Contact Lens Practice Pearls

Is Contact Lens Compliance Out of Our Hands?

Contact Lens Practice Pearls

Is Contact Lens Compliance Out of Our Hands?


I’m sure you all saw the recent article in USA Today (Bowerman, 2015) that “brought to light” the issue of contact lens noncompliance. While we know that educating our patients on this is a daily struggle, our patients don’t truly understand the risks that they take, making this article a welcomed endorsement…let’s hope they saw it!

According to the article, new surveys from the Centers for Disease Control and Prevention showed that “50% of contact users report wearing their lenses while sleeping and 82.3% of contact wearers keep their contact lens cases longer than recommended.” Our patients either aren’t listening or think that they are invincible—or we are not doing a good enough job educating them.

Show and Tell...Again

While a small percentage of patients are actually being prescribed lenses approved for use while sleeping, most are sleeping in their lenses regardless of the lens type and despite our instructions; they also would never dream of admitting this to us.

We can’t be blind to this fact, and we can’t just assume that because we said it, or perhaps gave it to them in writing, that they will follow our instructions. We know they don’t, or at least 50% don’t. So, how do we get this important message across?

I think we have to be realistic and take a lenient approach when taking a contact lens history. We all know the routine questions that need to be asked regarding contact lens habits, but we also need honest responses—otherwise, it’s just a waste of everyone’s time. We need to do a better job relating to our patients so that they know they can confide in us without judgment, but we still need to be stern in how we educate them.

While technicians can easily deliver the do’s and don’ts for contact lens wear, this is a conversation that should come directly from the practitioner. Aside from talking, providing patients with alternatives for sleeping in lenses (such as switching to a more convenient daily disposable lens) might be a good place to start.

Showing pictures of their own eyes to demonstrate signs of past inflammation or old corneal scars can be very convincing to those who think that they haven’t been affected all this time. Showing before and after photos of severe central corneal ulcers in patients who weren’t so lucky may also have a major impact because it’s very likely that patients have no clue what we really mean when we say “at risk for a potentially severe sight-threatening eye infection.”

In addition, handing out new contact lens cases and re-explaining the importance of replacing cases and using fresh solutions is always a must at every visit. We can never assume that they know these things simply because we told them the last time.

Another issue here that was brought up in the article is that “one-third of those surveyed reported they sought medical help for red or painful eyes related to wearing contact lenses.” This is significant and shows that patients do not have a good understanding of the risks that they are taking by misusing their lenses.

It is our responsibility, at every visit, to talk about the importance of discontinuing lens wear at the first signs of eye redness or irritation, followed by an office visit, as this could mean the difference between sight preservation and permanent vision loss. CLS

For references, please visit and click on document #240.

Dr. Mathew is a research assistant professor at the University of Houston College of Optometry. She manages patients who have severe corneal distortions and require specialty contact lenses, and she is also involved in basic science and clinical trial research with The Ocular Surface Institute. She has received research funding from Allergan, CooperVision, Clearlab, Essilor, Shire, TearLab, Menicon, and Vistakon. You can reach her at