the contact lens exam

Improving Compliance With Patient Education

BY JEFF SCHAFER, OD, MS, FAAO

Recent outbreaks of fungal and protozoan corneal infections related to multipurpose solutions have been well reported. Clinicians widely believe that poor compliance with certain disinfection systems was a contributing factor to the increase in cases of infectious keratitis.

The recalls of two multipurpose solutions from two different major manufacturers has certainly prompted me to more closely examine the patient education procedures that occur in my practice, and I'm sure most of you have revisited this in your practices as well. To provide the safest lens wearing experience for your patients, how well you educate them about lens disinfection may be one of the more important parts of your exam.

Start With the Basics

At The Ohio State University, we have a higher than average rate of transient patients. We see many college students as new patients who were fit with contact lenses elsewhere. In the past, I might have asked what solution they used and been happy enough to keep them using it unless I noticed any undesirable findings. I'm now much less likely to assume that established lens wearers are properly caring for their lenses. I ask them how they clean their lenses, and I make them show me on occasion. I ask what they do with the leftover solution and how they clean their case.

While I was never fond of norub labeling, I'm now much more vigilant in recommending that patients rub their lenses before rinsing and storing. I believe, now more than ever, in this crucial step of the disinfection process. I routinely recommend a specific solution to each patient and inform each as to why I chose that solution for him.

Topping Off and Case Care

The biggest change in my discussions about lens care is specifically addressing the issue of topping off with each patient as part of the case history. I've been amazed at the percentage of patients who routinely don't discard their used solution each morning. If you aren't asking your patients about this at every visit, you should be. Instruct your patients to use fresh solution each time they disinfect their lenses.

Also address the issue of case care during lens care discussions. I'm amazed by the little science experiments that patients unwittingly conduct on their bathroom counters. I've seen everything from lint to dirt to full grown fungal cultures on patients' cases.

Remind patients to clean their case daily with fresh solution, let it air dry and replace it frequently. I've lobbied solution reps for years to include a new case with each new bottle of solution. Some companies do this, some don't. To help remedy this problem, we've begun giving patients four new lens cases at their annual comprehensive exam and recommending that they replace them every three months.

Worth the Effort

As you know, it's a rare event to encounter a patient who's 100 percent compliant, so remind patients about proper lens care directed at their particular routine with each contact lens exam. Patients are often grateful when I take the time to review lens care with them. It seems quite confusing for many patients, who often thought they were doing it properly or never quite understood it in the first place. CLS

Dr. Schafer is a clinical assistant professor and chief of the contact lens service at The Ohio State University College of Optometry.