Six Keys to Ensuring RGP Compliance

BY EDWARD S. BENNETT, O.D., M.S. ED.
JUNE 1996

You provide your patients with the highest caliber eye care available and the most technologically advanced contact lenses on the market. Now, make sure they take full advantage of this excellent vision by following the lens care regimen you prescribe.

1. PATIENT EDUCATION

When RGP patients stop wearing their lenses, it's often during the first few months of lens wear. Proper education can instill lens handling confidence and avert an RGP dropout. For instance, patients should be able to remove their lenses using more than one method to bring the lids in contact with the lens edge to eject the lens.

Reinforcing the proper lens care regimen at follow-up visits is also important -- perhaps more important than the exam itself. By asking patients specific questions about their care routine you can assess their compliance. Ask them how they're doing with lens insertion and removal, what their wearing schedule is, what solutions they're using, and if they're cleaning their lenses and lens case every night.

2. ADEQUATE CLEANING

Always have patients repeat lens care instructions and procedures in proper order (i.e., wash hands, insert lenses with wetting/soaking solution, remove lenses, clean in palm of hand with cleaner, place in clean case with wetting/soaking solution).

Be sure they understand the importance of washing their hands prior to handling their lenses, especially after using hand creams or soft soaps. For patients who simply don't want to "hassle" with cleaning, consider reinforcing your message by showing photographs or a video of complications such as giant papillary conjunctivitis and red eyes. In some cases, it may be more beneficial to switch a noncompliant patient to a one-bottle system to ensure that at least some surfactant is reaching their contact lenses.

3. PROPER SOLUTIONS

Patients change solutions for many reasons -- to obtain a better price, for example, or because they forget the name of the proper solution and inadvertantly choose a similar but not identical solution.

One of the best ways to minimize this problem is to provide a two- or three-month supply of solutions at the dispensing visit. We give patients one complimentary bulk pack of solutions as part of their rigid lens service agreement. They can purchase additional bulk packs at a discount.

This practice shows patients the specific solutions we want them to use and helps avoid confusion over products that have similar names or packaging, but different uses.

You can also provide specific information on solutions as well as important care instructions on business cards that patients can carry with them.

4. TAP WATER

The use of tap water with RGP lenses is quite controversial. The risk of Acanthamoeba keratitis due to wetting or rewetting lenses with tap water, although very low, is always present. It can be argued that as long as patients don't use tap water prior to inserting their lenses in the morning (i.e., if they use tap water for rinsing off the cleaner at night, but not in the morning after disinfecting), they should be fine. However, studies by Larry Davis and others have concluded that most patients use tap water prior to inserting their rigid lenses. To avoid the possibility of ocular infection induced by tap water, I recommend adding aerosol saline to the patient's regimen.

5. CASE CONTAMINATION

Ideally, patients should clean their lens cases every night. Studies have demonstrated that most contact lens wearers have contaminated lens cases. The contaminant (usually bacteria, but less commonly Acanthamoeba) may become encapsulated via a glycocalyx slime and become resistant to some preservatives. Therefore, patients should clean cases with soap and water, using a cotton swab to clean hard-to-reach areas. They should then rinse the case with an aerosol saline and allow it to air dry. Encourage patients to replace their lens cases frequently, and when in doubt, provide them with several cases.

6. WARPAGE

With the newer super-permeable RGP lens materials, the likelihood of warpage increases. Patients wearing these lenses should gently clean them with their little finger, or if warpage continues to be a problem, they should use a cotton swab or a surfactant/soaking solution. CLS

Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis; he is executive director of the RGP Lens Institute.