BY MARY JAMESON, BHS, COA, NCLC, CPOT
Have new contact lens solutions and wearing modalities helped or hindered patient
compliance? Can non-compliance ever be resolved? Probably not, with the human factors involved (us and them) in the process. We do what we can to help patients understand the importance of following instructions. Here are a few suggestions that you may find helpful.
Disposable Contact Lenses
This lens modality is the most popular and (probably) the most prescribed today. Our society loves the word "disposable." Single-use and throw away is what "disposable" means to me. (Wouldn't you have thought that all lenses could be considered disposable?) An informal survey of disposable lens wearers showed that patients discard their lenses not according to schedule but when they feel it's time to throw the lenses away. Lenses were kept much longer as the package of lenses decreased. When you are instructing your patient about lens care and handling, provide him with a worksheet to write down when lenses have been changed. That way he will have a better idea how long he really has been wearing that pair of lenses.
Extended Wear Contact Lenses
For those of us who have been in the industry a while, they're back. For those new to contact lenses, they probably seem like a great idea. Patients have always loved the concept. The problem in the past has been lack of patient compliance in removing lenses on a regular schedule to allow the cornea to rest and breathe. Soft lenses also act as a bandage, so if there is any irritation or damage to the cornea, the patient is less likely to feel any pain or discomfort with the lens on the eye.
We must ensure that the patients we fit with this modality are the "dukes and duchesses of directions." A non-compliant patient in other lens modalities is not a good candidate for extended wear. Document and communicate with others in your office to make sure that a decision is made based on all facts if a previously non-compliant patient asks about extended wear.
After the patient has been fit with lenses, we need to instruct and reinforce the importance of lens removal and disposal, and lens care and maintenance during the extended wearing time. Be very clear and direct when teaching patients about these lenses. Tell them why you want them to perform something, not just how.
For an example: using a lens lubricant to rewet the lenses during the day. What do you usually say? Typically, with daily wear, we recommend this step due to lens dryness. Dryness occurs with extended wear patients as well, but we also need them to use lens lubricants to flush out debris that might be trapped under the lens. Otherwise, the debris can cause an irritation and develop into something serious before the patient takes his lenses out.
Reinforce your instructions with written materials and take-home fact sheets. Don't overload the patient when training. Focus and emphasize three to four points about care and handling during each session. You may want to schedule a short visit after the patient's first follow up to review care and handling steps.
Be thorough in your instructions and guidelines. Ask the practitioner about procedures that the patient may be using but weren't prescribed. Don't dispense advice about care systems and handling without the practitioner's approval. Document care and handling issues, compliance problems, etc., so that if a problem does occur, the information is there to help assess the problem and how it occurred.
Ms. Jameson is laboratory supervisor for the Department of Clinical Sciences at the Pennsylvania College of Optometry and past chair of the AOA Paraoptometric
Contact Lens Spectrum, Issue: February 2003