Switch to RGP Modality
To Enhance Compliance

BY JON KENDALL, O.D.
OCT. 1996

Practitioners face serious challenges in patient compliance today. Not only are there many new types of lens care solutions available, but the private labeling of solutions by discount pharmacies, warehouse stores and retail chains adds to the potential for solution sensitivities, allergic reactions and general confusion. How can we know if a 'plain wrap' disinfection system is safe for patients' eyes as well as their lenses, especially when patients constantly switch solutions for price? I solved this problem in my office long before it became of consequence.

CHANGE THE MODALITY NOT THE CARE SYSTEM

About 10 years ago, I noticed a shift in the type of contact lenses I was prescribing. Not only was I prescribing rigid gas permeable lenses for most new wearers, but I was refitting many more patients from soft lenses to RGPs. Although I can't recall exactly why this happened, I feel that I was just having more fun fitting RGPs. My enthusiasm made my patients enthusiastic, which in turn kept me motivated to continue with this modality.

PROFILE OF THE RGP LENS WEARER

RGP patients tend to be more concerned about eye health and more compliant about solutions and lens care than the average soft lens wearer. Since the fitting process for RGPs is more complex and lengthy, these patients seem to care about their visual welfare more than the average soft lens wearer does. In addition, these custom designed lenses seem to foster better doctor-patient relationships. This is not to imply that soft lens wearers don't appreciate their visual well-being, but it's been my experience that RGP patients exhibit these characteristics more consistently.

I now prescribe RGPs for more than 70 percent of my patients, and the numbers keep improving every year. The remainder of my contact lens population wear conventional soft lenses (daily wear, extended wear, torics), with about 10 percent in some type of disposable or frequent replacement lens.

Over the last year, many of my new RGP wearers switched from disposable lenses, and surprisingly, not necessarily to improve vision.

WHEN COMPLIANCE AND ECONOMY WORK TOGETHER

Margaret, age 36, had been wearing NewVues on an extended wear basis. When we first saw her in 1993, she was removing the lenses monthly. We explained that it was not healthy to keep the lenses on for such prolonged periods of time, and that manufacturers recommend only up to seven days of continuous wear. With this 'new' information, she changed her schedule to weekly removal for cleaning and disinfecting.

When we saw Margaret again last year, she was upset with the cost of disposable lenses. She admitted she was wearing her lenses for more than seven days at a time to save money. Eversion of her lids revealed mild GPC for both eyes. I explained the benefits of RGP lenses to her, and she decided to proceed with a fitting.

Margaret now wears extended wear RGPs from four to seven days before removal. We've redesigned the lenses a couple of times because she lost a significant amount of myopia since switching to RGPs. She was -2.00 OU and now is -0.50 OU. (Apparently, she had some myopic creep due to the low Dk of her soft contact lenses.) She is now able to go some days without having to depend upon any eye appliance. With her new lenses and the resultant decrease in myopia, Margaret is one of my most compliant contact lens patients and one of my best referral sources.

My RGP patients seem to have a better understanding of the proper care and handling of their lenses than the average soft lens population does. Because of this, I have experienced very few compliance problems. CLS

Dr. Kendall, a third generation optometrist, is in private practice in Santa Ana, Calif. A graduate of Southern California College of Optometry, he is a member of the Cornea & Contact Lens Section of the AOA.