Next, I ask them to use an allergy drop before contact lens application. Though you may have a favorite, familiarize yourself with all the newer medicines available because prescribing an allergy drop has become a much tougher task than one would expect. We receive several calls and faxes per day denying a particular allergy drop due to insurance coverage.
Ask your staff to help create a cheat sheet of local formulary preferences to help reduce your allergy Rx denials.
Pazeo (olopatadine 0.7%, Alcon) and Lastacaft (alcaftadine, Allergan) have convenient once-daily dosing. Pataday (olopatadine, Alcon) is the 0.2% version of Pazeo and is still indicated for once-a-day use, while Patanol (0.1% olopatadine, Alcon) and Bepreve (1.5% bepotastine besilate, Bausch + Lomb) are both twice-a-day use. These are convenient options for contact lens wearers—no midday dosing required.
However, if a patient has extreme allergies I may use Alrex 0.2% (loteprednol etabonate, Bausch + Lomb) instead or in addition to another allergy drop. In this case, I ask the patient to remove his contact lenses midday and rinse with preservative-free tears before instilling the drop into his eye.
I reserve Alrex and midday dosing for patients who are quite symptomatic—even in daily disposables—and who need to significantly reduce their wear time for added control. For patients somewhere in between, I ask them to flush their eyes with a contact lens rewetting drop, while wearing their contact lenses, at least once during the day.
We would certainly prefer that our allergy patients wear a daily disposable contact lens, but convincing them is sometimes another story. I’m surprised by the number of patients I see who are in minimal-to-great discomfort and have admitted to hearing about daily disposables from their previous eye doctors.
Not only did they resist the advice, but they ended up seeking care elsewhere. Perhaps our presentation skills for daily disposables could be honed—and allergy season is the perfect opportunity to do so.
I find that more patients agree to daily disposables during allergy season, so use this time to dive in and perfect your presentation to the patient. Discuss what you’re seeing while seated behind the slit lamp with him.
Focus the discussion on the health of the ocular surface and his current exposure to potential consequences. Be adamant. Be persuasive. Use external photos for added conviction.
Build your confidence through consistent prescribing during the next few months, and offer daily disposables to every contact lens patient you see.
Prepare for success by stocking up on the number of daily disposable samples in your trial room, and coach staff on how to support you in your endeavor. The greatest benefit will be to your patients, and your confidence will continue to grow as you see how much better they feel during this critical time of year.