Contact Lenses

Keep Dry Eye Patients in Contact Lenses

By Charles Aldridge, OD

The population of dry eye patients is expanding—and dryness is a prime issue with contact lens patients. You can address dryness issues and keep these patients comfortable in their contact lenses long-term.

Our aging population and the growing number of people on prescription medications means that you are seeing more patients with dry eye. In addition to providing them with care to relieve their condition, you also should think about the desire of many of these patients to wear contact lenses. If you are able to successfully address the dry eye, the patient will not drop out of contact lenses. This in turn will allow you to enhance your revenues both from the sale of contact lenses as well as from the treatment of dry eye disease.

According to Gallup, over 70 percent of people with dry eye complaints have seen at least three doctors and are still searching for a remedy. In addition, the majority of that 70 percent still searching for a successful treatment have tried at least three different artificial tear products that have not provided relief.

Providing dry eye patients relief and enabling them to wear contact lenses is a service to patients and a revenue-generator for your practice. According to “New Data on Contact Lens Dropouts: An International Perspective” by John Rumpakis, OD, MBA, a study published by the Review of Optometry in 2010, the loss of a single contact lens patient may cost your practice up to $24,000 over the patient’s lifetime.

Here are some of the ways I keep my dry eye patients comfortable in their contact lenses:

Educate the Patient

The process of aiding dry eye contact lens wearers begins with the right questions. For example, I ask: “Are you experiencing any fluctuations in your vision or irritation later in the day?” From there, I proceed to educate those diagnosed with dry eye about the disease. I let them know dry eye will make their contact lens wear more challenging and require additional visits, care and treatment. I also explain that treating dry eye is not part of their routine contact lens care, but it will be necessary if they want to be able to comfortably wear their contact lenses.

Set Expectations

I remind patients that dry eye is a chronic and progressive disease. It will also be worse seasonally (low humidity in the winter) and there may be times when we have to reduce/eliminate contact lens wear. This means it will not go away and will get worse with time, so even if we able able to achieve better contact lens comfort now, it will be an ongoing challenge to do so in the future. You must provide realistic expectations so there are no disappointments.

Explain that Additional Visits Will be Necessary

As soon as I determine dry eye is causing contact lens discomfort I tell patients that if they wish to continue wearing contact lenses it may require additional visits. I point out that even though these visits are not part of their routine contact lens follow-ups, we will be able in most cases to bill the visits to their insurance.

Prescribe Specific Solution

Einstein said, “Insanity is doing the same thing again and again while expecting different results.” I did a lot of insanity in my day. I’d keep changing the contact lens material and expect different results. If I did get some success it was short-lived since the patient’s dry eye would continue to progress and get worse. I found that the right contact lens solution can make a great difference, so now I write patients a prescription for a specific branded solution and give them a sample of the prescribed solution.
Switch to Daily Replacement CLs

If a patient has a silicone hydrogel lens they are wearing overnight I let them know that we are going to need to go to daily wear. At some point I may have to move to a more wettable hydrogel lens, but I don’t like giving up superior oxygen permeability unless I have to.

Offer Moisture-Facilitating Multifocals

It is not enough to offer contact lenses that help keep eyes moist. Dry eye patients are generally older and also presbyopic. Traditionally, these presbyopes did not do as well with contact lenses so they dropped out of contacts before the dry eye became much of an issue. Fortunately, newer multifocal contact lenses are now available and I expect this older population (and therefore a lot more dry eye patients) to enter the contact lens market. When prescribing contact lenses to dry eye patients, I explain the need to address both their dry eye as well as their presbyopia in the contact lenses they wear. Many who dropped out don’t understand that the new contact lenses you prescribe can aid both their vision and dry eye-related discomfort.

Additional Opportunity to Sell Eyewear

It would be great if all contact lens patients had current spectacles! However, dry eye patients understand the benefits of having eyeglasses. My opticians and I explain to dry eye patients that by not pushing their wear schedule they will experience more continuous comfort throughout the week–something that can easily be accomplished by removing their contact lenses earlier in the day and wearing eyeglasses.

Dry Eye Contact Lens Patient Generates Referrals

Dry eye patients who are able to continue wearing contact lenses are your best cheerleader! They eagerly tell others that you are the doctor that allowed them to continue wearing contacts–this is especially the case if their previous doctor didn’t address their dry eye issue and they dropped out of contact lens wear. You’ll be remembered as the doctor who got their contact lens wearing back on track.

Related ROB Articles

Improve Compliance and Comfort: Three Conversations that Work

Keep Contact Lens Patients Comfortable in Their Lenses…and Keep Them in Your Practice

Practice-Building Opportunity: Add a Dry Eye Clinic

Charles Aldridge, OD, is the owner of Aldridge Eye Institute in Burnsville, NC. To contact him: ccaldridge@yahoo.com.

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