Article Date: 5/1/2007

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contact lens care

Multifactorial Approach Solves Lens Wear Problem in Dry Eye Patient

BY SUSAN J. GROMACKI, OD, MS, FAAO (DIPL)

Often, the key to keeping our patients in contact lenses is a multifaceted treatment plan � and careful education. Michelle, a 22-year-old Asian woman, was referred to my practice�s corneal specialists to evaluate her "chronic pink eyes." He found previously undiagnosed meibomian gland dysfunction; I detected noncompliance with her contact lens care regimen. Her case illustrates what can happen if a patient is either misdiagnosed, misinformed � or both.

Not a �Typical� Noncompliant Patient

For those who consider noncompliant patients unintelligent, belligerent or lazy, think again. Michelle had none of these characteristics. A meticulous person and an honors graduate of a prestigious university, she will attend medical school in the fall. So why wasn�t she caring for her lenses properly?

Experts estimate that 75% of our patients receive improper contact lens care instructions from their eye doctors.1 Here is Michelle�s story.

Trial and Trial Again

A daily wear soft contact lens wearer for 9 years, Michelle was treated with antibiotics 5 years ago for presumed bilateral bacterial conjunctivitis. Over time, she became unable to wear her lenses comfortably. Previous practitioners tried changing lens materials: Extreme H20 (Hydrogel Vision Corporation), PureVision (Bausch & Lomb), Night & Day (CIBA Vision), O2Optix (CIBA Vision) and Acuvue Oasys (Vistakon). (She remembered all of these brand names. See �meticulous� in my description of the patient.)

Never instructed on lens replacement, Michelle wore 2-week disposables for up to 4 weeks. Twice, she wore lenses for 3 months while the optometrist was �still fitting� and would not give her additional trials. The practitioners tried Complete (AMO), Quick Care (CIBA Vision) and Clear Care (CIBA Vision), but never instructed her to rub or rinse her lenses. She did not always wash her hands before handling her lenses or rinse her case between uses.

Turning the Corner

Our corneal specialist prescribed a flaxseed oil supplement, warm compresses and Soothe Emollient (Lubricant) eye drops (Alimera Sciences) twice a day and loteprednol etabonate ophthalmic suspension (Lotemax, Bausch & Lomb) three times a day for 2 weeks.

Three weeks later, I saw Michelle. She was not using her last lens (Acuvue Oasys) and care system (Clear Care) properly. And she had been out of contact lenses for 1 month. I instructed her to continue with the flaxseed oil supplement daily, warm compresses and Soothe twice a day. Her lenses fit well, and she gradually increased her wearing time, starting with 3 hours and adding 1 hour/day. By the 2-week follow-up visit, she was comfortably wearing her lenses for up to 8 hours/day. She demonstrated excellent compliance with her contact lens care and replacement.

Back in Her Lenses

I did not change Michelle�s contact lenses or solution, but I did treat her dry eye. Perhaps most important, I took the time to instruct her properly on lens wear and care, and this paid great dividends. She is thrilled to be wearing her lenses again. She went on to write a paper detailing the consequences of contact lens noncompliance.

REFERENCES
1. Gleason W. Contact lens regulations and compliance. CL Spectrum. 1999;14:34-40.

Dr. Gromacki has a specialty contact lens and postsurgical comanagement practice as part of a multisubspecialty ophthalmology group in Ann Arbor, Mich. She serves on the speakers bureau for Ciba Vision and CooperVision, on the speakers alliance at Alcon and on the key opinion leaders panel at Bausch & Lomb.



Contact Lens Spectrum, Issue: May 2007