Contact Lens Dropout Long Term
BY KELLY K. NICHOLS, OD, MPH, PHD
We often read in the literature, "significant improvements were demonstrated over the course of the study." Sure, the product or treatment may have worked during the six-week to six-month time period of a typical study, but what about after that? The difficulty is that the long-term impact of these products remains unknown.
In particular, do short-term improvements in symptoms of lens discomfort result in fewer dropouts long term? Contact lens discontinuation is the issue we ultimately want to solve, but the question of what leads to discontinuation, or prevents it, is challenging to understand.
"Throwing in the Towel"
We've all had patients who tell us during the history that they used to wear contact lenses. When questioned about why they stopped, the responses vary from "my eyes felt dry" to "I don't know, it just was a hassle." On occasion, the exact time when the lenses were last worn is unclear. In reviewing a patient's record, you may notice that one year he wore the contact lenses to the exam, the next he brought them to the exam and the following year doesn't even mention contact lenses. In addition, it's harder to track contact lens wear (and compliance) through contact lens purchases because many patients take the prescription elsewhere.
In a patient's mind, the exact reason (or multiple reasons) for "throwing in the towel" becomes murky with time. Therefore, when he finally tells you, the distilled version of "why" may not represent what was actually going on throughout the process.
Pritchard and coworkers (1999) at the University of Waterloo evaluated
discontinuation of contact lens wear by surveying 4,415 random patients from 16
practices in Quebec, Canada. Their findings showed that 34 percent of patients had
discontinued lens wear at least once, and of those who discontinued, 48 percent
discontinued a second time. Approximately half of those who discon-
tinued had been refit at least once, and the primary reason for refitting was discomfort. From a patient management standpoint, the problematic refit should be the dropout "red flag," and may warrant additional lens care discussions, follow up and patient education regarding expectations.
In 2002, Young et al studied 236 lapsed contact lens wearers in a 15-center clinical study in the United Kingdom. Subjects reported reasons for drop out, and were subsequently refit with contact lenses and followed for six months. Similar to the Pritchard study, discomfort/dryness was the most frequent reason for initial discontinuation, and successful refitting reduced discomfort. However, discontinuation after refitting was more likely due to vision-related complaints, suggesting that advances in contact lens technology may help with lens comfort, but we shouldn't overlook visual complaints.
Dropout is Multifactorial
Like dry eye disease, contact lens discontinuation is a multifactorial condition. To translate short-term improvements to long-term successful wear, we need to treat the symptomatic contact lens patient like a moving target. At any given time you can make an improvement (better lens materials, better rewetting drops), but that short-term fix may eventually result in failure. The symptomatic lens patient walks a fine line between happiness and throwing away the lenses forever. Helping that patient achieve one day, one month or one year more of comfortable wear will win you a loyal patient for life. CLS
To obtain references, please visit www.clspectrum.com/references.asp and click on document #121. Dr. Nichols is an associate professor at The Ohio State University College of Optometry in the area of dry eye research.