PRACTICING OPTOMETRY MEANS that you get to address a broad spectrum of a patient’s visual and ocular health needs. Comprehensive eye exams go far beyond simply asking, “One or two?” Doctors who find themselves being passionate about certain sub-specialties of the profession can dive deeper and specialize in those topics in order to provide the highest quality care for patients with unique ocular and systemic conditions. During my time as an optometry student, I remember being initially interested in all of the available specialties – recognizing how each distinctly served populations that would otherwise struggle with vision and health challenges.
Specifically, early encounters in a specialty contact lens clinic highlighted the immense impact contact lenses can have.
I had the good fortune of managing a group of particularly complex keratoconus cases alongside talented optometrists in the cornea and contact lens clinic early in my optometry training. These patients walked into our exam room with vision that kept them from driving, working or even taking care of their families. Their reduced vision was disrupting their life and ability to perform everyday functions.
The medical devices we designed for them, however, transformed their vision in a matter of seconds. Once specialty contact lenses were applied to the eye, the patients saw better than they had in recent memory or, in some cases, ever. There was no anesthesia. There was no need for surgery. There was no recovery time. These patients arrived disabled and left with new visual abilities. I remember thinking, “Is this too good to be true?”
Luckily, for many patients with corneal pathology, ocular trauma, ocular surface disease and unique refractive errors, the answer to that question is no. When the cornea develops an irregular shape or the ocular surface becomes unhealthy, a specialty contact lens may be the only way a patient can achieve functional, comfortable vision. As a provider, the immense amount of professional and personal satisfaction I get from being able to provide specialty contact lens services is immeasurable. Few other specialties in healthcare can deliver such life-altering changes with minimal disruption. In many of these fitting situations, tears are not just examined in the slit-lamp – tears of joy and relief are sometimes expressed by the patients, their family and friends and providers.
The foundation of the specialty contact lens world is based in using specific types of contact lens materials and designs to fit patients with irregular corneas. These patients may have conditions like keratoconus that cause the cornea to thin and change shape or have irregular corneal surfaces due to trauma or previous surgeries. Optometrists can utilize gas permeable contact lens materials, corneal or scleral lens designs and evidence-based fitting strategies to design contact lenses that are specific to each individual eye. A unique aspect of the world of specialty contact lens fitting is that, for many complex cases, a fitting will require the optometrist’s solid understanding of the science of contact lens fitting paired with a dose of innovative and artistic problem-solving to achieve the desired results. This practice of science-based creativity makes working in this specialty fun and interesting with every new fit.
Beyond fitting corneal and scleral gas permeable designs for irregular corneas, the cornea and contact lens specialty has expanded into fields like ocular surface disease management. Scleral lenses are now used to alleviate signs and symptoms for patients with all levels of dry eye severity. Specifically, scleral lenses can offer significant relief for patients who suffer from advanced aqueous deficient dry eye, neurotrophic and neuropathic disorders, and those with systemic conditions that cause severe ocular surface degradation (Steven-Johnsons Syndrome, graft versus host disease, etc.).
Similarly, we’ve seen cornea and contact lens specialties embrace and make continued advancements in the area of myopia management. Specialty lenses like orthokeratology and soft multifocal contact lenses can be used to correct vison and slow progression of myopia in kids, preventing vision-threatening ocular disease later in life.
Finally, it is important to remember that the cornea and contact lens specialty also includes using unique contact lenses for many types of regular refractive error. For patients with high magnitudes of myopia, hyperopia or regular astigmatism, specialty contact lenses can deliver vision quality that is superior compared to traditional spectacles. Similarly, for patients approaching or progressing through presbyopia, a specialty contact lens with multifocal optics presents optics that are unmatched compared to soft contact lens or bifocal spectacle options.
As optometrists, our job is to correct and protect vision while simultaneously protecting and promoting ocular health. Being a specialty contact lens focused optometrist means I can do that at the highest possible level. The cornea and contact lens specialty allows me to refine vision while simultaneously preserving the ocular surface and tissue that provides that vision. It requires a foundation in scientific principles and a willingness to be imaginative when faced with a challenge. These elements keep me excited to continue in this specialty and see the innovation and outcomes we can achieve in the future.
About the Author
Dr. Erin Rueff received her Doctor of Optometry degree from The Ohio State University (OSU) College of Optometry and completed OSU’s Cornea and Contact Lens Advanced Practice Fellowship. After fellowship, she continued at OSU as a clinical instructor and completed a PhD in Vision Science. Her research has focused on understanding the relationship between visual discomfort and contact lens wear. She is currently an Associate Professor and Chief of the Cornea and Contact Lens Services at the Southern California College of Optometry at Marshall B. Ketchum University where she enjoys continuing her research, teaching students, and expanding her clinical interests in specialty contact lenses and dry eye. Dr. Rueff is a Fellow of the American Academy of Optometry (AAO) and a Diplomate of the AAO’s Cornea, Contact Lens, and Refractive Technologies Section.
