IT’S NO SECRET that contact lens dropout is a major factor impeding the growth of the contact lens market today. Despite plentiful motivators for patients to make the switch to contact lenses, ranging from cosmesis to the ever-annoying mask-induced fogging of glasses, studies suggest that up to 50% of wearers may drop out within the first three years (Markoulli and Kolanu, 2017; Young et al, 2002).

However, the news isn’t all that bad. Studies have also demonstrated that up to 74% of patients who dropped out can be convinced to restart wear if their concerns are adequately managed (Young et al, 2002). With the millions of patients out there who have past history of contact lens use and the numbers on our side, there presents a unique opportunity for clinicians to not only help patients but also to grow their contact lens practices at the same time. These patients just need practitioners who are willing to ask the right questions and alleviate concerns that their previous eyecare providers may have failed to address.

THE IMPORTANCE OF COMMUNICATION

The first step in tapping into the contact lens dropout market is to proactively identify potential dropout candidates. Fortunately, there are great ways to do so without losing a minute of valuable chair time.

Does your office use an intake form? Are these just for new patients? This is an excellent opportunity to screen existing contact lens patients. Gaining insights on symptoms of dryness or end-of-day comfort can go a long way in preventing a future problem. Alternatively, in practices that employ technicians, the technician may also play a “screening role.” Simply asking patients the same probing questions during pretesting can reveal all sorts of information.

Once potential candidates are identified, it’s important to set aside some time for a one-on-one conversation regarding the patient’s risks of abandoning contact lenses. The information obtained can be used to devise an individualized plan for addressing problems that could lead to dropout.

ADDRESSING COMMON CONCERNS

Study after study has revealed ocular surface disease (OSD), particularly meibomian gland dysfunction (MGD), as a major culprit driving contact lens dropout (Kwan et al, 2019). This goes hand in hand with findings from surveys of thousands of prior contact lens wearers who cited ocular discomfort as the top reason for dropping out (Young et al, 2002; Pritchard et al, 1999).

Therefore, a large part of preventing dropout comes down to aggressively treating and managing OSD, by spending a few extra months getting it under control before reinitiating lens wear and continuing maintenance therapy thereafter. While the mainstay of MGD treatment—increasing blink rate during screen time, warm compresses, artificial tears, and rewetting drops—should continue to be recommended, there are several additional options in our toolbox to consider in particularly challenging cases.

One study demonstrated that just five weeks on 0.05% topical cyclosporine can significantly improve contact lens tolerance and increase wear time by up to two hours per day (Hom, 2006). Topical cyclosporine or lifitegrast, combined with a short course of a surface steroid, is another great way to help patients feel better quickly as the slower-acting immunomodulator begins to take effect over the course of a few months (Periman et al, 2020).

Other options to consider for getting OSD under control include dissolvable collagen punctal plugs, intense pulsed light therapy, and heat treatment.

Ultimately, it is our role as practitioners to empower our patients with the best visual correction suitable to their unique lifestyles, goals, and visual needs. While addressing the root cause of dropout does take extra time and effort, it pays dividends in the end in terms of patient loyalty, referrals, and growing your contact lens practice. CLS

REFERENCES

1. Markoulli M, Kolanu S. Contact lens wear and dry eyes: challenges and solutions. Clin Optom. 2017 Feb 15;9:41-48.
2. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. 2002 Nov;22:516-527.
3. Pucker AD, Jones-Jordan LA, Marx S, Powell DR, Kwan JT, Srinivasan S, Sickenberger W, Jones L. Contact Lens Assessment of Symptomatic Subjects (CLASS) Study Group. Clinical factors associated with contact lens dropout. Cont Lens Anterior Eye. 2019 Jun;42(3):318-324.
4. Pritchard N, Fonn D, Brazeau D. Discontinuation of contact lens wear: a survey. Int Contact Lens Clin 1999 Nov;26:157-162.
5. Hom MM. Use of cyclosporine 0.05% ophthalmic emulsion for contact lens-intolerant patients. Eye Contact Lens. 2006 Mar;32:109-111. doi:10.1097/01.icl.0000175651.30487.58
6. Periman LM, Perez VL, Saban DR, Lin MC, Neri P. The Immunological Basis of Dry Eye Disease and Current Topical Treatment Options. J Ocul Pharmacol Ther. 2020 Apr;36:137-146.