CONTACT LENS CARE & COMPLIANCE
TIME INTERVALS BETWEEN COMPREHENSIVE EYE EXAMS
ANDREW D. PUCKER, OD, PHD
The American Optometric Association (AOA) recommends a complete eye exam biannually for healthy Americans between the ages of 18 and 60, but suggests an interval between eye exams (IEE) of one year for contact lens wearers because they have a greater risk of disease (AOA, 2016). A one-year recall for contact lens wearers is backed by about 98% of eyecare providers (ECPs) (Dumbleton et al, 2013). Unfortunately, many of our lens wearers fail to meet the yearly exam recommendation.
Understanding the Problem
While the recommended IEE for a contact lens wearer is one year, the mean overall IEE is 16 months (median = 14 months); the mean IEE for daily disposable (DD), two-week (2W), and one-month (1M) contact lens wearers is 14.7 months, 16.4 months, and 15.9 months, respectively (Dumbleton et al, 2013). There is a good chance that these extended IEEs are related to wearers not replacing their contact lenses on schedule.
While most patients (78%) understand the importance of doing so, only 74% to 78% of DD, 25% to 29% of 2W, and 34% to 36% of 1M wearers always replace their contact lenses on time (Dumbleton, Richter et al, 2010).
Potential Reasons for Noncompliance
Several studies have attempted to discover the reasons for poor compliance with replacement schedules (Dumbleton, Richter et al, 2010; Dumbleton et al, 2013). They determined that the two primary reasons why patients failed to replace their contact lenses on time were because they simply forgot to replace their contact lenses (39%) and because they were trying to save money (32%).
Additional reasons were because they forgot to order (11%), did not perceive a risk to over-wearing (18%), and their practitioner told them that it was acceptable to overwear (2%) (Dumbleton et al, 2013). IEEs also vary by income bracket; IEEs were longer for lower income brackets.
In-office patient education should always be your first step toward improving patient compliance, but you should also encourage patients to purchase annual contact lens supplies from your office (Dumbleton et al, 2013). A 2010 survey found that 66% of patients purchased contact lenses from eyecare providers, while 17% of patients purchased contact lenses from “optical outlets,” and 17% purchased them from “online stores” (Wu et al, 2010). Another study found similar results (Dumbleton et al, 2013).
A related study found that significantly fewer patients obtain annual exams if they purchased their contact lenses over the phone or from the Internet compared to those who ordered lenses from their ECP (Chalmers et al, 2016). Patients also were more likely to be compliant with the manufacturer’s replacement schedule if they purchased an annual supply of contact lenses (Dumbleton et al, 2013). This encouragement, along with cell phone or text message reminders, may greatly improve compliance (Dumbleton, Richter et al, 2010).
We are obligated to help our contact lens wearers maintain healthy and comfortable eyes. Providing annual eye exams should be part of this plan. Specifically, patients have better overall compliance habits, better vision, and better ocular comfort if they replace their contact lenses as recommended by the manufacturers; in addition, better compliance with wear schedule will make it more likely that your patients will return to the clinic on time (Dumbleton, Richter et al, 2010; Dumbleton, Woods et al, 2010).
Compliance may also be improved by refitting patients into DD contact lenses (Dumbleton, Richter et al, 2010; Dumbleton, Woods et al, 2010), an option that actually has a similar price to other wear schedules if used correctly (Efron et al, 2010). CLS
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Dr. Pucker is currently an assistant professor at the University of Alabama at Birmingham. He has also received research funding from Johnson & Johnson Vision Care and Alcon. You can reach him at email@example.com.