Motives for Poor Compliance
BY JOSEPH T. BARR, OD, MS, FAAO, EDITOR
Of all people, you'd think I would know how important it is to take good care of my contact lenses. Especially because I wear them only occasionally and when I'm not wearing them, organisms have ample opportunity to grow if I'm not careful. When I want to wear my lenses, I start by washing my hands (that's good, and I'm thorough about this step), then I take the lenses from the case, rinse them thoroughly with multipurpose solution (MPS) and apply them. I then rinse the case with MPS and let it air dry, and I give myself high marks for this. After wearing the lenses, I wash my hands (good job, Joe) and put fresh MPS in the case. Now comes the point where I'm not always so good. I may just put the lenses in the solution directly from my eyes or I may rinse them a bit and then store them. If the lenses have sat in the case for some time, then I may rub them and rinse them prior to application. Why not use daily disposables? I can wear just about any lens, but honestly, the daily disposable lenses aren't my personal favorites for vision and comfort. I wish they were.
Given my lens care habits outlined above, I learned something on vacation this summer when I was using my lenses so much at the beach. I had one two-fluid-ounce bottle of MPS. It was partially used when I got there and a little remained when I left. Did I skimp on rinsing? I sure did. And why? I went to the store every day. I could have bought solution. I bought food, drinks, tennis time and clothes, but not a bottle of solution that could have prevented an eye infection or at least prevented discomfort. It certainly wasn't the cost. It certainly wasn't the understanding. I just didn't do it because it would have been a hassle to take the few minutes to do it. And I knew that when I got back home I could get another sample. (I guess that means it was somewhat the cost.)
Manufacturers and contact lens investigators have shown repeatedly that compliance with proper contact lens care is less than 50 percent. How can we overcome the human nature to minimize solution use? How can we overcome the barriers to proper patient compliance, especially when the bottle is almost empty?
Educate patients about why each step is important. Tell them how many bottles of solution they should use each month (definitely more than two two-fluid-ounce bottles) and ask them to comply with this consumption rate for the same reason you educate them about why replacing their lenses every two weeks is better than replacing them every three weeks or four weeks (noncompliant) because of potential discomfort and inflammation possibilities.