PATIENT VIEWS OF CL ADVANTAGES

Spectacle Wearers Need to Know More About Contact Lenses

An analysis of the perceptions that patients have about the relative advantages of contact lens wear.

Charles W. McMonnies, MSc

Charles W. McMonnies is an adjunct professor, School of Optometry and Vision Science, University of New South Wales. He has written three books, five text book chapters, and over 120 scientific and clinical papers. He is a recipient of the Joseph Lederer Award and the British Contact Lens Association Medal in recognition of his contributions to contact lens education and research.

For many patients, the decision to be fitted with contact lenses is made on the basis of wanting to be able to see without wearing glasses. Anecdotal evidence suggests that the decision is usually cosmetically based—wanting to get married and be photographed without glasses, for example. Women in particular, but men as well, may have been exposed to negative messages regarding spectacle wear (Sherrow, 2001).

Movies and television typically have characters undergo character transformation from a stereotypically less attractive persona to one that is more appealing by removing their spectacles—think of the bookish girl in a teen movie or Superman’s timid alter ego Clark Kent, who both take on more compelling personalities the moment that they take off their glasses. The girl becomes very popular with boys who had previously ignored her, and Superman’s image soars when he saves someone, or the entire world, with his x-ray vision.

Other reasons for switching to contact lenses may be unrelated to cosmesis—playing sports or performing in the theatre without the need for glasses are two typical instances.

There are numerous visual and other practical, non-cosmetic advantages to contact lens wear (Table 1), but it’s unlikely that spectacle wearers will know most of them. Many of those benefits cannot be properly anticipated or fully appreciated without actually wearing contact lenses in a variety of circumstances. Once contact lens wear has started, occasional use of glasses helps demonstrate their limitations.

However, other factors can contribute to the decision of whether or not to be fitted with contact lenses. Initial and ongoing costs as well as perceived difficulties with their application and/or care may be important issues. Those pros and cons are relative to the pros and cons for and against spectacle use. Ultimately, a rational comparison can be made only after a comprehensive assessment of an individual’s suitability for contact lens wear has been made—once you’ve fitted an individual with diagnostic contact lenses and explained matters such as the relevant fees, need for aftercare, and any pertinent limitations. Many people become long-term wearers when experience allows them to confirm anticipated benefits and to become increasingly aware of unanticipated advantages of this form of vision correction.

The confidence and enthusiasm with which recommendations are made by a contact lens wearer or a practitioner are big factors in helping people to make a decision to proceed. New wearers are often very enthusiastic about their success, and this energy can be put to good use. The collective advantages for wearing contact lenses may be a more persuasive factor than the individual advantages taken by themselves (some or many will not be applicable to all wearers). Possible disincentives such as affordability become less of an issue if enough potential benefits are anticipated and then realized once contact lenses are worn.

Expectancy Theory

Expectancy theory is one of a class of theories based on the principle of expected value. This principle suggests that people make choices based on the expected payoff of the alternatives (Mitchell, 1979).

Expectancy theory does not distinguish between extrinsic (unessential or extraneous) rewards and intrinsic (inherent) rewards in determining the valence or value arising from performing a particular behavior. It assumes that they simply are cumulative, so that there is a greater likelihood of performing a behavior that has both intrinsic and extrinsic rewards, other things being equal (Long, 1998). For example, some advantages of contact lenses may not be relevant to a patient because they are specific to a particular age, activity, or class of wearer.

However, awareness of such factors may nevertheless combine with advantages that are relevant to that patient to help him make a decision to proceed with a fitting. The algebraic sum of the ‘for’ and ‘against’ factors is the decision maker, with the pros and cons being weighted according to personal preferences and needs. For instance, visual acuity for highly hyperopic patients is not the only criterion for preferring contact lenses over spectacles; this is confirmed by the continued use of contact lenses by some patients when visual acuity is actually better when they wear glasses. Apparently, advantages such as a wider field of view and avoiding the over-large eye appearance created by spectacles combine to outweigh the acuity loss.

Desire to have something can increase with the number of people who already have it (Mitchell, 1979). Market statistics reveal that there were 130 million contact lens wearers worldwide in 2011 (Morgan et al, 2012). Although 130 million is a significant number, it is only a small percentage of the estimated one billion myopes in the world (Norton et al, 2005). Contact lenses are impractical for many potential wearers for reasons that may include their cost and/or living in conditions or climates that are counter to successful contact lens use. In addition, there may be poor access to contact lens practitioners, and for too many people there is no access to any form of eye care (Holden, 2007; Woo and Woo, 2013).

Yet in Australia, where contact lenses are more affordable compared to many other countries, only 5.1 percent of the population wore contact lens in 2009 (Edwards et al, 2009). This is a low rate compared to countries such as Japan, the United States, New Zealand, and England (Morgan et al, 2011). In urban and rural populations in the Australian state of Victoria in 1999, the prevalence of myopia greater than –0.50D was 17 percent (Wensor et al, 1999). Myopia has been steadily increasing in prevalence (Wensor et al, 1999) (Rose et al, 2001), and a higher prevalence would be expected now. Considering the increased prevalence of myopia since the 1998 finding of 17 percent, as well as indications for contact lenses other than to correct myopia, the 5.1 percent usage among Australians reported in 2009 (Wensor, 1999) is only about one quarter of the expected potential for contact lens use.

Reduced fitting rates may result from many other factors including low recommendation levels by practitioners and limited awareness of the potential vision and other advantages provided by contact lens wear.

Addressing the Unmet Potential

Unfortunately, contact lens wearers often do not transmit positive messages about wearing contact lenses because they are not readily identifiable as successful contact lens wearers. Unless they are remembered as spectacle wearers, they appear in contact lenses to be free of the need for any vision correction at all. Ideally, they would wear a badge or T-shirt proclaiming, “I am a very happy contact lens wearer.” However, this would conflict with any desire to keep contact lens wear a private matter.

In contrast, a negative message related to contact lens use can be disseminated when, for example, a character in a film is obliged to portray the cliched moment of being inconvenienced by losing a contact lens or being irritated by contact lenses.

It appears that there is a large unmet potential for contact lens use by spectacle wearers whose knowledge of their many advantages is likely to be limited. Awareness of the wide range of potential advantages that contact lenses offer over spectacles can be increased using a list of those advantages titled “Why millions of people love wearing contact lenses,” (McMonnies, 2011). This study examines the potential of such a list of advantages as a means of informing and educating spectacle wearers of the wide range of prospective advantages of contact lens correction.

Expanding Awareness

However, it cannot be assumed that existing lens wearers, even those who have extended experience, have an extensive knowledge or appreciation of the many potential advantages of contact lens use. This limited understanding of those advantages may result in a reduced ability and/or willingness to advocate contact lens correction to relatives, friends, acquaintances, and work colleagues. The purpose of this study was to quantify the level of awareness of the advantages of contact lens correction among existing contact lens wearers. This measure may indicate the potential for their increased awareness of those benefits, so that they can better advocate for contact lens wear.

The original version of the list of 33 advantages (McMonnies, 2011) was increased to 44 for this survey with advice from Graeme Young, MPhil, PhD, FCOptom, DCLP, FAAO; Alan Saks, MCOptom, Dip. Optom, FCLS, FAAO; Russell Lowe, BSc Optom, FAAO, and John Boyce, BSc, Dip Opt. Optometrists were asked to submit the survey to current contact lens wearers, asking them to indicate which of the potential advantages of contact lens correction were unknown to them. Participation was voluntary, and all responses were anonymous.

Table 1 indicates the ranking of contact lens advantages according to the percentage of respondents who indicated that they were not aware of them. The three least aware respondents indicated being unaware of 56 percent, 48 percent, and 41 percent of the advantages, compared to the three most aware respondents, who were unaware of only 6 percent, 9 percent, and 9 percent of the advantages. On average, the respondents indicated unawareness of 27 percent of the advantages. Many respondents will not have experienced those benefits because they are too old or too young, have a different type of refractive error, don’t play sports, etc.

This is not a surprising result, but many of these contact lens wearers might be better at recommending contact lens use if they were provided with the list to give to spectacle wearers. Making current contact lens wearers aware of the survey should widen their appreciation of the numerous advantages of contact lens correction. Theoretically, that enhanced appreciation can add to increased motivation and enthusiasm for successful and positive interactions with spectacle wearers.

Copies of the list can be provided to contact lens wearers to support their recommendations when they are speaking to spectacle wearers. A longer list, recently increased to 50 advantages, might even be more likely to impress and motivate spectacle wearers to seriously consider contact lens use—any one of those advantages might be the key to triggering that exploration. Even when cosmetic considerations don’t factor into a decision to consider contact lenses, there are many other advantages that can provide enough motivation. Spectacle wearers need to know about them. CLS

To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #213.