Contact Lens Care
It's All About Compliance by the Prescriber
Joseph Barr, OD, FAAO
We have the greatest soft contact lenses ever. Hypoxic contact lens complications are becoming obsolete. And our lens care systems are better than ever, too. But if the prescriber and the provider don't insure that the patient is pristinely healthy and don't continually educate the patient about proper use of these great new products, then we will continue to have contact lens-related complications and contact lens dropouts.
Realize that the FDA approves a lens care system as if it would be used with complete compliance. But we know lens care compliance is very poor.
I have three messages.
1. Prescribe the lens care system strongly. Make a firm recommendation about what each patient should use. Make sure the patient knows what product you want him to use and that he should never change the lens care system without your approval. This assumes, of course, that you are up-to-date on all the latest information on contact lens care. If not, then you can learn more at www.CLSpectrum.com or subscribe to www.CLToday.com.
2. Educate, educate, educate to get compliance, compliance, compliance. Contact lens patients are notoriously noncompliant. So tell them why they should rub, rinse and soak their lenses after each removal in totally fresh solution in a clean case. Tell them why they should not top off the solution in their case. Tell them to replace their case regularly, and re-educate them at each visit that if they do these steps, they can have a longer, healthier, better-vision, contact lens-wearing lifetime. If you care about their compliance and their safety, bond with them and make them believe this education is important to their success.
3. Do a slit lamp exam with fluorescein. Yes, for soft contact lens wearers. It doesn't take long; the patient will be impressed with you, and, in fact, you may even detect something that could be important. Sure, most patients don't have clinically significant staining, but if they do, it could be important. Recent studies indicate that future corneal infiltrative events, although rare, may be associated with previous reports of corneal staining.
Fortunately, the eye's immune system protects our patients every day from a lens that they have infected, despite the fact that the lens care system should have been protective. Don't assume that their state-of-the-art lenses and lens care system will protect them when you know they will be noncompliant.
In summary, make sure you know what you and your staff want to recommend for lens care and recommend it strongly. Educate your patients repeatedly to comply with proper lens care (clean, rinse, soak in totally new solution, in a clean case) and use fluorescein to examine the cornea for potential compromise.