By Teresa Narayan, OD
Contact lens patients are valuable—so dropouts are costly. Educating patients on proper lens care can increase comfort levels and decrease dropouts. Here’s how.
Reduce Dropouts, Increase Profits:
Compute the cost: Patients drop out of contact lenses, and don’t tell you or even disappear; this is a revenue loss for your practice.
Stem the tide: Patients drop out of contacts due to discomfort. Ask questions to see if they have discomfort–then treat it.
Educate continually: A pro-health, pro-comfort message is an easy conversation to have; it will help retain valuable contact lens wearers.
Contact lens-wearing patients love the ease and convenience of contact lenses and the freedom from eyeglasses, but many probably aren’t crazy about the lens care regimen. As little as our patients like to deal with it, caring properly for contact lenses is the key to long-term patient comfort and the ability to continue wearing contacts. Here is how I educate my patients about why they need to care properly for their contact lenses.
Contact Lens Dropouts Often Due to Improper Lens Care
I don’t have specific percentages, but I certainly think a large number of contact lens dropouts are related to following a non-recommended wear and care regimen. When a patient decides that contacts aren’t for them, I usually try to dig into exactly how they were wearing the lenses and how they cleaned the lenses. I might say something like: “OK, I understand that your lenses aren’t comfortable, so you want to switch back to glasses. That’s fine, of course, but I just want to make sure that there is nothing else that we can try.” Then I’ll ask about their replacement schedule and solution use, making sure to emphasize that it’s OK if they aren’t doing what was recommended, just that we need accurate information to decide if there are any other options to try. If they admit to improper wear or care, I will suggest that they strictly adhere to the recommendations for one to two months and see if it improves overall comfort and vision.
Educate Patient When Prescribing Contact Lenses
I definitely try to impress on new wearers the importance of adhering to the recommended schedule and cleaning regimen. Generally, new wearers are a little more receptive than experienced wearers because they haven’t settled into the bad habits that many established wearers develop. I go over the cleaning regimen and have them go through the rub technique which I usually recommend even with “no rub” solutions. A typical conversation might go something like this: “These lenses are designed to be replaced monthly and even though the lenses might still feel fine at the end of the month, you will be increasing your chance of infection and complications if you wear the lenses longer than recommended. Cleaning the lenses as directed is also important to minimize chance of infection and to keep your eyes feeling as comfortable as possible.”
Re-Educate When Renewing CL Prescriptions
Long-time wearers of contact lenses definitely get sloppy with their care–I know because I am one of them! I approach the conversation by presuming that they aren’t following the proper wear and care regimen, but of course, you have to do this gently and without judgment. Instead of asking “Do you sleep in your lenses?” I will ask: “How many times per week do you sleep in your lenses?” By phrasing it that way, patients are much more likely to admit their occasional extended wear. Similarly, about solutions, let’s say you recommended Biotrue solution for their care regimen. Instead of asking: “Are you still using the Biotrue solution?” I will ask: “What solution are you using now? Do you use any specific brand or a generic solution?” When phrased this way, patients again seem to be much more comfortable telling you that they stopped using your recommended solution and now use whatever is cheapest.
The other thing I do is try not to make any comments after patients give me the answers to my lens care questions, which are usually asked during the history portion at the beginning of the exam. I just jot down the information and then continue with the examination. At the end, after the slit lamp, then I’ll go over the replacement, care and cleaning recommendations, and discuss how it differs from what they have been doing. By waiting until after the examination is over, you can bring up points about how the contact lens over-wear is affecting their eyes so that there is some clinical justification. So, the conversation might be something like: “I’m seeing some inflammation and redness in your eyes which appears to be related to your contact lens wear. Long term this can have some very negative consequences for your eyes and your vision. You know that great feeling you get when you put in a new lens? If you use this solution as directed with a rub technique and replace the lenses every month as recommended, you should be able to get that great feeling all the time, your eyes will be much healthier, and you will have a lower risk of infection, as well.”
Broach Conversation with Obvious Non-Compliant Patient Who Denies Non-Compliance
At the end of the exam, I will say something like: “Your eyes look a little inflamed and they have some signs of irritation due to contact lenses. Are your current lenses a little older than a month? Have you used any different solutions? Did you sleep in your lenses at all? If not, then we’ll probably need to think about switching to a different lens or solution to make sure that your eyes stay healthy.” Usually, once presented with the information that their eyes are showing some signs of contact lens over-wear, the patient will admit to some habits that are not recommended. Tone of voice is very important here; I try to ask the questions in a casual manner without sounding accusatory.
Another thing that can can help is to show non-compliant patients pictures of adverse contact lens-related conditions. The Efron Grading Scales for Contact Lens Complications is an easily available chart where you can show the patient the “normal” level, compared to the level that their eyes are and then the level that things can progress to if left unchecked. I’ve also seen flip books with pictures of actual eyes with CLARE, ulcers and infiltrates, among other conditions, that can be shown to patients which really impress on them the risk of dangerous complications.
Have Staff Reinforce Doctor’s Lens Care Instructions
Our office has a staff member who is very educated on contacts lenses and about proper instruction and care. I make sure to have all my recommendations clearly written down. When the patient leaves the exam room, they are sent to the contact lens area to get any needed trials or sample solutions and this staff member always makes sure to repeat the recommended wearing time, replacement schedule and recommended contact lens solution.
Provide Sample Solution to Direct Purchase
I like to provide a sample of the solution I recommend so that they get started off on the right foot. I explain that certain lens materials work better with certain solutions and this specific solution should work best for their lenses and for their eyes. I’ll mention how generic solutions can change their formula without changing the labeling, so it’s hard to know exactly what is in the bottle each time. Of course there are always some patients who will continue to return to a generic solution despite recommendations; in that case I might pull out the Andrasko staining grid and at least recommend a specific store generic that would work best with whatever lens material they are in or I will try to switch them to a hydrogen peroxide based solution where preservatives aren’t a factor.
Offer Ongoing Help Worksheet for New Wearers
For new wearers, we have a sheet with fill-in-the-blanks for recommended wearing time, replacement schedule and solution, as well as some other recommendations (no swimming, remove lenses if eyes becomes red, painful or vision becomes foggy, etc). The back side of the sheet has some insertion and removal tips. The written instructions give first-time wearers a reference in case they have questions about how they should be wearing and caring for the lens. We have them read through the sheet of recommendations and sign it, and then we put a copy in their chart, as well.
Adjust Lens Care Conversation When Patient is a Child or Teen
If it’s a younger child, I will have the parent in the exam room so they can hear everything that is discussed, but I still think it’s important to direct the instructions to the child so that they can start to take responsibility of their own eye health. At the end, I’ll first answer any questions the child might have and then ask the parent for their questions and concerns. If it’s an older child/adolescent, I will give all the instructions directly to the teenager and then just have the parent go through the recommendation sheet at the end and have them both sign it.
Patient Lens Care Education Important As Bad Habits Are Hard to Break
Bad habits of contact lens wear are very hard to avoid, as I know from personal experience of wearing lenses for over 15 years. Relating some personal anecdotes about contact lens complications can bring what seems like a remote potential danger closer to a possible reality for the patient. I try to be honest and tell patients that I can see why recommendations are sometimes ignored in order to save money, but that I just want to make sure that they have the best vision possible and that their eyes stay healthy.
Educate Patients on Proper Lens Care: Action Plan
START YOUNG. Address younger patients directly so that they can begin to take responsibility for their own eye health. You want the child or teenager to know proper insertion and removal techniques and care regimens so that they can know what to do if a lens falls out at school or at a friend’s house, for example. Eventually they will be solely responsible for the contact lens care so they should begin to take charge as soon as they are put in contact lenses.
DEMONSTRATE COMPLICATIONS. Show non-compliant patients visual aids to demonstrate potential contact lens complications. Explain that sometimes just one adverse event permanently damages eye health and decreases vision. Pictures of these adverse events can drive the point home.
GIVE IT TO THEM ON PAPER. Back up verbal instructions with written material that the patient can take home to refer to as needed. Especially for a new wearer, they are hit with a lot of information that can get glossed over because they are so excited to be in contact lenses. The care and cleaning part often gets forgotten until later and the written reference will help them remember the proper techniques.
AVOID JUDGING. Try hard not to be judgmental if patients don’t adhere to your recommended wear and care schedule. Most of the time when a patient goes against what you told them, it is because they don’t understand the justification behind the recommendations. Take an extra minute or two to explain why the lenses need to be replaced even if they feel good and also to explain the difference between generic and branded solutions. Doing so can go a long way in improving patient compliance.
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Teresa Narayan, OD, is an associate at Shoreline Eye Associates, P.C., in East Haven and Guilford, Conn. To contact: firstname.lastname@example.org