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A New Analogy to Help Increase Contact Lens Compliance
BY CHARLES W. MCMONNIES, MSC
Studies show that many patients are more or less negligent in regard to lens handling and maintenance. It is possible that the great comfort and ease of use initially enjoyed with new contact lenses encourages a noncompliant attitude. However, some patients eventually present with clinical signs and symptoms such as lens awareness at the end of the day, vision disturbances, and chronic redness. These are frequently a result of poor compliance with recommended lens management.
Reasons for Noncompliance
Improving (or maintaining) compliance is a routine aftercare responsibility. However, one of the most difficult tasks can be trying to improve compliance for patients who have enjoyed initial success despite negligent maintenance. As a consequence of their initial success, these patients have concluded that compliance is not essential to successful wear.
Other factors may contribute to noncompliance. For example, motivation to wear lenses may be low, and lapsing into poor compliance may occur more easily for such patients. In these patients, findings such as chronic redness and/or lens awareness at the end of the day are more likely to develop and can become the basis for giving up lens wear. At first they may just reduce their hours and/or days of lens wear.
However, voluntary cessation of lens wear may occur even when the complications are at a low level. Too many people who are initially satisfied—or very satisfied—with their ability to wear contact lenses full-time resort to occasional lens wear or end up abandoning lenses permanently.
Consider a Different Angle
Improving compliance, however, is not easy. Re-issuing the same information about lens management in the same format that you originally used can be unproductive. You need to take a variety of approaches to help patients sustain or improve compliance, as well as to keep lens discontinuation at a sub-threshold level.
Following is the text of a onepage handout I use with established patients that may be a useful addition to the materials that you use to maintain or improve compliance. It is titled "Too Many Contact Lens Patients Are Heading for Trouble…":
"Contact lens complications are not so rare if they happen to you. After several weeks, months or years of wearing contact lenses, and without experiencing a lot of complications, people with poor lens wear and maintenance habits often mistakenly form the view that following the rules of good lens management is unnecessary.
"A lottery analogy can help to show how this view is incorrect. In the case of lotteries, the more tickets you buy, the more frequently you buy them, and the longer you continue to buy them, the better the odds are that you will win a prize.
"The same principles apply to the odds of experiencing contact lens complications. The more often you break the rules, the greater the number of ways you break them, and the longer you continue to break them, the better the odds are that you will experience complications. However, instead of winning, you lose.
"The chances of ‘winning’ small prizes are greater. In these cases comfort levels could be reduced, and/or vision could be less clear, and/or eyes could become constantly red and tired looking.
"The chances of ‘winning’ a larger prize are less but the consequences are more serious. Lens wear may have to be abandoned temporarily, or in some cases a permanent return to spectacle wear might become necessary.
"The chances of ‘winning’ first prize are even less, but the consequences are even more serious. An infection might lead to permanent vision loss, in addition to having to abandon lens wear. Studies show that poor hygiene causes infections, not the lenses.
"How easy is it to increase the chances of these complications?
"1. Not washing hands with soap, and rinsing thoroughly, prior to lens handling.
"2. Re-using or topping-up storage solution.
"3. Not using enough storage solution to completely cover lenses.
"4. Not keeping the storage case clean and not replacing it regularly.
"5. Contaminating the solution bottle nozzle with fingers, or by leaving the cap off.
"6. Using tap water to rinse your lenses or case.
"7. Not cleaning and rinsing lenses after removal.
"8. Using products that have not been recommended for your type of contact lenses.
"9. Not replacing lenses according to the recommended schedule.
"10. Failing to have regular reassessment of your ocular health.
"11. Wearing lenses while swimming, or in a hot tub, or spa.
"12. Sleeping in lenses, especially if unwell or if lenses are uncomfortable.
"13. Continuing to wear contact lenses when your eyes are abnormally red, or abnormally irritated, or when vision has deteriorated suddenly.
"Thirteen is an unlucky number of ways to get into trouble, and the more of these ‘tickets’ you ‘buy’, and the more often you ‘buy’ them, and the longer you keep ‘buying’ them, the better are your chances of losing. I wish you a long and successful career as a contact lens wearer, but you may have to improve your performance."
To facilitate adaptation and use in different practices, a one-page word file of this document is available upon request from: firstname.lastname@example.org. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #175.
Charles McMonnies is a Professorial Visiting Fellow, School of Optometry and Vision Science, UNSW. He conducted a contact lens practice for over 40 years and has published more than 100 papers and articles.