continuous wear colloquy
Rules for Successful Continuous Wear
BY N. REX GHORMLEY, OD, FAAO
Patient selection, a proper contact lens (minimum Dk/t of 125) and patient compliance all play a part in successful continuous wear (CW). Patient compliance increases with patient education. It's your and your staff's responsibility to continuously educate CW patients about the "rules for CW." A progressive practice will also educate patients with written material, video and DVD presentations, a newsletter, on-hold messages and a Web site.
My CW Rules
I suggest that you present the following rules for successful CW to every CW contact lens patient:
Wear your CW contact lenses on a CW schedule only when you are 100 percent healthy. If you have a cold, sinus problems, severe allergies and just don't feel good, then remove your contact lenses every night for cleaning, disinfection and a night's rest. Don't resume CW until you feel 100 percent healthy. I tell my patients that I am fitting them with a "BMW" type of contact lens. But, just as they need to slow down when driving in poor weather, they also need to slow down their contact lens wear when they aren't 100 percent.
If you're sick and are using medication to get well, then don't wear your contact lenses. Make sure that you always have updated eyeglasses to wear. Many contact lens patients develop anterior segment pathology after wearing their lenses when they were sick. Educate your patients that contact lenses are healthcare devices and that they should wear them only when healthy. Also stress to all CW patients that it's important to have eyeglasses in a valid prescription that will provide good vision.
If your contact lens is dirty or an object gets under the lens, then wash your hands, remove the lens and thoroughly clean and rinse it. This seems like common sense, but patients tell me all the time that "I've felt something under my lens for the past several days." You should also stress the importance of proper hand washing. Many infections result from improper patient hygiene.
Don't sleep in your contact lenses after swimming or soaking in a hot tub. Wash your hands, remove, clean and disinfect your lenses and leave them out for one night. Consider the chemicals that treat pools and the "other" debris and materials that you may find in them. In addition, hot tubs are a breeding ground for contact lens contaminants.
Replace your contact lenses with fresh, clean lenses every month. Patients shouldn't try to extend the life of their CW lenses beyond the prescribed one-month replacement schedule. Fortunately, studies have shown increased patient compliance with a one-month replacement schedule as compared to a two-week replacement schedule. I instruct all CW patients to change their lenses on the first of each month.
Visit your practitioner every six months to evaluate vision, lens fit and eye health. This also allows us to review lens care and the "rules of the game." CW patients don't leave our exam room without scheduling their next six-month appointment.
Your eyes should always look good, feel good and see good. If not, then remove your contact lenses immediately. We can all thank Dr. Stan Yamane for this "Yamane Triad" that he wrote many years ago. Today, it's still a useful tool in educating patients.
Compliance Breeds Success
Please feel free to use my "rules of CW" with all of your CW patients. CW can grow your practice, but patients will succeed only if you teach them the principles of safe CW.
Dr. Ghormley is in private practice in St. Louis, MO. He is a past president of the American Academy of Optometry and a Diplomate of its Cornea & Contact Lens Section. He is also the team optometrist for the St. Louis Rams (NFL) and the St. Louis Blues (NHL).