editor's perspective
Today's Three T's of Treatment Adherence
BY JOSEPH T. BARR, OD, MS, FAAO, EDITOR

Recently we had a conversation about making sure that pregnant women who were indigent and poorly compliant with health care could be helped by reminders to make their prenatal appointments and even provided with transportation to these visits. The long-term result of this program to improve compliance was well patients, both mother and child. You can imagine the improvement in long-term outcomes with similar caring for diabetic patients, glaucoma patients, etc. Studies show that compliance to a treatment regimen is often poor even in life- and sight-threatening diseases, especially when the disease has a chronic course.

Much about lens care is mundane, boring and not immediately rewarding. Have you ever had a patient tell you that his whole person, eye or hand felt better after he cleaned his lens and put it in the case at night? No. In fact, patients prove to themselves over and over again that they can be non-compliant and not have an immediate problems in most cases. Of course, we see the exceptions with infiltrative keratitis in our examination rooms.

How can you help your patients comply more with treatment? Teach them to care for their lenses if those lenses are reused, teach them to take lenses out, and teach them to toss their lenses.

We prescribe basically two types of lens replacement regimens: single-use, including daily disposable and 30-day continuous wear disposable, and reusable, which includes daily wear and extended wear modalities. Extended wear of reusable lenses adds risk for the poorly compliant. For extended or continuous wear patients, key compliance issues are removing the lens and calling you if they encounter problems. For daily disposable patients, the key compliance issue is tossing the lens at the end of each wearing day. For reusable lens patients, key compliance issues are washing their hands, cleaning the lens with rubbing and/or thorough rinsing and soaking/disinfecting the lens in a clean case with fresh solution.

Experts in adherence to treatment regimens in health care say the following about improving compliance:

• Bond with your patients. Love them or make them believe you love them.
• Repeatedly educate them in terms they can understand as to how and why they need to comply.
• Compliance has nothing to do with gender, education or income. (Health care professionals are not necessarily more compliant.)
• Threaten your patients as a last resort.

Studies show complete adherence to lens cleaning and disinfection is well below 40 percent, half the patients who should rub their lenses regularly do not, and patients are only half as compliant with lens replacement schedules on the average.

Take care to take them out, toss them, and keep on teaching.