cultivating compliance

Taming Contact Lens Noncompliance Issues: Act 2

BY ROSALYNN H. NGUYEN, OD, & TIMOTHY B. EDRINGTON, OD, MS, FAAO

Contact lenses should not intimidate practitioners or patients. Simple solutions to noncompliance issues are effective ways to keep patients happy and healthy in their contact lenses.

You can find noncompliance issues No. 6 to 10 of this top 10 list in the August 2008 issue and on the Spectrum Web site. Now, let's continue the countdown.

5. Don't forget the eyelids! Routine eyelid hygiene before and after contact lens wear is important to maintain eye health and patient comfort. Daily lid scrubs and warm compresses help to treat blepharitis and minimize dry eye issues. Patient instructions for lid scrubs and warm compresses are available by searching the archives at www.clspectrum.com.

4. Can one desire too much of a good thing? Extended wear contact lenses make it rather tempting for patients and practitioners alike to become complacent about wear time. Keep in mind that overnight contact lens wear is not the best option for every patient. This is especially important with patients who have high prescriptions or wear toric lenses. The increased thickness profiles of these contact lenses reduce oxygen transmissibility and put the patient at higher risk for corneal hypoxia.

Evaluating the patient's lifestyle, level of responsibility, and corneal health is crucial in determining wearing schedules.

3. Where art thou patient? Regular follow-up visits help to curb contact lens dropout. Contact lens wearers should follow up with their eyecare provider six months after the initial fitting to assess the efficacy and safety of their contact lenses. Thereafter, annual comprehensive eye examinations and contact lens follow ups are recommended.

Practitioners should take a thorough case history, review lens care systems and discuss replacement and wearing schedules with patients at each visit.

2. A solution by any other name may not work as well. Prescribing a lens care system may be just as crucial as prescribing the proper contact lens.

Perusing the eyecare aisle at the drugstore may be overwhelming, but encourage patients to stay with the same care system and rewetting drop brand that you prescribed. Switching care systems or using a generic brand puts patients at risk of preservative hypersensitivity as well as solution/contact lens material incompatibility.

1. "Delays have dangerous ends," especially when it comes to regular replacement of cases.

Contact lens case contamination has been well-documented in studies. Yung et al (2007) established that most of the noncompliance issues were associated with improper care of the contact lens cases. The use of silver-impregnated contact lens cases can reduce microbial contamination by making it more difficult for microorganisms to adhere to the case surface. However, regardless of the type of contact lens case, it's highly recommended that patients clean contact lens cases daily with solution — not tap water — and then let the cases air dry.

Patients should also replace contact lens cases at least every three months.

Full Circle

Successful lens wear is a team effort between the practitioner and the patient. By stressing the importance of compliance through patient education, we all can increase lens success and decrease dropout. CLS

To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #155.

Rosalynn H. Nguyen, OD, completed her residency training in Cornea and Contact Lenses at the Southern California College of Optometry in June 2008. Currently, she serves as a faculty member in the Ophthalmology Service at Loma Linda University. Dr. Edrington is a professor at the Southern California College of Optometry. E-mail him at tedrington@scco.edu.