Article Date: 5/1/2013

Simplify Compliance, Differentiate Your Practice

Learn how these practitioners ensure lens care compliance and how recommending specific products helps set them apart.

Arthur B. Epstein, OD, FAAO: As contact lens practitioners, we must ensure that our patients not only wear their lenses as prescribed but also care for them properly to achieve the best vision, comfort and experience with their lenses. Years of clinical experience confirms that Clear Care Cleaning and Disinfecting Solution (Alcon) is safe and effective, with excellent activity against bacterial1 and fungal2 biofilms and low rates of corneal infiltrates and corneal staining.3-5 Let’s focus on perhaps the greatest challenge clinicians face. I would like to explore two specific compliance issues. First, how can we maximize compliance with our lens care instructions when we recommend Clear Care solution? And second, how can the recommendation of a specific product help us gain compliance as well as differentiate our practices?

LENS CARE SIMPLICITY

Dr. Epstein: Dr. Brujic, why do you prefer Clear Care solution over other peroxide products? Specifically, I’d like you to focus on neutralization differences between products.

Mile Brujic, OD: I like to minimize the number of required steps, whether we’re treating disease or correcting vision with contact lenses. Clear Care solution is highly effective as a disinfectant, and with its platinum disc for neutralization, it’s simple to use. Patients follow four easy steps: 1) place each lens in the appropriate side of the cage and rinse with Clear Care solution for 5 seconds; 2) fill the vial to the line; 3) place the cage in the vial; and 4) tighten the cap and store for 6 hours. They don’t have to worry about adding anything else to neutralize the solution.

Dr. Epstein: Other disinfecting systems use catalase to neutralize the peroxide. Does anyone want to comment on issues they’ve seen with systems using a separate neutralization step?

Christopher W. Lievens, OD, MS: One issue is repeatability. The catalase tablets sometimes neutralize at different rates, which can be problematic if the peroxide isn’t fully neutralized when the patient expects it to be. One of the benefits of the platinum disc is that it’s relatively long-acting and consistent. Another issue relates to the fact that we’re human and we forget things. I’ve heard of instances where patients have run out of catalase tablets, soaked their lenses in the peroxide, put them in the next day and ended up with very uncomfortable eyes. Because the platinum disc is part of the case, there’s no concern about running out of the neutralizing agent.

Christine W. Sindt, OD, FAAO: Another advantage is that when the disc needs to be replaced, the entire case must be replaced, which eliminates worries about case hygiene.

Dr. Epstein: That’s a great point. It also minimizes the issue of biofilms and other contaminants collecting in the bottom of the case.

Dr. Epstein: Is peroxide a safe system, or does the complexity make it less safe? I know some clinicians have concerns about patients being able to follow even simple instructions.

Loretta B. Szczotka-Flynn, OD, PhD, FAAO (Dipl): I’ve never seen a toxic or hypersensitivity type of complication directly attributed to any peroxide system when used properly. Patients who misuse peroxide may experience a transient, acute ocular surface toxicity response, but they always recover with no long-term adverse effects.

Dr. Epstein: Your point is well put. Peroxide is as safe as the patient allows it to be.

Dr. Szczotka-Flynn: I call it a gentle giant. It’s strong, but it’s gentle when used properly.

EDUCATE FOR COMPLIANCE

Dr. Epstein: Dr. Brujic, how do you educate your patients on the proper use of Clear Care solution?

Dr. Brujic: When patients are new to Clear Care solution, I do two things. I begin educating them about it in the examination room, and my technical staff reinforces the message before they leave our office. I explain that I believe Clear Care solution is the best system for them to use, and I stress that it’s important to carefully follow instructions. I believe my recommendation and the time I take to discuss it makes a difference. The technician reviews exactly what patients need to do, and patients leave our office with a trial kit, so they can practice using the product before they need to purchase it.

Dr. Sindt: Does your staff spend more time explaining peroxide to your patients and how to use it than they spend explaining a multipurpose solution?

Dr. Brujic: My staff members discuss the importance of following the directions to ensure the peroxide is neutralized, but they don’t go into specifics about how peroxide works. The discussion may take a little longer because technicians remove the product from the box to show it to patients, which they don’t necessarily do with a multipurpose solution.

Dr. Epstein: Dr. Townsend, how do you reinforce the importance of fully neutralizing peroxide before applying lenses?

Dr. Townsend: Many patients already have a mental image of what hydrogen peroxide can do, because they’ve used it to treat a wound or disinfect their countertops. I explain that a hydrogen peroxide contact lens care system is formulated to kill microorganisms on their lenses. If they apply their lenses before the peroxide is neutralized completely, they will experience some burning and stinging.

Dr. Epstein: Dr. Brujic, how do you ensure that patients continue to adhere to your lens care instructions? I think one of the biggest problems we face are initially compliant patients who later “fall off the wagon.”

Dr. Brujic: I try to safeguard against poor hygiene practices by having patients bring in their lens cases, care solutions and any products or drops they use for their lenses and their eyes. This may seem somewhat rudimentary, but it’s effective. It gives me a true picture of what my patients are doing, and it gives me an opportunity to reinforce proper care. I’m sometimes amazed by what patients bring in and it gives me an opportunity to recalibrate their views when it comes to properly taking care of their eyes.

DIFFERENTIATE YOUR PRACTICE

Dr. Epstein: Here’s what I believe will be a pivotal question for our colleagues. Even though my practice in NY was at one time limited exclusively to contact lenses, I always sought ways to differentiate it from other practices. So I’ll ask the panel, can recommending a specific product help to differentiate your practice?

Dr. Brujic: In this era of commoditization, sometimes the only thing that differentiates us from others is our patients’ perceptions of their experiences at our practice. For example, we take contact lenses very seriously. We take the time to let patients know we’re prescribing the best lenses and pairing them with the best lens care solutions for their eyes; we explain why we believe this, and then we teach them how to properly use the products.

Dr. Epstein: As a doctor, it’s important that patients use the products I recommend. There are significant formulation differences between apparently similar products and we’re dealing with the eyes, which have some of the most sensitive and fragile tissues in the body. Clear Care solution wasn’t created by accident. It was carefully and scientifically formulated and is broadly recognized as the gold standard.

Some practitioners allow patients to try various care products and choose the one they prefer. How do you feel about that approach, Dr. Brujic?

Dr. Brujic: Taking a generic grab-bag approach to lens care isn’t in the best interest of the patient or the practice. The best approach is clearly defining what you want your patients to use. If a peroxide disinfecting system is in a patient’s best interest, I make it clear that I want him to use Clear Care solution and why, and then we teach him exactly how to use it. It’s simply one more way to decommoditize our services.

Dr. Lievens: I agree. The secret to building a strong doctor-patient relationship often lies in answering the question, “Why?” Why am I prescribing this particular lens in your spectacles? Why am I prescribing this specific glaucoma medication for your glaucoma? Why am I giving you this specific contact lens prescription and this specific solution? It’s all about why, and when those whys are answered, the doctor-patient relationship blossoms. The patient becomes more compliant, the practice grows and everybody wins.

Dr. Epstein: That is sage advice indeed. Making sure you take the time to explain why makes all the difference in the world, and using products that you truly believe in distinguishes you and your practice and strengthens your business. I don’t think anyone should underestimate the power of conviction. Patients know when you’re doing the right thing for them. CLS

PARTICIPANT DISCLOSURES

Dr. Epstein is a consultant/advisor to Alcon, NiCox, Tear Science and Valeant Pharmaceuticals. He has received research support from Alcon. He is a lecturer for Alcon and VSP.

Dr. Brujic has been an advisor to Alcon, Allergan, Eyemaginations, NiCox, Transitions, TelScreen, VMaxVision and Vistakon. He has received reserach support from Alcon and VMaxVision. He has lectured for Allergan and Bausch + Lomb.

Dr. Lievens has received research funding from Alcon, Allergan, Eyegate and Merck. He has received lecture honoraria from Alcon, Transitions and Zeiss.

Dr. Sindt is a consultant/advisor to Alcon and Vistakon, and has received research support from Alcon.

Dr. Szczotka-Flynn She has received research support from Alcon, CooperVision and Vistakon.

Dr. Townsend is an advisor to Alcon, TearScience and Valeant. He has received research support from Odyssey and TearLab.



REFERENCES

1. Szczotka-Flynn LB, Imamura Y, Chandra J, et al. Increased resistance of contact lens-related bacterial biofilms to antimicrobial activity of soft contact lens care solutions. Cornea 2009;28;918-926.

2. Retuerto MA, Szczotka-Flynn L, Ho D, Mukherjee P, Ghannoum MA, Efficacy of care solutions against contact lens-associated Fusarium biofilms. Optom Vis Sci 2012;89:382-391.

3. Diec J, Evans VE, Naduvilath TJ. Performance of Polyquad, PHMB and Peroxide Solutions With Silicone Hydrogel Lenses. Poster presented at: Annual Meeting of the Association for Research in Vision and Ophthalmology; May 7, 2009; Ft. Lauderdale, FL.

4. Carnt NA, Evans VE, Naduvilath TJ, et al. Contact lens-related adverse events and the silicone hydrogel lenses and daily wear care system used. Arch Ophthalmol 2009;127:1616-1623.

5. Diec J, Evans VE, Tilia D, Naduvilath T, Holden BA, Lazon de la Jara P. Comparison of ocular comfort, vision, and SICS during silicone hydrogel contact lens daily wear. Eye Contact Lens 2012;38:2-6.



Contact Lens Spectrum, Issue: May 2013