What are the benefits of custom toric lenses versus other specialty contact lenses?
Dr. Napolitano: Especially with scleral lenses, a lot of patients who are not familiar with the product will feel intimidated by the larger lens. If you have ever seen a scleral lens in actual life, it can be intimidating. It’s big, it’s hard and it’s like “Oh my God! That thing has to go in my eye?” Then, they’re like “What other options do I have?”
Obviously, I feel that the patient that has more of an issue in terms of a corneal issue, or they have tried soft lenses and maybe they have severely dry eyes, and cannot tolerate the soft lens, that kind of patient is going to be more open to the idea of trying something different versus someone who just has Presbyopia.
For example, I have a lot of patients that are like 46, 47 and are just entering the presbyopia stage and they do have astigmatism and wear contact lenses. I don’t find those patients to be as open-minded when I mention scleral lenses.
Scleral lenses also have a learning curve to use them. It’s not just like the soft lens you pop them in and out. Some people don’t see the need to almost be bothered by all that extra work that goes into what a scleral lens.
Therefore, I have had success with custom soft toric multifocal lenses. I can keep these patients in soft lenses, keeping them happy with good vision. And on top of that, they have custom contact lenses that they cannot buy them online.
Are these custom lenses monthly wear? Daily? Weekly?
Dr. Napolitano: Monthly.
Are these covered by insurance or it’s almost not?
Dr. Napolitano: Usually it’s not a medically necessary contact lens like somebody who has keratoconus and needs scleral lenses. Normally, they have a visual plan. They will get an allowance for contact lenses, such as if they have VSP, where they can get say $130 allowance. So, it’s not a medically necessary contact lens & will incur out of pocket expenses.
Would you say the cost though as far as comparatively to daily lenses? Is it close or is it still more?
Dr. Napolitano: Probably more than daily lenses.
So, if a patient were to wear these lenses, would it be because they were really struggling with contacts and don’t want to wear eyeglasses? In other words, this is the next best option that’s somewhat expensive but less expensive than scleral lenses and less intimidating?
Dr. Napolitano: Not expensive as sclerals but definitely more expensive than your standard soft contact lenses.
When patients wear toric lenses, are they generally very happy with it? Do toric lenses have a lifespan, where after a few years, it doesn’t help so much?
Dr. Napolitano: Well, most likely their vision will stay the same unless they have some other issue going on already. But what will change would be the presbyopia, so the near vision will deteriorate as time goes on. So, we do find the patient 2-3 years down the line will need an updated prescription.
But these patients enjoy them? In other words, these are basic soft contacts that are easy to get used to?
Dr. Napolitano: Absolutely.
In one week, I had 3 patients with astigmatism coming in asking me about these contact lenses. Candidates for toric lenses often will com in saying something like “I can’t read! Even with my contact lenses, I still can’t read. What do I do?”
Often, a patient with a high astigmatism plus presbyopia will visit other doctors for contact lenses, and the response is often “there’s no way you can wear contact lenses.”
Then, when they come to my practice, of course, I can fit her in contact lenses.