Reader and Industry Forum
A New Lens Compliance Tool for Your Everyday Practice
By Claudine Courey & Etty Bitton, OD, MSc, FAAO
Patient compliance, or lack thereof, has always been an issue with contact lens wear. However, in the past few years, noncompliance has taken center stage as product recalls and ocular infections have revealed that patient lens care habits fall short (Cardona and Llovet, 2004; Szczotka-Flynn and Pearlman, 2010; and others, full list available at www.clspectrum.com/references.asp).
In an effort to standardize instructions given to new contact lens wearers, some practices have developed their own guides and written recommendations for proper lens application, removal, and general care. However, due to new information concerning the use of tap water and biofilms developing in lens cases, uniform guidelines based on the latest evidence are needed.
New Guide Available
To that end, the Association of Optometric Contact Lens Educators (AOCLE), a non-profit organization dedicated to contact lens education, has developed a Healthy Soft Contact Lens (CL) Habits Guide to address lens compliance issues.
This guide, which comes in the form of a tear-off pad (Figure 1), can be reviewed in office with novice wearers or with patients needing compliance reminders and can be subsequently reviewed at home. The illustrated guide, available in three languages (English, French, and Spanish), reviews basic hygiene and lens care issues, and each statement is referenced if patients, students, office staff, or practitioners need further information. The guide can be used in any practice setting, as it uses simple terms and is non-product specific.
Figure 1. The Healthy Soft Contact Lens Habits Guide.
The Healthy Soft CL Habits Guide begins with basic hygiene such as hand washing and is followed by the practitioners' recommended solution regimen, lens care instructions, and avoiding the use of tap water in the care of contact lenses. It is well known that patients nap or sleep in lenses not designed for that purpose, resulting in decreased oxygen supplied to the ocular tissues. In an effort to address this issue, one of the points in the guide directly asks patients to discuss daily versus extended wear with their practitioner.
Regarding the use of cosmetic contact lenses that change the color of the eye, it has been reported (Steinemann and Fletcher, 2005; Steinemann and Pinninti, 2003) that some patients, mainly teens, share their contact lenses to try different colors. The guide reiterates that this should never be done.
Instructions for novice lens wearers usually involve lens application, removal, and basic contact lens care and maintenance. Case hygiene has traditionally been underemphasized, in part because practitioners held the assumption that patients would maintain a clean case for storing something that they would later apply to their eyes. With the concern of biofilms leading to ocular infections, recent literature (Yung et al, 2007; Willcox et al, 2010) has drawn our attention to stricter lens case hygiene. The guide addresses the importance of not topping off solutions in the case as well as appropriate cleaning and replacement frequency of contact lens cases.
Recent information reported by Dumbleton et al (2010) has shown that replacement schedules are not always followed. In an effort to reinforce compliance with contact lens replacement schedules, the pad allows practitioners to choose the appropriate replacement frequency (one day, two weeks, or one month) as a reminder to patients.
A Lasting Reminder
Patients are inundated with information during their office visit. A written reminder, which has been proven to enhance compliance, can serve as a reference tool at home (Cardona and Llovet, 2004). The Healthy Soft CL Habits Guide is accessible for practitioners to download online at www.aocle.org. The guide was unveiled in the fall of 2010 at contact lens clinics throughout the 21 North American Schools and Colleges of Optometry (in the United States, Canada, and Puerto Rico).
The AOCLE's goal in creating this tool is to educate optometry students to discuss each key point with contact lens patients and to develop a routine that will carry over into their practice. It is hoped that this guide will be valuable to both future and existing practitioners. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #186.
Claudine Courey is a third year student at the École d'optométrie, Université de Montréal and assisted with this project as a summer intern. Dr. Bitton is an associate professor of optometry at the École d'optométrie, Université de Montréal and is the Externship Director. She is also the immediate past-chair of the Association of Optometric Contact Lens Educators (AOCLE). She is a consultant/advisor to Ciba Vision, Alcon, AMO, B+L, and J&J.