Changing the Practitioner's Role in Compliance
With lens-solution interactions becoming more
common, we need to choose the right solution and convince our patients to stay
CORBIN: A major health risk
related to contact lens disinfection has been in the news. We have an eye-opening
educational example for contact lens practitioners, as well as for noncompliant
patients who handle their lenses with a careless lack of commitment. We have an
important opportunity to educate eyecare practitioners so that we all can fulfill
our obligation to teach patients and raise awareness of the importance of using
the right solution.
Many practitioners have not treated contact lens
solutions with the same seriousness as therapeutics, but that is changing today.
Our challenge is to educate our colleagues about the differences between various
solutions and to get practitioners more involved in prescribing solutions rather
than just dispensing them.
ROLES OF PRACTITIONER
it comes to contact lens regimens, educating patients is often divided between the
practitioner and the staff. Where are those lines drawn?
Contact lens practitioners have to do the prescribing, even if the technical staff
does the instruction. A lot of offices, including mine, used to just send patients
out of the exam room and let a technician in the dispensing area select the regimen.
But times have changed, and
we need to say to technicians, "This is Mrs. Smith, and I'd like her to use this
solution." In my practice, the technicians no longer assume anything. They always
wait for my instructions before they dispense a solution.
We need to be very specific in
prescribing and marrying lenses with solutions. Gone are the days when practitioners
told patients, "Just go to the eyecare aisle at your local pharmacy or grocery store
and pick whichever lens solution you like." I tell my patients exactly which product
I want them to use, and I often write the brand name on a prescription form to emphasize
Even though we've taken back
control of prescribing contact lens care products, we still rely on our staffs a
great deal, and they need to learn about what we're learning. In many practices,
contact lens practitioners might even continue delegating that role to staff, so
it's even more important for them to teach their staffs. Staff members can't be
tempted to fill up a big goodie bag of solutions or be influenced by a friendly
sales rep. They need facts.
TOWNSEND: My staff does
all the contact lens training, and they review solutions with patients. I think
it would be a very wise move for solutions manufacturers to speak to staff members
in addition to doctors. We need to reinforce solution differences to educate them
as well. They want to know how to make informed decisions that impact the patients
in their practices.
time we see established contact lens wearers in my practice, we give them a kit
with their lens care products before the doctor even walks into the exam room. When
I see patients, I review the reasons why I'm prescribing their particular products.
I explain that I don't want them to brand swap or switch to store brand products
because not all products may be compatible with their lens materials, and they may
have different disinfection profiles. The whole presentation takes only about 15
seconds, and my patients come back 99% compliant. They're using the same product
I prescribed for them the year before.
In the past, I wasn't telling
patients why I didn't want them to switch, so they didn't have a reason to stay
with the product I gave them. I'd always wonder why they swapped brands. It was
very simple. As the practitioner, I never prescribed contact lens care for them.
We just gave them a sample kit and told them how to use the product. They chose
another multipurpose solution at the store because they thought they were all alike.
It's incumbent upon contact lens practitioners to prescribe the solution and explain
proper care to the patient.
It's important to continually educate patients as they return for their annual visits.
My patients have responded better to receiving instructions on paper. It has a formality
about it. We give patients a handout with their name printed at the top, the name
of their solution, and how to use it. We have patients read it with us, which reinforces
the teaching. It includes instructions like, "Throw it away every day," "Dry your
case every day," and "If your eyes get red..." as well as the statement, "Do not
change solutions unless you talk with us." We emphasize the last line when we talk
to patients about lens care, and we explain why it's important to use the prescribed
SINDT: I use visual aids
to explain why my patients need to stay with their solution regimen. For instance,
I'll show them a picture of a healthy cornea versus one with corneal staining. This
way, they see it with their own eyes, something they may never have seen in the
past, and they understand this could be happening to them without their knowledge.
EMPHASIS ON PATIENT
If we treat contact lens care and its role in ocular health as though it's unimportant,
then patients will perceive it as unimportant. But if we treat it as a highly important
part of the medical process, patients will perceive it that way.
We can emphasize this idea during
staining, too, by explaining we're having patients remove their lenses so we can
use a dye to see changes on the eye's surface that might be damage from contact
lens wear. We don't want to scare them, but we want them to know that damage is
possible. It's an opportunity to explain that we're partners with our patients in
caring for their ocular health. We make the healthiest choices, and they need to
follow them responsibly.
can share the literature, too summarized in a handout to show patients
that a solution has been used on hundreds of patients with lenses similar to theirs
with great success.
It sounds like what we're talking
about here is practitioner-driven care, instead of consumer-driven care. And it
should be that way. Practitioners should drive the lens care products to patients,
and the patients shouldn't be looking for it on their own.
We need to tell patients what
to use, and then hand them the product. Some patients will want to use the cheapest
thing on the market anyway, but we hope to minimize those patients. We do the best
we can and arm ourselves with experience, published studies, and clinical trials
to back up what we're saying. It's powerful information, and we need to use it.
All of us can take this approach, even for patients who find an ARVO poster too
technical. If we present it in a simple way, they'll listen. If we hand them a simple
summary and make it a highlight of our daily interactions with patients, I think
they will listen. Studies are powerful.
A POSITIVE WAY TO SAY
of our efforts to make an impression as an authoritative figure is to impress patients
with the results of noncompliance. How do we get patients to understand the risks
of noncompliance? We take a positive step by giving them a prescription. So now,
do we need to give them the negative take on what will happen if they don't do what
It's a fine line because we want
patients to know the risks of noncompliance, but we also want them to know that
contact lenses are a safe modality for vision correction. Some 30 million people
in America are wearing them today, and only a handful of patients have problems.
But like any other medical device, it's dangerous if you don't care for them in
the prescribed manner.
If a patient comes in with layers
of lipids and protein, I show them pictures of GPC, papillary changes, infiltrates
and staining. I'm not trying to bombard patients and scare them into refractive
surgery, but I want to convince them to take care of their eyes in a responsible
Telling patients, "Do this,"
and "Don't do that," isn't my communication style, partly because I've seen how
it makes my kids want to do the very thing that I am telling them not to do. We
adults are somewhat like that, too. When I talk to my patients, I prefer to put
things in a more positive light and positive tone. "For the best comfort, do this,"
or "For the best eye health, do this." This approach makes it a positive experience
and doesn't dwell on telling people what they can't do.
BURST OF AWARENESS
Have you seen a heightened awareness generally among your patients in terms of solutions
because of the reported case of Fusarium keratitis in the last month or so?
I certainly have. I've had a number of patients come in and want to talk about contact
lens solutions. They want to know about the news, and they want to know if they're
at risk or if a family member is at risk. Patients want me to give them enough information
to make a confident choice in their contact lenses.
I've actually had several patients schedule appointments because they had minor
discomfort lately, and they were worried about a fungal infection. It's enough to
make them come in to chat about it. New contact lens patients have had no hesitation,
but established wearers want to make sure they're using the correct product. It's
an opportunity to educate people, make sure they're using the right solution and
reassure them. They're very appreciative. They're likely to stay in their lenses
and comply with their regimens.
Contact Lens Spectrum, Issue: August 2006