Developing a Continuous Wear Patient Education Program
BY NISH RAJANI, OD
I often begin presentations on silicone hydrogel lenses for continuous wear with the following Jessamyn West quote: "We want the facts to fit the preconceptions. When they don't, it's easier to ignore the facts than to change the preconceptions." I use this quote because silicone hydrogel materials are so revolutionary that they force us to change our preconceptions.
Before you can educate your patients about silicone hydrogel lenses, you must know about them yourself. Start by searching the journals or the Internet (such as the
www.siliconehydrogels.org Web site) or by attending seminars to learn everything you can about these new lenses. The clinical literature will give you confidence to recommend the lenses to patients, and the practice management pieces will show you how and why continuous wear is a viable and profitable growth opportunity for your practice.
Let's assume you don't want to be left standing at the platform as the express train of advanced technology pulls out. That's what's happening with silicone hydrogels. Here's how to counter this situation.
Update Your Thinking
First, let's challenge the preconceptions:
Overnight wear isn't safe. Several years ago, it was prudent to tell patients not to sleep in their lenses because of concerns of corneal edema and infection.
But a silicone hydrogel lens is more than simply an "improvement" of a HEMA-based lens. Infection with silicone hydrogel lenses is less severe.
I won't sway my patients. Two kinds of patients exist: compliant and noncompliant. Compliant patients have listened to you all those years that you've told them not to sleep in their lenses. Of course you can sway them. Indeed, you have additional credibility because the science had to convince you before you recommended the lens.
Noncompliant patients have been listening, too. And chances are, they feel a little guilty about not acting on your advice. So make them honest. Put them in a lens that offers greater comfort and convenience.
Patients won't pay extra for overnight wear. You'd be surprised. Some of my patients pay the slightly higher price and don't wear the lens overnight, or do so only occasionally. I've converted nearly 40 percent of my contact lens patients to CIBA Vision's Night & Day lens. About 80 percent of these patients wear the lens for up to 30 nights continuously, but one in five prefer daily or flexible wear. Many of these patients can't wear HEMA-based disposable lenses comfortably for more than a few hours at a time. Switching them to Night & Day has been rewarding: They can now wear their lenses for a full day -- a convenience for which they'll gladly pay extra.
Patient Education Program
If at this point your preconceptions are sufficiently shaken up, then you may wonder how to implement a patient education program. Well, you're more than halfway there. (Practitioner reluctance is the single biggest factor in holding back success with silicone hydrogel continuous wear.)
Educate your staff. Try your presentation out on them. This will give you a chance to fine tune it before presenting to patients. (And your staff will hear first-hand why you're changing your tune on overnight wear.)
In my practice, we have a staff meeting every week where I make a quick presentation. I've made Night & Day the topic at quite a few of these meetings so that everyone could feel comfortable with the lens.
As your success builds, you can also discuss the expanding candidate pool or create in-office promotions. Here's how:
► Fit some of your staff members with the lens. They can tell patients first-hand how great it is.
► Encourage staff to ask patients about their wearing experience. Patients routinely come in and tell my staff how delighted they are with the lens. That adds to the staff's confidence.
► Place brochures and educational materials in the reception area. Patients often come to the exam room with a brochure in hand. Plus, many patients know the CIBA Vision brand names, so they'll know that the new technology wasn't created in somebody's basement.
► Make the initial presentation to patients yourself. I use simple-to-understand explanations. For example, in explaining its higher oxygen transmissibility I say, "Overnight swelling with this lens is similar to overnight swelling without a lens." That's an enormous difference -- and one they completely understand.
► Find the best point of entry for your presentation. Ask patients some simple questions to determine which presentation will resonate with them. For example, I might ask if a patient uses computers during the day or how his lenses feel at the end of the day. Often, patients volunteer shortcomings with their current lens. If a patient says, "I think I'm wearing my lenses too much," then imagine his delight when I say, "I have a new lens that you may be able to wear even more."
► Don't wait for patients to ask if they can sleep in their lenses. It won't happen. After a decade of you telling them not to sleep in their lenses, they're terrified to ask. Open the door for them. I try to give every patient a demonstration pair (except for new contact lens patients -- see sidebar). About 95 percent of candidates do try the lens for a month, and about 80 percent convert.
► Tell patients about an adjustment period. I typically tell patients that they'll feel more lid sensation from this lens for the first three or four days. Letting them know ahead of time reduces the number of worried phone calls mid-week.
► Make certain that your staff knows the warning signs. Review signs and symptoms for which you would want to see a patient immediately. For example, my staff knows to automatically schedule any continuous wear patient who has a red eye. I'll typically see those patients urgently, but perhaps not for the reason you might expect: I know that other practitioners (emergency room doctors, for example), might overreact if a patient who wears his lenses continuously presents with red eye.
► Find teaching moments. The red eye patient going to the emergency room is a true example. Sure enough, the doctor on call there told my patient he was reckless and cavalier for sleeping in lenses. When I saw the patient, he was a little rattled. It was my chance to say, "Frankly, it sounds like this doctor hasn't learned about these new lenses." and to reassure him.
A Change for the Better
When I first starting prescribing silicone hydrogel lenses in 1999, they didn't have much of a track record. But I believed in the science that says a lens should meet a 125 Dk/t threshold to eliminate contact lens-induced corneal edema, so I was willing to try it. Within three months, I knew it was a fantastic product that would change my practice.
With more recent experience, I see that it has applications far beyond the continuous wear category. Five years later, I'm still changing my preconceptions.
Use Daily Disposable Lenses to Build
Neophyte A/R Confidence
I believe that silicone hydrogel lenses are the best option for most soft contact lens patients who fall within the parameters of the available lenses. But for brand new contact lens wearers, I first prescribe Focus Dailies (CIBA) for one month of daily disposable wear so they gain some level of confidence with applying and removing contact lenses. Then after one month, I'll move them into a continuous wear lens if they so choose. (I've found that when I place new patients directly into continuous wear, it's often challenging for them to remove the lenses for the first time 30 days after their initial application/removal training.)
Dr. Rajani is in private practice in Dons Mills, Ontario, Canada. He was a panel presenter on "Global Success Stories with Silicone Hydrogel Lenses" last year at the Canadian Continuous Wear Summit in Ottawa, sponsored by CIBA Vision.
Contact Lens Spectrum, Issue: February 2005