Patient Bad Habits Might not Be so Hard to Break
BY MARY JO STIEGEMEIER, OD, FAAO
Modern technology has given practitioners many options when it comes to choosing a contact lens for a patient, which thus allows practitioners to prescribe a lens for almost any patient need. Similarly, contact lens solutions available today allow us to choose the lens care system most compatible with each patient's lenses and lifestyle.
As exciting as this is for practitioners, these choices may seem confusing to our patients. Advertisements in the media for contact lenses and the variety of lens care solutions on the shelf at the local pharmacy can be daunting.
The options available, anecdotal lens-related advice from colleagues or friends and infrequent discussions with an eyecare practitioner about lens care and maintenance can result in poor compliance. These factors can exasperate the tendency of lens wearers to adapt lens wear and care to suit their daily routine.
Noncompliance not only has the potential to result in sight-threatening complications, but it can also impact lens comfort, which can result in dissatisfaction and ultimately discontinuation. It's estimated that 40 percent to 91 percent of contact lens patients are noncompliant in their recommended care and maintenance regimen.
A new survey by Synovate Inc. of 508 daily wear contact lens wearers older than age 18 highlights the prevalence of noncompliance among contact lens wearers. Specifically, the survey investigated lens hygiene habits in everyday situations and reveals:
• Two out of five do not wash their hands prior to handling their lenses, thus facilitating the transfer of microorganisms from their hands to the lens and ocular surface.
• One out of five do not use fresh solution every time they store their lenses, which compromises disinfection efficacy.
• Two out of five have put their lenses in their mouth to clean them, risking bacterial contamination.
• Seven out of 10 have admitted to swimming while wearing their lenses, while one-third swim while wearing their lenses regularly, thus exposing the lenses to a multitude of microorganisms including Acanthamoeba.
Attain Compliance With TLC
The survey shows that contact lenses and solutions are safe when patients follow proper care as directed by an eyecare practitioner. It's important to recognize your intrinsic role in communicating the golden rules of lens care and maintenance to contact lens patients.
The survey results emphasize the value of patient education as part of every contact lens-related office visit, with the educational aspect equally as important as the clinical assessment. However, instruction alone is no guarantee of compliance. Effective two-way communication between you and your lens wearers is the key to establishing healthy lens care habits.
To ensure higher levels of compliance, take care to involve lens wearers in decisions about their lenses to establish a patient-specific Tailored Lens Care (TLC) Plan. Effective dialogue with your patients will set their expectations about lenses, commitment to lens care and previous experience with lenses. You can then prescribe the combination of a contact lens, a compatible lens care solution and a care regimen as a package — a TLC Plan — specific to each patient's needs.
As part of a TLC Plan approach, include the prescribed lens care solution on every contact lens prescription and give every prescription an expiration date. Emphasize the importance of contact lens care for healthy and comfortable lens wear. Ask for the patient's commitment, document the TLC Plan and reinforced it at every visit.
Review Lens Care Basics
While individualizing a TLC Plan for each patient is important, there are some basic guidelines relating to lens care and hygiene that apply to all contact lens wearers and that should be emphasized at every visit. The AOA has a set of universal recommendations for safe and healthy contact lens wear that I've found useful in my practice. The eight steps are:
1. Always wash your hands before handling contact lenses.
2. Carefully and regularly clean contact lenses as directed by your practitioner. If recommended, rub the contact lenses with fingers and rinse thoroughly before soaking lenses overnight in sufficient multipurpose solution to completely cover the lens.
3. Store lenses in the proper lens storage case and replace the case at least every three months. Clean the case with a sterile contact lens solution after each use, and keep it open and dry between cleanings.
4. Use only products recommended by your practitioner to clean and disinfect your lenses. Saline solution and rewetting drops are not designed to disinfect lenses.
5. Use only fresh solution to clean and store contact lenses. Never reuse old solution. Contact lens solution must be changed according to the manufacturer's recommendations — even if the lenses are not used daily.
6. Always follow the recommended contact lens replacement schedule prescribed by your practitioner.
7. Remove contact lenses before swimming or entering a hot tub.
8. See your practitioner for your regularly scheduled contact lens and eye examination.
Office staff can explain and reinforce these basic rules effectively and consistently at every visit.
A TLC Plan developed by you with the patient in mind combined with a proactive approach to contact lens education by office staff at every visit will facilitate improved compliance by delivering a clear and consistent message to patients about the importance of contact lens care. CLS
Dr. Stiegemeier is in private practice in Beachwood, Ohio. She lectures throughout the country on the subject of contact lenses and performs clinical research.