Patient Compliance With Disinfection
Rather than staying with their same products, patients often shop around. The result can be problematic.
DR. CORBIN: When I describe contact lens care products to patients, I compare them to insurance. When you're feeling great, it doesn't matter how bad your insurance is. But if you get one major illness, you're in trouble.
When everything is going well and patients are not having problems with their eyes, it doesn't matter which solution they are using. But when they're noncompliant, or they run into an issue from using the wrong solution, they could be in trouble. The right solution may help minimize the problems with noncompliance or a patient error.
DR. LIEVENS: Education is a challenge because we don't know what patients will do on their own. For example, they want to save time or money, so will they stop using a solution that you recommended? Or will they top off the lens case to stretch out their solutions if it saves them a trip to the grocery store? If some of the ingredients are taken up by the lens and the case, then tossing a new disposable lens into the old topped-off solution may not disinfect the lens adequately.
Not only do we need to carefully choose the solutions patients use, but we also must try to change their bad habits. Certainly, we can't rely on their getting symptoms, so we need to emphasize the health impact to drive them to act on something they can't see or feel.
NO SYMPTOMS, NO PROBLEM?
DR. SINDT: The real problem with compliance is that patients don't necessarily have symptoms when they have problems on the cornea. Patients think, "If I were having a problem, it would be obvious to me. I'm fine, so I can continue using this product."
They don't equate end-of-day discomfort with the solution they used that morning. They may be having corneal staining, but we all know that it's frequently asymptomatic.
DR. TOWNSEND: We published a study1 of Group 4 lenses and ReNu MultiPlus. We asked patients, "How do your eyes feel?" and most patients said their eyes feel great. When we removed the contact lens, the fluorescein staining was surprising. Investigators in another study2 evaluating contact lens solutions used esthesiometry to evaluate corneal sensitivity in patients with solution-induced keratitis. It showed that these patients experience some reduction in corneal sensitivity, so that may be why patients with significant punctate keratitis are relatively asymptomatic.
We have to use all our persuasive powers. When my patients don't use the solution I recommend, I take digital photographs and show them their corneas. Some patient says, "Is that my eye? Oh, my gosh! It doesn't hurt, but it looks terrible!" That makes believers and compliers out of a lot of patients. They can see there's something going on.
DR. CORBIN: Not only does the compliance problem point to what we need to teach, but it also emphasizes the care products we should prescribe. Certainly, a compatible disinfection system is important for lens care, and it's even more important for noncompliant patients.
DR. CORBIN: In many offices, practitioners prescribe and dispense contact lenses without telling patients why they should stay with the recommended care products. If we don't explain why patients should not switch solutions, they won't see a reason on their own. Why do patients use saline instead of a multipurpose solution for storing their lenses? Because they don't know the difference between the two.
DR. SINDT: Frequently, patients see the same brand name and think the products are the same. They're buying ReNu saline, for example, instead of multipurpose solution.
DR. CORBIN: And store brand products are another problem. Store brand solutions can have the same chemical formulation as a branded product. They're not necessarily identical to the newest technology in some branded product.
DR. TOWNSEND: The store brand labeling sometimes says, "Compare to so-and-so." Patients buy it and think they're doing the right thing. They really think they're following the doctor's orders.
DR. LIEVENS: To make matters more confusing, a big retail corporation like Wal-Mart or Target can have an agreement with a solution manufacturer to produce their store brand solution in 2004, and then contract with a different manufacturer in 2005. It has the same name, and it goes on the same shelf, side-by-side with a different formulation from last year.
DR. CORBIN: That's one of the reasons why store brands are a concern. A patient might have no problems, and then problems occur later, even though the product appears the same. The formulation changes with no notice.
DR. TOWNSEND: There was a time when contact lens solutions and materials were fairly simple. But over time, they've become more and more complex. With so many different lens polymers and solution formulas, that safe feeling of "Anything works with anything" is gone. Now we really have to educate ourselves and our colleagues about these changes. We have to take the time to tell each other, and then to pass that emphasis along to our patients.
1. Townsend W, Katims S, Rosen J. Investigating a new-generation multipurpose solution. Contact Lens Spectrum. 2005;12:35-37.
2. Epstein AB. Contact lens care products' effect on corneal sensitivity and patient comfort. Eye & Contact Lens. 2006;32:128-132.