Reader and Industry Forum
GP Compliance Packs Reinforce Patient Education
BY KEITH PARKER, NCLEC
As a manufacturer since 1976, I have heard my share of claims and theories about contact lens issues, complications, and remedies. I am happy to see that wetting issues, which need to be divided into two categories—posterior and anterior surface debris—are finally addressing tear chemistry and solution compatibility.
In the past, poor wetting, filming, or debris on the lenses was commonly blamed on manufacturing. Now that the industry as a whole, and most of GP manufacturing, has adopted water-soluble blocking compounds, the effect of non-wetting surfaces is being directed toward the root cause. The root cause, in my opinion, is poor training and poor compliance.
Answers by Lens Type
There is never just one answer to the “wetting, filming, fogging, and/or debris buildup” questions. With corneal GPs, it is often blamed on the lab. In reality, the mucin secretions and lipid deposits are distributed from the tear layer to both the front and back surfaces of a GP lens through normal tear exchange with the common blink. This secretion then dries onto the front surface of the lens, because the front surface is more exposed to the atmosphere. As the lens gets worse, it is often just returned back to the lab; several weeks of no issues had transitioned to a “defective” lens a month later. And, despite the lack of a real manufacturing issue, it’s not uncommon for the manufacturer to just replace the lens, and then the cycle starts over again.
Sclerals, on the other hand, create a diaphragm type of phenomenon, with the full blink sucking up excess mucin debris and epithelial waste collected at the periphery of the lens edge and into the anterior chamber. This results in fogging and filming of the tear layer that does not get exchanged to the front surface as it does with corneal GPs.
Rather than remove the lens, some have suggested flushing the tears out of a scleral lens with fresh saline applied throughout the day. I have seen this to be very effective.
There may be multiple solutions for any related complication, but there are always contributing factors to be considered. Many clinicians from around the world have offered acceptable answers to the question of fogging and filming of sclerals. However, any corneal stimulation by the lens—either mildly touching or irritating any part of the ocular surface or eyelid—will stimulate secretions of the eye’s normal defense mechanism. And by secreting more mucin to protect itself, there is a greater chance of fogging and filming; this would then require more user intervention. In essence, it creates a loop that keeps building on itself.
Therefore, proper fit of the scleral lens regarding sag, limbal alignment, landing, and peripheral clearance will aid in reducing complications. But, even if all of these physical relationship criteria are met, the perfect lens will still fail every time if patients are not properly trained to keep their lenses clean.
The Importance of Education
Almost daily, I speak to patients who were referred to me about contact lens-related issues. Many times, their issues turn out to be self-induced by their own ignorance of basic/proper compliance. Often, a patient’s problems can be resolved by simply taking the time to train him about the basics of compliance. Now, more than ever, there is a need for better training and compliance.
Just showing patients a video or handing them a brochure is not proper training. Taking the time to teach each patient (and re-teaching upon return visits) about proper compliance is the number one key to success with long-term healthy lens wear.
In the GP solution market, we have seen the discontinuation of “starter kits” for almost all of the GP solution brands. Practitioners should seriously consider the need to build the cost of proper care solutions for their GP patients into their pricing of contact lens dispensing. In fact, eyecare practitioners should “prescribe” care solutions for their patients. Leaving their patients to just figure it out on their own by picking something off the shelf at the grocery store is just plain silly—or may be better described as incompetence.
To solve this, patients should be provided a scleral compliance pack or “starter kit” that includes everything that they need to get started. This will raise their potential for success tremendously. The cost of this pack should be included as part of the fitting fees.
The kit should include the following items: a lens application/removal device, a multipurpose solution, a GP cleaner, wetting drops, a new contact lens case, and, most importantly, non-preserved saline. The contents of one such scleral compliance pack are offered online at www.mygpsolutions.com, which allows for easy delivery in the mail directly to your patient.
Many times, the answers to our question are right in front of us. Unfortunately, we just don’t take the time to look for them or to tell patients. CLS
Keith Parker is president of Advanced Vision Technologies. He is a past president of the Contact Lens Manufacturers Association and currently serves as chair of the GP Committee.