By JeanMarie Davis, OD
Contact lens dropouts are costly to an eyecare practice, and dropouts usually are caused by lens discomfort. You can keep patients comfortable in their contact lenses long-term by understanding–and talking to patients about–the factors that affect comfort and eye health, like tear-film stability.
Tear-film stability, the ability of the tears to adhere and spread easily and evenly across the ocular surface and remain intact, without evaporation causing dry spots in between blinks, is critical to your patients’ ability to wear contact lenses comfortably. The tear film protects and lubricates the ocular surface, as well as providing other functions such as providing nutrients, aiding with immunity and refraction, to name a few. Tear-film stability is important for ocular health and comfort for everyone, especially contact lens wearers.
The Value of Contact Lens Patients—and the High Cost of Losing Them
Patients who wear contact lenses are highly valuable to your practice. Said another way, contact lens dropouts are very costly.
How costly? According to the Management & Business Academy’s Best Practices of Contact Lens Management (p. 28), a typical OD practice with $500,000 in revenue has 1,200 of its 4,000 active patients wearing contact lenses. If 10 percent or 120 contact lens wearers drop out, that represents a loss in revenues of $31,680 in subsequent years. That figure increases the larger the practice.
Other factors: Contact lens patients tend to visit a practice more often than spectacles-only patients (18 months vs. 24 months), a factor accelerated by annual supply sales. Further, contact lens wearers also buy spectacles and premium sunwear—and more so if you recommended these optical goods.
Action Point: Ask contact lens patients, “Are you comfortable in your contact lenses?” Patients who drop out of contact lens wear (often without informing their doctor) usually do so because of discomfort—the very issue that ODs are well-equipped to address with new lens materials comfort drops, dry eye solutions and lens care products and instruction. —ROB editors
The rate at which the tear film evaporates is considered as a functional indicator of the stability of the tear film lipid layer1. When a contact lens is present, the tear film lipid layer is significantly altered. It is hypothesized that changes to the lipid layer may cause ocular dryness and discomfort in contact lens wearers.1
A contact lens on the eye compartmentalizes the tear film into two portions: the pre-lens tear film and the post-lens tear film. ¹ Reduced pre-lens break-up time has been associated with decreased contact lens comfort. Therefore, it is important that the pre-lens tear film remain stable while wearing contact lenses.1
Educating patients about the effect that quality daily-replacement contact lenses like Alcon DAILIES have on pre-lens tear-film stability is essential. Once patients understand the science behind keeping their eyes comfortable, the more likely they may be to give high-quality daily-replacement contact lenses a try.
Tear Film Stability:Especially Important to Your Dry Eye Patients
Anyone lacking tear film stability, such as dry eye patients, are more prone to ocular discomfort. Symptoms vary from one person to another, however, dry eye patients who are able to wear contact lenses are often symptomatic. Therefore, it is important to address tear-film stability and the ocular surface in all patients and particularly in contact lens wearers prior to prescribing contact lenses. Existing contact lens wearers should have their ocular surface and tear-film stability assessed during their regular examination and any issues should be addressed prior to refitting with contact lenses.
When I was in private practice, and a contact lens patient complained about contact lens discomfort, I had great success in improving their comfort by assessing their tear film and ocular surface and addressing any issues discovered prior to refitting them in contact lenses. I would take them out of their lenses and conduct a full ocular surface/dry eye evaluation. It was not uncommon to discover some sort of tear-film stability/ocular surface disorder that contributed to their discomfort. Management of these patients would depend on the type and severity of findings. Once the ocular surface and tear-film stability were improved the patients were more comfortable and had a successful contact lens wearing experience.
Make Tear-Film Stability Part of Contact Lens Patient Exam
Understanding the status of the ocular surface and tear-film stability of a contact lens patient is important when fitting contact lenses. Tear-film stability is most commonly assessed by observation at the slit lamp. Tear-film break-up time (TBUT) is measured by instillingfluorescein dye and counting how many seconds it takes before the tear film breaks up and is no longer uniform across the ocular surface. Evaluation of corneal and conjunctival staining are additional observations that provide valuable information regarding the state of the ocular surface and tear-film stability. Other methods of measuring tear-film stability exist, although not as commonly used, such as interferometry, using the topographer to assess tear-film stability and even a keratometer can be used to assess tear-film stability.
For contact lens wearers with healthy ocular surface and tear-film stability, it is equally important to provide them with a contact lens that will support the stability of the pre-lens tear film to provide them with superior comfort.
Have the Conversation with Patients
Contact lens discomfort is the number one reason for contact lens drop out. ² Contact lens wearers want to have a comfortable lens wearing experience and stay in their lenses. When it’s explained to them, patients seem to understand the importance of protecting the ocular surface by keeping it completely covered by the tear film for the entire time between blinks without tear film breaking up and creating dry areas. I might say: “Sarah, I think this daily-replacement contact lens I have prescribed will provide you with superior comfort. These DAILIES AquaComfort Plus contact lenses support comfort throughout the day with the expression of blink-activated moisture. The technology in this lens supports a stable tear film. A stable tear film protects the surface of your eyes by keeping that surface completely covered by tear film to avoid any dry spots from developing. A contact lens that supports a stable tear film will provide you with greater comfort.”
Ask Contact Lens Sales Representatives for Data
Most ODs understand tear-film stability, but may need some additional information on how pre-lens tear-film stability is impacted by the kind of contact lens the patient is prescribed. Your sales representative can discuss this with you and provide you with scientific data you can use to guide your conversation with patients.
Educate Contact Lens Techs About Tear Film Stability
The education you receive from contact lens sales representatives, or other sources of information like professional journals and continuing education, should be passed along to your contact lens technicians. As the people in your office who work with patients on how to properly wear and care for their contacts, these staff members need to be conversant on why the doctor prescribed the lenses the patient is wearing and why it is important to follow the recommended wear and care schedule.
It is always a good idea that contact lens technicians be educated on factors affecting contact lens comfort and be familiar with data on the lenses their patients are being fitted with. The best way for them to learn this is to review this information with the OD they work with and understand how they should use this information when working with patients. A contact lens technician might say: “Tom, before you leave the office, I want to go over your contact lens prescription with you. The doctor prescribed these DAILIES AquaComfort Plus lenses because she feels, based on scientific evidence, that they are the healthiest and most comfortable option for you.
One of the values of DAILIES AquaComfort Plus is the Blink Activated Moisture Technology that supports a stable tear film. A contact lens that supports a stable tear film over the contact lens surface may provide you with greater comfort. Following the wearing schedule the doctor discussed with you in which you throw away the lenses at the end of each day and put in a fresh pair the next morning is important to keeping your eyes moist and comfortable.
Tear-Film Stability: Keep Your Patients in Contact Lenses Long-Term
Assess tear film stability on patients without a contact lens on the eye and address any underlying ocular conditions. This includes patients new to contact lenses prior to prescribing the lens, as well as established contact lens wearers when they come in for their annual exams. Don’t forget to examine the lid margins as certain conditions affecting the eyelids can affect tear film stability. If there is an issue with tear-film stability, address it with patients and prescribe an appropriate treatment plan for those patients. Any underlying ocular condition should be addressed prior to contact lens wear. Patients should be educated on long-term hygiene, lubrication or treatment.
Evaluate the data on contact lens material, surface technology and any direct data on how that lens affects tear-film stability when deciding which lens to prescribe.
Choose the contact lens that has superior wettability, lubricity and deposit resistance that supports tear-film stability.
Follow-up with patients who have any signs of tear film instability, dryness or discomfort. These patients often drop out of contact lenses. Follow-up will provide the opportunity to address any symptoms and provide them with a positive contact lens wearing experience.
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JeanMarie Davis, OD, is global head, technical, Global Performance Development for Alcon. To contact her: firstname.lastname@example.org.
1. Rohit A., Willcox M., Stapleton F. Tear Lipid Layer and Contact Lens Comfort: A Review. Eye & Contact Lens,2013; 39(3):247-253.
2. Rumpakis JMB. New data on contact lens dropouts: an international perspective. Rev Optom. 2010;147(1):37-42.