Contact Lens Practice Pearls

Become a Good Historian

BY JASON R. MILLER, OD, MBA, FAAO

To have a successful contact lens practice, maintaining ocular health in our lens wearers is critical. Minimizing dropouts related to red eyes is something for which we all strive. By prescribing lenses and care systems that best match patients’ lifestyle and visual needs, we hope to prevent contact lens-related complications.

But, it is difficult to completely eliminate lens-related problems. They continue to happen, and eyecare professionals typically blame this situation on the contact lens wearers. At the top of the list is contact lens abuse. But do we really know? Is it compliance? Is it the contact lens materials or solutions? Is it some other cause?

These “other cause” complications are sometimes difficult to fix because our patients may have developed multiple bad habits. I have witnessed a patient take a new contact lens out of the package and rinse it with tap water before applying it. How does that habit begin?

Here, I outline a few steps to uncover those “difficult to fix” contact lens-related issues.

Ask Plenty of Questions

To be good historians, eyecare professionals have to be curious. That means having good observation skills and asking lots of questions. If patients tell you that their contact lenses are “fine,” but their eyes look irritated...ask more questions. Most patients do not offer detailed information about their contact lens wearing experiences unless we ask them.

One of my patients returned six months after her exam and contact lens evaluation. She was a new patient at the initial exam, and her new contact lenses had improved the lens comfort quite a bit. She returned wondering why her eyes continued to get red, which seemed to worsen throughout the day. Upon evaluation, she had mild limbal injection (Figure 1) and quite a bit of ocular surface irritation (Figure 2).

Figure 1. Mild limbal injection in our red eye patient.

Figure 2. Fluorescein staining of our red eye patient.

Upon further questioning, this patient admitted to using Visine everyday for the past 25 years, often while she was wearing her contact lenses. She did not admit to using any over-the-counter eye drops at her initial exam. Visine toxicity was the cause of this contact lens-related red eye.

Don’t Assume Anything

If we assume that patients are replacing their lenses on time, not sleeping overnight in their lenses, and caring for them perfectly, we are most likely missing something. This fact was exposed publicly last year in USA Today (Bowerman, 2015). A majority of our patients are not compliant. Let’s make it a focus to improve this statistic.

We, as eyecare professionals, can’t take compliance lightly. Whether a contact lens wearer presents with no problems or with an acute red eye, it is important to be a good historian. Finding out the underlying cause or any underlying bad habits is critical to diagnosing and treating problems quickly. It is key to getting red eye patients back into their contact lenses and to maintaining healthy lens wear. CLS

For references, please visit www.clspectrum.com/references and click on document #244.

Dr. Miller is in a partnership private practice in Powell, Ohio, and is an adjunct faculty member for The Ohio State University College of Optometry. He has received honoraria for writing, speaking, acting in an advisory capacity, or research from Alcon, Allergan, CooperVision, and Visioneering Technologies. You can reach him at drmiller@eyecarepowell.com.