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 with it.
DR. 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 AND STAFF
DR. CORBIN: When it comes to contact lens regimens, educating patients is often divided between the practitioner and the staff. Where are those lines drawn?
DR. SZCZOTKA-FLYNN: 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.
DR. LIEVENS: 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 the significance.
DR. SINDT: 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.
DR. 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.
DR. CORBIN: Every 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.
DR. TOWNSEND: 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 solution.
DR. 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 CARE
DR. CORBIN: 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.
DR. TOWNSEND: 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.
DR. SZCZOTKA-FLYNN: We 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.
DR. CORBIN: 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.
DR. SZCZOTKA-FLYNN: 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 "OR ELSE"?
DR. CORBIN: Part 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 we say?
DR. TOWNSEND: 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 way.
DR. SINDT: 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
DR. TOWNSEND: 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?
DR. SINDT: 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.
DR. CORBIN: 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.