editor's perspective

TREATMENT PLAN ADHERENCE:
Don't Do It, Reap the Consequences

BY JOSEPH T. BARR, OD, MS, FAAO, EDITOR
September 2000

The contact lens field uses the term "compliance" to describe how people do not comply with contact lens care. Modern healthcare investigators call this "treatment plan adherence." In our case, this means adhering to rubbing with a cleaning agent, rinsing and storing in fresh disinfecting solution (with clean hands and in a clean case, of course) when patients care for their contact lenses. I have always thought, and others have documented, that even with life-threatening treatments, about one third of people care for their lenses in a nearly compliant fashion, one third are partially compliant and one third are totally derelict. Too many patients view contact lenses as cosmetic and not medical devices, and patient contact lens compliance worsens.

There is no short-term reward to contact lens compliance. Certainly one's fingers and palms do not feel better after taking care of one's lenses. Are complaints of dryness and discomfort at the end of the day and poor vision associated with poor lens care? Likely. Indeed, poor lens care may lead to decreased wear time or cessation of lens wear. Modern frequent replacement/disposable contact lens modalities and even new materials may help, but patients still need to adhere to their care.

Lenses need to be cleaned every time they are worn. Yet a recent survey indicates 50 percent of wearers do not digitally clean on a daily basis. This is an apparent worsening of compliance from two years ago when a similar study indicated only 38 percent did not digitally clean. Costs, forgetfulness, carelessness and lack of reinforcement by the eyecare practitioner compromise adherence to the plan.

There is more competition than ever for refractive error care. To keep contact lens treatment a viable option, eyecare practitioners must optimize contact lens care and comfort and provide best vision. Patients are more likely to blame their devices or practitioners than their poor adherence to lens care. I've always said that lens care needs to be reviewed at every visit by the practitioner and staff. And more of our colleagues than ever prescribe the lens care system and discourage switching without consultation with the practitioner.

Contact Lens Spectrum will continue to stress new information about lens care effectiveness and technology advancement. These topics include microbial effectiveness, shortened disinfection cycles and digital rubbing. Eventually, assuming all patients are not using a lens only once in daily or extended wear, the logical evolution is a solution that cleans, dissolves deposits and disinfects with no more patient compliance than just popping the lens in a (typically dirty) case with (typically dirty) hands.