Recent advances in contact lens technology have given us a host of new lens options in the realms of presbyopic, toric and single vision designs. Positive improvements in contact lens care systems also continue to provide additional benefits to those who use them. Together, these developments have increased our arsenal of options to re-engage with those contact lens wearers who may have dropped out in the past.
However, other reasons for contact lens drop out still remain. When a lens wearer abuses their modality or care system, complications—although rare—can arise as a result of non-adherence to practitioner recommendations, a common problem across all health conditions, especially contact lens care regimens.1 This month, we share five highly effective ways to better emphasize the importance of adherence to your contact lens patients. By increasing and tailoring our efforts, we improve our patient’s chances of successfully wearing contact lenses, which will ultimately help keep them in lenses long-term.
1. Be aware of how your patients are caring for their lenses. How often do contact lens wearers walk into our practices without any idea of which solution or rewetting drops—if any—they are using? What about the condition of the patient’s contact lens case? Certainly, migrating patients to a daily disposable contact lens will help eliminate these potential issues, as they obviate the need for care solutions and lens cases. However, the patient may still be using drops that you are unaware of to alleviate comfort issues.
So, how do you find out what exactly your patients are doing to care for their lenses? The answer is fairly simple: ask them to bring in their contact lens case, solution and any other care products, as well as any drops they may be using. Seeing them firsthand gives us the opportunity to educate patients on proper lens care if needed and gives us the opportunity to intervene with appropriate clinical solutions if necessary, including refitting them into a daily disposable lens or suggesting an alternate product.
2. Educate patients on how to appropriately care for their lenses. While proper lens care is common knowledge for the eye care practitioner, many patients are not as educated regarding its importance and influence. Surprisingly, even the most seasoned contact lens wearers may not know how to appropriately care for their lenses. Try asking your contact lens patients to explain their process for applying and removing their contact lenses.
How do you educate these patients? Devise a consistent conversation to have with all contact lens patients and modify it according to each patient’s individual needs. Explaining the importance of adherence and correcting patient-specific errors means they are more likely to adhere to your guidelines. As an example, you can say, “I want you to be able to consistently wear your contact lenses comfortably and in a healthy way. This can best be achieved by following our recommendations on cleaning and caring for your contact lenses.” Next, follow this with the actual steps necessary to care for the lenses, and consider a discussion of a daily disposable lens use.
3. If the patient has issues or complications, show them. Sometimes, patients will present with symptoms caused by contact lens abuse, such as GPC on the superior tarsal plate from lens overwear when deposits occur on the lens surface and interact with the lid while blinking.2 This response leads to the clinically evident giant papillae and, often, excessive mucus production. In these instances, contact lens wearers typically seek symptomatic relief—and delivering it will likely create a more compliant lens wearer.3
But what about changes that are less symptomatic, but still important to teach patients about? In these cases, we often use slit lamp imaging systems as an educational tool. For example, the patient who is sleeping in hydrogel lenses, but who is asymptomatic, may have significant corneal neovascularization that can be imaged and demonstrated. Or, someone who is keeping their lenses in for longer than prescribed who presents with significant deposits on the lens surface might benefit from seeing those deposits up close. In either case, imaging of these scenarios helps the patient understand their condition and hopefully, the need for more compliant wear.
4. Give them the tools they need. As practitioners, we have heard almost every single excuse in the book for why our patients are noncompliant with their replacement schedules. We have made it a point to make it as easy as possible for patients to remember to replace their contact lenses. So, regardless of the modality, be sure to give them the best tools possible to help them remember their replacement schedule.
Obviously, daily disposable lenses are the easiest modality to replace. It’s one of the main reasons these lenses are associated with such a high level of adherence.4 For patients wearing two-week or monthly disposable lenses, however, we need to guide them to select a day or two days, depending on the modality, as their designated replacement day.
Depending on your practice, you may also have the means to provide patients with contact lens cases, solution and other accoutrement to help with adherence.
5. Don’t assume non-adherence is the reason. A patient wearing contact lenses who comes in with a corneal infiltrative response is often immediately assumed to be someone who has abused their contact lenses. While this is often the case, take caution to consider other clinical entities that may present similarly.
For example, a point-of-care test such as AdenoPlus can be used to rule out adenoviral keratoconjunctivitis in a contact lens wearer presenting with an acute red eye and corneal infiltrates.5 Clinically, we will often pigeon-hole these patients as contact lens abusers when in fact they are contact lens wearers who simply have another etiology responsible for the cause of their red eye.
It is well understood that adherence in health care is a constant challenge. But by incorporating these strategies, we can help influence contact lens adherence in a positive way, reduce complications and ultimately help those patients who may discontinue lens wear continue wearing their lenses successfully.
1. Claydon BE, Efron N. Non-compliance in contact lens wear. Ophthalmic Physiol Opt. 1994 Oct:14(4):356-64.
2. Elhers WH, Donshik PC. Giant papillary conjunctivitis. Curr Opin Allergy Clin Immunol. 2008 Oct;8(5):445-9.
3. Chigbu D. The management of allergic eye diseases in primary eye care. Cont Lens Anterior Eye. 2009 Dec;32(6):260-72.
4. Dumbleton K, Woods C, Jones L, et al. Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in the United States. Eye Contact Lens. 2009 Jul;35(4):164-71.
5. Sambursky R, Trattler W, Tauber S, et al. Sensitivity and specificity of the AdenoPlus test for diagnosing adenoviral conjunctivitis. JAMA Ophthalmol. 2013 Jan;131(1):17-22.