editor's perspective

Does Red-Eyed and Whiny Mean Dropout?

BY JOSEPH T. BARR, OD, MS, FAAO, EDITOR
April 2001

A very experienced, wise contact lens practitioner taught me a few things about bad contact lens candidates. Their eyes are red, they sniffle and they complain about their fees. I'm not going to talk about the fee-troubled people. Let's talk about why people drop out of contact lens wear.

First of all, there are no prospective long-term studies of why people drop out of contact lens wear, once, twice or more. There is little you can do in most situations, beyond detecting obvious disease, to be really sure who will fail. It is even more difficult in this age when we have so many great contact lens options for treatment.

According to Professor Des Fonn from the University of Waterloo, there may be as many as 10.5 million dropouts from contact lens wear in North America. Some would suggest there are more. The idea that 15 to 30 percent of lens wearers drop out per year is not new, according to our past publications in Contact Lens Forum and Contact Lens Spectrum. It's certainly over two million previous wearers per year, according to Mark André, FCLSA, in Portland.

Will daily disposable and extended wear silicone hydrogels make a difference or just make life better for daily wear and extended wear patients until they drop out? Certainly, economic, vision, comfort and convenience issues are involved.

I firmly believe more people in the past dropped out due to vision problems. But modern manufacturing of spherical, toric and multifocal lenses keeps more people per day in contact lenses in this age. Let's face it, if you can't obtain good vision for your patients with today's lens offerings, then you need to get a life. It's all about normal comfort today. No more looking for eyes that can wear "Coke bottle bottoms" to be your patients.

Today we believe the major reasons for dropout (see "Preventing Contact Lens Dropouts," March 2001) are discomfort related to dryness (whatever that is) and inconvenience. Inconvenience is manageable with easy-to-use, low toxicity or even preservative-free lens care systems, daily disposable lenses or extended wear lenses. But discomfort due to dryness or inflammation (I hear the wise old doc speaking) is more difficult to manage. Numerous new materials may solve the dryness problem, and daily disposables certainly minimize the deposit issues. No matter what lens material or replacement schedule you use, remember what Ben Franklin said, "Put nothing into your eye except for your elbow." I think the wise old doc may be right: if a patient is destined for problems because he is an inflammatory or inconvenienced, low-paying patient, send him down the street for contact lenses.

If you want to maximize your long-term success for your patients and your practice (because long-term contact lens patients are more profitable than spectacle-only wearers), communicate, strive to keep patients comfortable and stay away from red-eyed, sniffling, whining patients.