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Ensuring Compliance and Patient Satisfaction

BY JAMES C. LANIER, JR., OD, FAAO

In a busy day-to-day eyecare practice, it's not unusual for patients to come in with complaints of ocular discomfort. As a practitioner, it's my priority to troubleshoot and solve my patients' problems. It can be a challenging task sometimes, but I've found some innovative ways to get to the source of my patients' complaints, communicate with them effectively and prescribe accurately to treat and prevent future discomfort.

Following are a few steps I take in my practice that help to ensure compliance and patient satisfaction.

Step One: Identify the Source of the Discomfort

It's important to determine any change in a patient's vision and/or ocular health. Blurred vision and ocular discomfort are the most frequent complaints that patients present with in an eyecare office.

When a contact lens patient presents in my office with symptoms of ocular discomfort, the first things I want to know are the length of time the symptoms have existed, the patient's lens wear schedule and the approximate age of the contact lens. Further, visual changes and any signs the patient has noticed (discharge, redness) are helpful. Lastly, the number of hours the patient can wear the lenses asymptomatically is useful information. Abbreviated wearing time may indicate poor tear quality or ocular surface disease, which is a major cause of contact lens dropout.

Unfortunately, more and more often I see patients who have ocular discomfort and report a wearing schedule that exceeds the recommended lens replacement cycle, or patients who have decided on their own to change their wearing modality from daily wear to extended wear. We must assume patients sleep in their lenses unless proven otherwise. Even rephrasing our question from "Do you sleep in your lenses?" to "How often do you sleep in your lenses?" has become more appropriate.

Contact lens overwear is a major cause of lens-related ocular discomfort in contact lens practice today. Even highly educated patients are presenting with overwear issues. The statement, "I wear my lenses until they bother me" is all too common. Additionally, some patients are being told by their peers that it's acceptable to wear their contact lenses until they become uncomfortable, which sometimes is weeks beyond the prescribed wearing schedule.

Many of these patients are developing damage to their corneas, conjunctiva and eyelids, which can be very uncomfortable. When patients over wear their contact lenses, they often develop corneal toxicity, corneal neovascularization, conjunctival injection and even giant papillary conjunctivitis. This mechanical and/or allergic condition of the tarsal conjunctiva is occurring more often with some silicone hydrogel contact lenses because of their stiffer modulus. Common GPC symptoms include itching, mucus discharge, ocular irritation, injection and lens discomfort.

Easily, the most frequent patient complaint from compliant patients in my practice is rooted in underlying ocular surface disease and poor tear quality. It's critical patient management to treat the tear problem before attempting to refit a lens. Tear supplements or replacements, lid scrubs or even prescription medications are all options.

It's important for me as a practitioner to stress to my patients the importance of timely lens replacements. Simply telling patients to do it is often highly ineffective. However, a visual demonstration of potential problems helps me explain why it's important to their overall ocular health, and I find that when I use this method patients are more likely to be compliant. Beside every exam chair I keep photographs of hyperemic eyes, corneal ulcerations and GPC with the maxim in mind that "a picture is worth a thousand words." Effective communication is the key to long-term ocular health and overall successful contact lens wear, and I'm willing to risk a little shock factor to get my message across and to enhance compliance.

Step Two: Effective Patient Communication

Good, effective patient communication is vital to long-term patient compliance and ultimate contact lens success. This communication must come first from the practitioner, but it's equally important for patients to also hear it from the staff. At an initial lens fitting, I stress the need for cleaning and disinfection as well as for following lens replacement schedules. No one sets the replacement schedule but me. After all, who knows the appropriate replacement time better than the practitioner who just performed the patient's eye exam?

It's valuable to supply visual examples of the complications resulting from noncompliance. I try to make patients understand that following the replacement schedule isn't about me selling more contact lenses, but is more appropriately about long-term ocular health. I've found pictures and diagrams from my chair-side computer to be very effective teaching tools. Patients seem to "get it" when they can see the results of poor compliance, and as a result they're less likely to take the advice of a spouse or neighbor over that of my office.

Appropriate contact lens care is another area I like to stress. Most current soft lens care solutions are multipurpose or all-in-one formulations. Although when used properly they're highly effective, many times patients believe simply placing their lenses in the solution at night is sufficient cleaning and disinfection. The phrase "no rub" has misled many patients into believing their lenses don't need to be touched after removal and that they'll be clean and safe the next morning.

To combat this misperception, I have my staff take a black Sharpie pen and in front of a patient cross out the words "no rub" from the label. This is a vivid example to the patient. The staff then instructs the patient on the proper method of digital lens cleaning, which I feel is a must for long-term success. Again, chair-side photographs of lens deposits caused by poor lens care make my point.

At the follow-up evaluation I like to ask patients how their solution is working and I have them show me how they're cleaning their lenses at night. Not only do these questions help me discover patient misunderstandings, but they also allow me to reinforce correct care. Then, as a rule, I instruct them to stay with the same prescribed solution even though they may save a few pennies by switching to a generic brand.

Step Three: Prescribing the Right Products

My first lens care recommendation is the same solution that I personally use: Complete MoisturePlus from Advanced Medical Optics. It contains both a cleaning ingredient and a demulcent that coats the lens and soothes and protects the eye. This combination of ingredients seems to make contact lens wear more comfortable for the majority of my soft lens patients.

If at a follow-up appointment patient symptoms or signs indicate a need for a rewetting agent, I usually recommend Blink Contacts (AMO) lubricating drops. Unlike some rewetting drops, I believe Blink allows for a more extended lubrication and for prolonged comfortable contact lens wear. Because a new contact lens wearer has a long list of things to remember at the initial dispensing visit, I like to reserve this lubricant recommendation for a subsequent visit.

Keys to Contact Lens Success

I believe the best way to troubleshoot patients' problems is to prevent them in the first place by being a good listener and communicator. Using chair-side photographs and diagrams helps me get my message across to my patients, and recommending quality products ultimately enhances their contact lens success. CLS

Dr. Lanier is in private group practice in Jacksonville, Fla., specializing in contact lenses. He is a Diplomate in the Cornea and Contact Lens Section of the American Academy of Optometry, he has lectured internationally on contact lenses and related diseases and he currently serves as a consultant to several contact lens manufacturers.