice.

It’s a great way to develop not only your business but your team too: you can encourage a dialogue on how to introduce your new specialty, go through the training together, and look at how everyone will be involved in offering the service. You may be surprised at how well people rise to the challenge and get behind something new and exciting.

So why not shut out all the gibberish, let the Mad Hatter and the Cheshire Cat do their thing and focus on you and those close to you. Get that right and you’ll make a difference to more than those nearest to you; you’ll make a difference to everyone you come into contact with. But remember to always make time for a sit down and a lovely cup of tea...

We’re all mad here

Case Study Series Biofinity® toric multifocal, from CooperVision CASE #2: 44-year-old teacher with active lifestyle

Grow with your astigmatic presbyopes

Patient background

A 44-year-old female presented to the practice as a new patient. She was a teacher with demanding needs for near and computer screen viewing and was also keen to avoid compromising the quality of her distance vision at work. Outside of work, her hobbies included playing the piano, reading and running. She mentioned she liked the freedom of contact lenses, and the fact that they were unnoticeable when worn.

Previous lens wearing experience

The patient was a lapsed contact lens wearer and currently, albeit somewhat reluctantly, relying on spectacles. She had previously worn single vision toric contact lenses, giving up wearing them a few years ago when she could no longer comfortably focus on small print while reading. She had previously tried monovision but was unable to tolerate the disparity in focus even with a modified monovision option. She continued for a while using single vision toric contact lenses plus top-up reading spectacles to manage the near work, however, this solution did not last long; it was too inconvenient, and she did not like how using reading spectacles made her feel and look ‘old’. She had ultimately stopped wearing contact lenses, reverting to full-time spectacle wear. She ideally wanted to be able to wear contact lenses that could help with clear vision for near tasks as well enable her to see at distance. She had heard about multifocal contact lenses and was hoping that switching to a multifocal design could help achieve these aims, however, she had previously been told that multifocal contact lenses would not be a viable option because of her astigmatism.

Biofinity® toric multifocal lens fitting notes

This patient’s high level of motivation suggested she would be a good candidate for Biofinity® toric multifocal. Her up-todate spectacle refraction was:

R -2.50/-1.50 x 75

L -2.75/-0.75 x 85 with +1.00D reading addition

Based on the fitting guide the following initial Biofinity® toric multifocal lenses were trialed:

The lenses settled quickly and when assessed after fifteen minutes showed less than five degrees of rotation. They also had optimal centration and fit and, importantly, were rotational stable even after large eye and head movements. The patient immediately noticed the difference in her visual experience. She achieved both distance and near binocular vision of 6/6 and N4 (distance and near). She was extremely happy with the overall quality and clarity of vision at distance, intermediate and near, reporting that they all exceeded her expectations. She was also very happy with the comfort of the lenses and indicated that she wanted to continue with the lenses.

Case outcome and lessons learned

This case describes a patient who had dropped out from lens wear who was highly motivated to return to contact lenses. Her experience illustrates the positive benefits that toric multifocal contact lenses can offer astigmatic presbyopes. However, the learning from this patient translates to all emerging presbyopic contact lens wearers in practice. They should be counseled early on about their contact lens options, making them aware that there are lenses available for them to help with near vision when the time comes. This proactive approach helps keep patients feeling happy, with corrected vision that performs for their active and youthful lifestyles. The multifocal part of this lens behaves exactly like the spherical Biofinity® multifocal lens and the toric part exactly as the Biofinity® toric lenses. Eye care professionals can have confidence in the performance of the lens, with simple, time-efficient fitting possible too. Following the fit guide led in this case to the final prescription being achieved with just one pair of trial lenses. The patient in this example mentioned the lenses were life changing, making her feel that she had her “normal eyes” back.

Ceri Lian Penson is a contact lens optician working for an independent group of 10 practices based in Norfolk and Suffolk. This is my 20th year in optics. I feel very lucky to be working in this time where I am spoiled for choice with lenses and have products available to allow me to fit almost any patient. I have a particular interest in presbyopic fitting as I enjoy giving patients their “old eyes back”. Biofinity® toric multifocal final lens prescription

RIGHT LENS LEFT LENS

Sphere power

-2.50

Sphere power -2.75

Cylinder power -1.25

Axis 75

Add power +1.00 (D lens)

Cylinder power -0.75

Axis 85

Add power +1.00 (D lens)

AVAILABLE PARAMETERS

Sphere power (DS) -10.00 to +10.00 in 0.25 steps or 0.50 steps beyond +/-6.50

Cylinder power (DC) -0.75 to -5.75 in 0.50 steps

Axis

5° to 180° in 5° increments

Add power +1.00, +1.50, +2.00, +2.50 in both D and N center designs