A survey of UK practitioner attitudes to the fitting of rigid gas permeable lenses

Abstract

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 prescribing. 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). 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 and more 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. 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.