Compliance Insurance

BY JOSEPH T. BARR, O.D.; JEFF DOUGAL, O.D.; TIM EDRINGTON, O.D.; STEVE GRANT, O.D.; MICHAEL LARKIN, O.D.; LYNN LASSWELL, O.D.; & JOSEPH VEHIGE, O.D.
NOV. 1996

You've reasoned and pleaded, bullied and cajoled. Now try these strategies to convince your patients that lens care compliance counts.

The noncompliant patient is a frightening patient because usually nothing goes wrong. As one practitioner tells his patients, "Not getting an infection from poor contact lens compliance is like driving 120 miles per hour on the freeway every day and not having a wreck."

Fortunately, the eye disinfects the contact lens in most of our patients most of the time, so those who don't comply are likely to get away with it. Yet the implications of poor contact lens care can be profound and sight-threatening, and it's our responsibility to make patients understand that one slip-up in their lens care routine can have devastating consequences.

THE PRACTITIONER AS MATCHMAKER

Although most practitioners choose a care system based on patient physiology, lens material and personal preference or experience, there are other issues that may influence your decision.

Consider a peroxide system for patients with a history of eye infections or for people who work at jobs where they're likely to get their hands dirty.

The real value of one-bottle lens care systems may be for patients who have a history of noncompliance. Sometimes a patient's age will factor into your choice of lens care regimen. Very young or elderly patients may benefit from a simplified system. If another family member is using a particular product, it's wise to keep everyone in the family on the same system. Lens care must be kept simple so patients cannot confound it readily.

A WORD ABOUT SALINE

At the 1994 Academy of Optometry meeting in San Diego, an Australian study reported that, compared to other solutions, too much saline is sold in the United States. This means people use it not only as intended, but to 'disinfect' as well. We need to explain to patients what saline is for and what it's not for.

On the other hand, adding a saline rinse to a patient's lens care regimen can often resolve minor sensitivity problems in some patients.

SELLING COMPLIANCE

'Sell' compliance at every follow-up visit. Explain the need for compliance to every patient every time you see them. Ask them what care products they use and when and how they use them. It's likely that at least 50 percent have either changed something or forgotten a step. As many as 25 percent won't know what they're using.

When patients come in, review their lens care routine step-by-step, including how often they clean their lenses. In most cases, you should start from scratch and explain lens care completely all over again.

Be sure patients understand that care systems are approved by the FDA when all steps are used -- clean, disinfect and rinse. Simply soaking a contact lens in a disinfectant may not be enough to destroy all the organisms that could cause infections.

Use language patients will understand. Explain that lens cleaning is important because the dirt on their lenses can be a haven for 'germs' that can invade their eye. Refer to 'lens cleaning pills,' rather than enzyme tablets.

For patients in planned replacements, some practitioners recommend providing a six-month supply of solutions at each dispensing visit.

TRUTH & CONSEQUENCES

There are risks with anything, and it's our job to explain the risks associated with contact lens wear under certain circumstances so patients can make an informed decision.

Practitioners are divided on whether patients should wear their lenses during water sports, for example, but all agree there are risks involved when they do. The question is if the risks of wearing contact lenses while swimming outweigh the risks of not seeing. Patients need to know that even one day of swimming and improper lens care can cause infection. They need to know that a contact lens infection is dangerous and that they could permanently damage their cornea.

People think there's an antibiotic for everything. It's important that they know to call us as soon as they think they have a problem and that they know to remove their lenses until we can examine them.

As good as the new lens care systems are, they don't always kill microorganisms very well. Combine that with liability-consciousness on the part of most doctors today and you understand why we need to educate our patients and document that we have given them complete and appropriate lens care instructions.

SWITCHING AT THE SHELF

Patients will buy their solutions wherever they're most cost-effective. To help avoid some of the problems that can develop when patients switch solutions, ask them to check with your office first before they make a change. Consider providing them with a list of acceptable substitutes. In the long run, we'd rather patients do something in the way of compliance rather than nothing at all.

DOING IT RIGHT EVERY TIME

Ideally, every patient performs every step of his lens care routine exactly right every time. We must teach patients how to care for their lenses and why they should comply with our instructions, as well as the positive implications of doing it right and the negative implications of doing it wrong. We're promoting good eye health and good lens care, and compliance is key. CLS

The authors, all members of the Contact Lens Study Exchange of Orange County, Calif., met recently with Contact Lens Spectrum Editor Dr. Joseph T. Barr to discuss lens care and compliance.

Dr. Dougal is in private practice in Placentia, Calif. Dr. Edrington is a professor and contact lens director at the Southern California College of Optometry (SCCO). Dr. Grant is a member of the California State Board of Optometry. Dr. Larkin is an assistant professor at SCCO and a frequent consultant to the contact lens industry. Dr. Lasswell is senior director, clinical research, for Chiron Vision Corp. Dr. Vehige is manager, contact lens product development, for Allergan.