a survey of uk practitioner attitudes to the fitting of rigid gas permeable lenses

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  • A survey of UK practitioner attitudes to thefitting of rigid gas permeable lenses

    Felicity R. Gill, Paul J. Murphy and Christine Purslow

    Cardiff University, School of Optometry and Vision Sciences, Contact Lens and Anterior Eye

    Research, Maindy Road, Cardiff CF24 4LU, UK


    Purpose: Rigid gas permeable (GP) contact lenses may provide the safest option for lens wear, but

    prescribing rates are in decline. This study investigated the effect of practitioner attitudes on GP lens


    Methods: A questionnaire was developed using a focus group and a pilot study. Questions

    addressed clinical time spent fitting GP lenses, specialist equipment requirements and perceived

    safety and comfort. With ethical approval, the questionnaire was sent to 1000 randomly selected UK

    registered eye care practitioners (ECPs).

    Results: In general, ECPs enjoy the challenge of fitting GPs, although fitting takes longer than soft

    lens fitting. There is a difference in attitude between longer qualified andmore recently qualified ECPs.

    Longer qualified ECPs more frequently reported enjoyment of the fitting challenges, recommended

    GP lenses to patients and were less likely to believe that GP lenses were becoming obsolete. ECPs

    are in strong agreement on the ocular health advantages of fitting GPs. They do not feel specialist

    equipment is generally needed, although some reported a topographer to be advantageous. The large

    majority of ECPs do not have access to the specialist equipment they perceive to be normally

    associated with GP fitting (radiuscope, V-gauge). They believe that initial fitting discomfort of GP fitting

    is a major drawback to their fitting, and while they feel this greatly improves with adaptation, they do

    not feel it reaches soft lens wear comfort. A total of 30.3% of ECPs feel it is clinically acceptable to use

    topical anaesthetic during GP fitting, but only 1.4% of ECPs regularly do so.

    Conclusions: ECPs are aware of the benefits that GP lenses provide in terms of ocular health. They

    find GPs take longer to fit, but they enjoyed the challenge of fitting, which suggests that they are not

    lacking in clinical skill, nor any specialist equipment. However, they are unhappy with initial patient

    comfort, and are not yet prepared to use topical anaesthetics during initial fitting. As a consequence,

    ECPs believe that GP lenses are becoming obsolete. Negative practitioner attitudes toward various

    aspects of GP fitting may mean fewer recommendations to patients and reduced GP prescribing.

    Keywords: contact lens, prescribing, rigid gas permeable, survey


    Following the introduction of soft contact lenses in1970, Atkinson predicted their success and a consequentdecline in rigid lens prescribing. In 1976, he reported

    that soft lenses already made up 50% of all contact lensts recorded in the UK (Atkinson, 1976). Although rigidgas permeable (GP) prescribing did decrease, thereduction was gradual, and, by 1991, 39% of newcontact lens ttings were still GP lenses (Pearson, 1998).In 1996, a survey, designed to investigate prescribing

    trends, was randomly distributed to 1000 UK ECPs whowere asked for details about 10 consecutive contact lensts (Morgan and Efron, 2006). This survey has sincebeen distributed annually, both in the UK and interna-tionally, to monitor contact lens prescribing trends(Morgan et al., 2002; Morgan and Efron, 2006; Morganet al., 2006). In 1996, 23% of new contact lens ts were

    Received: 18 November 2009

    Revised form: 17 June 2010

    Accepted: 19 June 2010

    Correspondence and reprint requests to: Christine Purslow

    Tel.: 02920 876316; Fax: 02920 874859.

    E-mail address: purslowc@cardiff.ac.uk

    Ophthal. Physiol. Opt. 2010 30: 731739

    2010 The Authors. Ophthalmic and Physiological Optics 2010 The College of Optometrists doi: 10.1111/j.1475-1313.2010.00790.x

  • GP, indicating a marked reduction in GP prescribingbetween 1991 and 1996, and in subsequent publicationsof the survey results, a relatively steady decline in rigidlens prescribing has been recorded (Figure 1). By 2007,just 3% of new ts were GP; however 16% of rets wereGP (Morgan, 2007). This may indicate that GPs areoften retted to existing GP wearers or in cases were softtting is unsuccessful.It is clear that rigid lens prescribing is, at best, static or

    in decline in the UK. This may be logically attributed to avariety of factors including perceived GP disadvantagessuch as initial discomfort, increased chair time, and theincreased skill required to t and manage such patients.Also, major investment has been made in developing andpromoting new soft lens materials and designs.However, there is no published evidence regarding

    practitioner attitudes to contact lens or, specically, GPlens prescribing. Therefore, it is not known whethercontact lens prescribing trends are associated withpractitioner misgivings about GP lenses. These mightinclude the increased time, skill and specialised equip-ment required to t GP lenses; that use of topicalanaesthetic (TA) to aid tting is an unacceptablepractice; and perceived comfort issues with GP lenses.Without an understanding of practitioner attitudes to

    GP lenses, it is not possible to hypothesise what partECPs, and indeed, their experience and environment,have played in the decline of GP prescribing. The aim ofthis study was to survey a large number of UK-basedECPs in order to determine their current practice andattitudes.


    Questionnaire design

    Since no existing questionnaire was available to obtainthe desired information, a questionnaire was designed

    for this purpose. Initially a literature review wasundertaken followed by focus group meetings andinterviews with optometrists. The questionnaire designwas discussed to ensure that each item was relevant,appropriate and elicited all the required information.Results from this process were collated and a pilotquestionnaire produced; this was completed by a num-ber of optometrist colleagues. The pilot results wereassessed to identify unnecessary items and the question-naire was gradually rened to the nal format.The questionnaire comprised 20 questions

    (Appendix 1). Questions 19 asked for general demo-graphic information about the practitioner. The remain-ing 11 questions asked the practitioner to consider astatement with respect to contact lenses in general, andthen with respect to GP lenses specically. A Likert-typeresponse scale was employed. This provided the respon-dent with a 7 point response scale to indicate level ofagreement or disagreement with a statement (Likert,1932). Psychometricians advocate 7 or 9 point scales asthey produce better internal reliability than those withfewer categories (Masters, 1974). The responses e.g.strongly agree through to strongly disagree werecoded numerically from 0 (strongly disagree) to 6(strongly agree). A score of 0, 1 or 2 was considered toindicate disagreement, 3 indicated neither agreement ordisagreement and a score of 4 or more indicatedagreement with the statement.

    Subject recruitment

    Ethical approval for the study was obtained from theCardiff School of Optometry and Vision SciencesEthical Committee. The questionnaires were posted to1000 randomly selected UK eye care practitioners(including optometrists and contact lens opticians) onthe General Optical Council registers in April 2007.Each questionnaire was accompanied by a covering

    Figure 1. Between 1999 and 2009, a relatively steady decline in rigid lens prescribing has been recorded (adapted from Morgan et al., 2002,

    2006, 2010).

    732 Ophthal. Physiol. Opt. 2010 30: No. 6

    2010 The Authors. Ophthalmic and Physiological Optics 2010 The College of Optometrists

  • letter, explaining the purpose of the study and invitingECPs to complete the questionnaire and return it to theinvestigator, in the stamped, addressed envelope pro-vided.Data produced from Likert response scales are

    considered to be ordinal and therefore non-parametricstatistics were employed for analysis. Results weretabulated within SPSS and examined using statisticaltests, including Wilcoxon Rank and Pearson ChiSquare.


    Demographic information

    Demographic information relating to questionnaireresponses is found in Table 1: the length of timepractitioners have been qualied is shown in Figure 2.Responses from practitioners not involved in contactlens tting were excluded from the contact lens ttingstatistics, but their subjective responses were included inthe remaining opinion-based analyses. The number ofpractitioner responses used in the analysis for eachquestion is given in Tables 24. Contact lens opticians(CLO) accounted for 4.4% of our respondents, which issomewhat less than the anticipated 10.7% on the GOCregisters.

    Frequency of contact lens practice

    The average number of contact lens patients seen perquarter showed large variation amongst ECPs (130,02275; median, range). Predictably, CLOs tended to seemany more contact lens patients than the optometrists,

    as their clinical time is dedicated to contact lens work.Approximately 89% of all contact lens appointmentsare devoted to soft contact lens work and 11% to GPwork (Figure 3).

    Practitioner attitudes to contact lenses

    Generally, ECPs reported that they enjoyed the chal-lenges involved in both general lens tting and specif-ically GP tting (Table 2). However the ECPs responseswere more positively skewed towards general CL ttingcompared with GP tting (Wilcoxon Rank test,p < 0.05). More experienced ECPs, those qualied for10 years or more, tended to respond more positively tothe statement I relish the challenges involved in GPtting compar


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