Be a doctor
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by John Coble, OD, FAAO, and Tom Annunziato, OD
Many optometrists, unfortunately, do not recommend a specific artificial tear or contact lens disinfectant. When I have asked why, many have remarked that all of the solutions are good.
I do agree that most tears and solutions on the market are acceptable, but my concern is that we need to be doctors and instruct the patient on what we want them to use. When a patient goes to the store and is overwhelmed with all the options, they have no idea that some may work better than others for their specific needs.
Using tear film as an example, if there is an aqueous deficiency or an evaporative concern, not all over-the-counter (OTC) lubricants will suffice. As doctors, we need to explain to patients why we are prescribing a specific drop and instruct them to use our recommendation. Otherwise, the patient will continue trying various drops with limited relief. Also, we need to document our recommendations in the exam record for medico-legal reasons and so our front desk can reinforce our recommendations with the patient if they call. Never just hand out samples and say, “Try them and see if one works.” Be specific and understand the choices you make.
The same applies with contact lens solutions. Are they all the same? Do they all work? Maybe. But as a doctor, we need to instruct the patient on what may work best with their particular contact lenses. One way is to match the solution with the contact lens manufacturer. This will make a lot of sense to the patient and keep the patient using a quality solution. Most manufacturers of contact lenses have formulated their own contact lens solution. Matching contact lenses to solutions can eliminate the guess work for patients as they get mesmerized by the wall of choices at the store.
You know what works. Help the patient before they have problems or make assumptions that there is no difference since you did not tell them any different. There is a myriad of generic solutions on the market. If you don’t tell the patient why you are prescribing a particular solution for them, they may be tempted to go with a generic brand that is being promoted or costs less. Also, there is currently no law in place that prohibits a manufacturer from making the claim, “Compare to brand ‘X’,” when in reality the generic solution does not contain the same ingredients. The main ingredient may be present, but not the preservative molecule; for example, some solutions have brand-name preservatives while others may contain benzalkonium chloride and potentially cause adverse reactions.
So, be the doctor and recommend and prescribe the eye care product that you believe is best for the health of your patient’s eyes. It will be best for your practice and, certainly, best for the patient.
For more information:
Tom Annunziato, OD, is in general optometric practice weighted heavily in geriatric care in Ft. Worth, Texas. He can be reached at: TomAnnunziato@gmail.com.
John Coble, OD, FAAO, owns a multi-doctor medical optometry clinic in Greenville, Texas. He is also on hospital medical staff and an adjunct professor at the University of Houston College of Optometry. He can be reached at: DrCoble@EyeCareofGreeneville.com
Disclosures: Annunziato reports no relevant financial disclosures. Coble has previously been an advisor/lecturer for Alcon, Essentia, Essilor, Katena, NuLids, Ophthonix, OOGP and Percept.