contact lens practice pearls
Help Your Patients Be Compliant
BY THOMAS G. QUINN, OD, MS, FAAO

This year's outbreak of contact lens-related fungal keratitis has heightened not only our awareness of the importance of proper care in ensuring safe contact lens wear, but it has also brought the issue into the forefront of the public's consciousness. How can we best turn this into a teaching moment for our patients?

Role of Compliance

Although a higher incidence of fungal keratitis was associated with a particular chemical care system, patient behaviors such as reusing old, dirty cases and topping off solution are suspected contributing factors.

In a recent study sponsored by CIBA Vision, only 33 percent of soft contact lens wearers reported following the recommended lens replacement schedule, 30 percent reported storing lenses overnight in saline or eye drop solution, and 23 percent said they rinsed their lenses with water.

On a more hopeful note, in the same study 96 percent of wearers reported that they considered taking care of their eye health to be an important part of their overall wellness. Our challenge is to help patients link lens replacement and compliance with eye health.

I've found the most receptive audience for this message are new wearers. They're excited to be moving into the freedom of contact lens wear and want to be successful. I tell patients I'll do my best to fit them with the right lens, but they need to do their part by following my instructions on care and replacement.

I inform new wearers that my goal is to have them performing at a high level at all times when wearing their contact lenses. To achieve this, they must replace their lenses before they begin to irritate their eyes or degrade their vision. This is a proactive attempt to avoid the common and misguided mindset of replacing contact lenses "when they start to bother me."

The Patient in Pain

One of the great joys of my profession is providing relief to a patient suffering from eye pain. Rarely do I find a more appreciative soul in my chair. When pain is due to contact lens abuse, seize the moment to educate about proper compliance. Tell patients that most lens complications are associated with dirty, over-worn lenses. Review proper care, then clarify by asking the patient to recount the key points back to you. Provide guidelines in writing to further reinforce your message.

Talk Compliance Regularly

Incorporate compliance reinforcement into your patient care structure. Ask each patient how often he replaces his lenses. Verify this by checking your records to see when you last provided a lens supply or issued a new prescription. If he says he's replacing his lenses monthly but you provided a year's supply two years ago, you know something is awry.

Ask patients what solution they use and how they use it. It's important to ask this in an open way so as not to lead the patient. For example, "Tell me what you do with your lenses when you remove them at the end of the day," will provide more insight than, "Are you rubbing your lenses when you remove them at the end of the day?" Ask, "How often do you sleep in your lenses?" Asking this way will reap a more honest response than asking, "Do you sleep in your lenses?"

Persistence is Key

Once we know how patients are using and caring for their lenses, we can discuss compliance in a more informed and focused manner. But we first have to ask — and ask often. Then we must educate, and educate often.

For references, please visit www.clspectrum.com/references.asp and click on document #132.

Dr. Quinn is in group practice in Athens, Ohio, is a diplomate of the Cornea and Contact Lens Section of the American Academy of Optometry and advisor to the GP Lens Institute.