Reader and Industry Forum
Simple Rules for Improving Lens Comfort and Reducing Dropouts
BY CRAIG SULTAN, OD
I was amazed at the number of articles in the December 2009 issue on the subject of contact lens dropouts. We know that there are many reasons why patients drop out of contact lens wear: I really like the way I look in my new glasses, visual acuity is sharper with my glasses, it's less of a nuisance to wear my glasses, and—of course—my contact lenses are not as comfortable as I'd like them to be, which was the main focus of many of the December articles.
I have been practicing for 32 years, and I'd like to share some simple, basic rules that I learned through self discovery that could make a difference in overall comfort for most of your patients; they have had a positive impact on my patients for the past 15 years.
Rules for Reducing Dropouts
Following are my instructions for all daily wear soft contact lens patients. The primer rule is: always wash your hands thoroughly before applying or removing your contact lenses and dust your hands by rubbing them together lightly to remove any lint from the towel.
The following three rules can help improve overall lens comfort for your patients:
Rule #1 “Never remove your contact lenses dry. Put a drop of your multipurpose solution (MPS) in each eye. This loosens the lens enough to remove it with little to no epithelial damage.”
Dry removal, especially after a number of hours of wear, can rip the ocular surface, many of the cells of which are lubricating goblet cells. Repetitive dry removal in dry eyes, I feel, causes trauma and damage to the outer epithelial layer that I suspect makes healthy lubrication more difficult.
Rule #2 “Always clean your contact lenses when you remove them—not the next day.”
Many patients either do not rub their lenses or do so the following morning. This is what I say to my patients: “After you do your wet removal, I want you to put the lens in the palm of your hand, make a puddle with your MPS and rub your lens for five seconds in the direction of your fingers, flip the lens over, rub the other side for another five seconds, and then place the lens in your case and fill with fresh MPS. Repeat with the other lens. Rinse your case out with MPS daily after you apply your lenses.”
Rule #3 “Once a week, drop your empty case into a pot of water that you boiled. Take it off the stove and let the case sit in the hot water for at least 20 minutes. This will kill virtually anything that can and does grow in your case.”
More than 90 percent of my own patients as well as patients I have seen in other offices and corporate offices in which I have worked have said, “No one has ever told me this before.”
Rules for Sleeping in Lenses
In addition, regarding sleeping in contact lenses, I have all of my patients go by what I call “the three amigos,” which are: look good (the eye should not look red or swollen), feel good (no dry, scratchy feeling), and see good (vision should not seem less clear than it did earlier in the day). If any one of these amigos is missing, I tell patients that they sleep alone, without their contact lenses. I tell patients, “If you have all three amigos, you may sleep in your lenses that night as long as you instill a drop (MPS is fine) before closing your eyes and one when you wake up.”
Experience the Difference
This is how I have handled all of my contact lens patients for the past 15+ years, and although I do not have statistics to back this up, I welcome you to introduce these elementary and fundamental changes in contact lens procedures to your patients. CLS
Dr. Sultan is in private practice at The Eye Works Optometry in Napa, Calif. You can reach him at firstname.lastname@example.org.