lens practice pearls
Your Patients Be Compliant
THOMAS G. QUINN, OD, MS, FAAO
year's outbreak of contact lens-related fungal keratitis has heightened not only
our awareness of the importance of proper care in ensuring safe contact lens wear,
but it has also brought the issue into the forefront of the public's consciousness. How can we best turn this into a
teaching moment for our patients?
Role of Compliance
Although a higher incidence of fungal keratitis was associated
with a particular chemical care system, patient behaviors such as reusing old, dirty
cases and topping off solution are suspected contributing factors.
In a recent study sponsored by CIBA Vision, only 33 percent of
soft contact lens wearers reported following the recommended lens replacement schedule,
30 percent reported storing lenses overnight in saline or eye drop solution, and
23 percent said they rinsed their lenses with water.
On a more hopeful note, in the same study 96 percent of wearers
reported that they considered taking care of their eye health to be an important
part of their overall wellness. Our challenge is to help patients link lens replacement
and compliance with eye health.
I've found the most receptive audience for this message are new
wearers. They're excited to be moving into the freedom of contact lens wear and
want to be successful. I tell patients I'll do my best to fit them with the right
lens, but they need to do their part by following my instructions on care and replacement.
I inform new wearers that my goal is to have them performing at
a high level at all times when wearing their contact lenses. To achieve this, they
must replace their lenses before they begin to irritate their eyes or degrade their
vision. This is a proactive attempt to avoid the common and misguided mindset of
replacing contact lenses "when they start to bother me."
The Patient in Pain
One of the great joys of my profession is providing relief to
a patient suffering from eye pain. Rarely do I find a more appreciative soul in
my chair. When pain is due to contact lens abuse, seize the moment to educate about
proper compliance. Tell patients that most lens complications are associated with
dirty, over-worn lenses. Review proper care, then clarify by asking the patient
to recount the key points back to you. Provide guidelines in writing to further
reinforce your message.
Talk Compliance Regularly
Incorporate compliance reinforcement into your patient care structure.
Ask each patient how often he replaces his lenses. Verify this by checking your
records to see when you last provided a lens supply or issued a new prescription.
If he says he's replacing his lenses monthly but you provided a year's supply two
years ago, you know something is awry.
Ask patients what solution they use and how they use it. It's
important to ask this in an open way so as not to lead the patient. For example,
"Tell me what you do with your lenses when you remove them at the end of the day,"
will provide more insight than, "Are you rubbing your lenses when you remove them
at the end of the day?" Ask, "How often do you sleep in your lenses?" Asking this
way will reap a more honest response than asking, "Do you sleep in your lenses?"
Persistence is Key
Once we know how patients are using and caring for their lenses,
we can discuss compliance in a more informed and focused manner. But we first have
to ask and ask often. Then we must educate, and educate often.
For references, please visit
and click on document #132.
Dr. Quinn is in group practice
in Athens, Ohio, is a diplomate of the Cornea and Contact Lens Section of the American
Academy of Optometry and advisor to the GP Lens Institute.
Contact Lens Spectrum, Issue: November 2006