Creating Contact Lens Compliance
Follow these five tips to get patients to adhere to the prescribed wear and care instructions.
MARK HINTON, ASHEVILLE, N.C.
More than half of contact lens (CL) wearers surveyed are not compliant with their two-week or monthly schedule, says a recent Contact Lens Anterior Eye study. Also, the study reveals “significant” non-compliance with lens care steps and case hygiene. Unfortunately, this is just one of several such studies. As this non-adherence places patients at an increased risk for ocular issues, such as corneal ulcers, that can, in turn, prompt CL drop out, it’s essential eye-care practitioners focus on improving patient compliance.
Here, I provide five tips on how to accomplish this.
1 Show adverse events.
Create a one-page handout that contains photos of non-compliant behavior-caused CL complications, including GPC, corneal infiltrates, erosions, ulcers, etc., and have you or your staff say something similar to:
“Kathy, I want you to understand the importance of following the exact prescribed wear and care schedule. To help illustrate this, these are images of eyes of contact lens patients who said they didn’t think these outcomes would ever happen to them. Some are unable to wear contact lenses again, and others have experienced worse outcomes. This is to inform, not scare you. I imagine you’d like to avoid these types of infections, right?”
A clinical image makes a strong impression, as it enables the patient to actually “see” the likely outcomes of noncompliance vs. just hearing the names and descriptions of the aforementioned conditions.
Engaging the patient is also a crucial component here.
Sometimes, practitioners and staff talk “at” patients rather than making them part of the conversation. Saying, “I imagine you’d like to avoid these types of infections, right?”, “Does that make sense?” and “Is that important to you too?” engages the patient, letting him/her know that he/she plays a primary role in his/her CL success.
2 Provide a support form.
Social science studies reveal people recall less than 10% of what they hear. Given this statistic, provide a support form that includes the prescribed CL, solution, drops (if applicable), care and CL and case replacement times. Make sure the form contains a patient signature line, so he/she can acknowledge understanding of and take responsibility for the information. Also, make sure the patient and practice have a copy of the signed sheet. This is another form of patient engagement. (See “Example Form,” page 25.)
YOUR IMPORTANT CONTACT LENS WEAR & CARE INSTRUCTIONS Date:______
□ New contact lens patient: Wear for 4 hours the 1st day, then add 1 hour each day for a maximum of 8 hours the 1st week.
□ Daily wear contact lenses: Remove contact lenses before going to bed.
□ Flexible wear contact lenses: These are approved for overnight wear, but remove lenses 2 nights out of the week and one 24-hour day.
□ Extended wear contact lenses: These are approved for continuous, overnight wear.
REPLACEMENT SCHEDULE FOR YOUR CONTACT LENSES
□ 1 Day □ 2 Weeks □ 1 Month □ 3 Months □ Yearly
*It is imperative to replace lenses as advised, EVEN IF THE LENSES FEEL OKAY. Research indicates that beyond advised wearing time, the amount of oxygen that MUST flow back and forth through the lens will be reduced to an unhealthy level.
Dr._______ wants you to use _____________________ solution.
Note: Most solutions state that they are NO RUB. BUT, Dr._______ wants you to “mechanically” rub your lenses the way you were instructed, immediately after removing them from your eyes. This removes most of the bacteria and debris sometimes absorbed into your lenses during wear.
If you need eye moisture drops, be absolutely sure they are approved for contact lens wear. USE:________
A FEW IMPORTANT NOTES...
▪ Wash your hands thoroughly with an approved soap, rinse very thoroughly, and dry with a lint-free towel before touching your lenses.
▪ Don’t use soaps containing creams, lotions or oily cosmetics before handling your lenses. USE: _______
▪ Do not wear your lenses when you have a cold, due to increased risk of eye infection and reduced tear levels, resulting from the anti-histamine eye-drying effects of cold/flu medications.
▪ Handle your lenses with your always-clean fingertips. Avoid lens contact with fingernails.
▪ Always keep your contact lens case and solution with you.
▪ Absolutely never use tap water, saliva or a hard lens solution on soft contact lenses.
▪ If you swim in your contact lenses, you must throw them out after the swim. Chemicals and chemical “vapors” will be absorbed into the lens and destroy the matrix chemistry of the lens. If eyes become red or irritated, remove your contact lenses, and call the office.
▪ If you lose a lens and then find it after it has “dried up” and it is brittle, DO NOT re-hydrate the lens. It will be warped and can scratch your eye.
▪ If chemicals of any kind (household products, gardening solutions, lab chemicals, etc.) contact your eyes: FLUSH EYES IMMEDIATELY WITH COOL TAP WATER FOR 5 MINUTES, AND CALL THE OFFICE OR VISIT THE EMERGENCY ROOM WITH OUT DELAY.
▪ If eyes become red, irritated, painful or if you have discharge or reduced vision: REMOVE CONTACT LENSES IMMEDIATELY, AND CONTACT THE OFFICE AT:________
Your cornea is an amazing transparent tissue structure, devoid of blood vessels and not to be taken for granted. The cornea maintains a perfect equilibrium of water, oxygen and nutrients. When you wear your contact lenses according to doctor directions, you can expect to maintain a “clear” cornea. When the cornea is in danger, your immune system tries to protect it and may cause corneal “clouding” in an effort to “pump” the cornea back to its natural equilibrium. You are born with a specific number of NON-REGENERATIVE corneal endothelial cells (pumping mechanism). When they are damaged, they will not regenerate, and you may lose sight and not wear contact lenses again. Love your eyes. We’ll make sure they’re healthy.
3 Discuss reminder technology.
Inform patients about the various wear and care schedule reminder technologies. To start, Acuminder (www.acuminder.com), from Vistakon, enables patients, regardless of their CL brand, to sign up for free to receive automatic e-mail and/or text messages about when it’s time to change their lenses, purchase new ones and/or schedule an eye appointment. LensAlert (www.lensalert.com), from WatchDog Group, is a timer (in days) that tells patients when to replace their lenses and lens case.
Further, an array of reminder smart phone apps and electronic calendars, the latter accessed via computer and able to sync to smartphones, enable wearers to create CL dates to remember.
4 Prescribe an annual supply.
Many practitioners have found patients are more likely to adhere to their replacement schedule when a fresh CL is readily available. So, prescribe an annual supply of CLs.
To overcome the cost barrier to this step, explain to patients how an annual lens supply decreases their likelihood of CL-induced adverse ocular events. An example script:
“Kathy, Dr. Rossi has prescribed an annual supply. This is because he wants you to have a fresh lens when it’s time for you to ‘toss and replace,’ according to the prescribed replacement schedule. Your tears produce calcium deposits, which attach like glue on the backside of the lenses, harden like little sharp points and can scratch your eye and infect it. As a result, if you wear your lenses past the prescribed replacement schedule, you can develop an infection, and you may be unable to wear CLs for a period of time or permanently. You want to avoid that problem, right? What address would you like me to have your annual supply shipped?”
Also, show patients the “true” cost when factoring in the bulk purchase savings, his/her health insurance and rebates. Reference rebates as a “Savings Certificate” or “Added Savings.” The reason: Consumers become more interested in products that can save them money. Also, make the savings sound extra special and not always available:
It’s possible to overcome the cost barrier associated with an annual supply of CLs.
“Kathy, there’s an added bonus for you today because we’re ordering an annual supply. On occasion, the manufacturer provides a mail-in-savings rebate, and you’re in luck because I have one for you today.”
Scarcity of something desirable often yields great consumer interest.
A caveat: Don’t make rebates the focus when explaining an annual supply’s benefits. The reason: You send the message to patients to search for the best deal when they require a new supply of lenses, say some practitioners.
If your office gives an additional discount for buying the annual supply, say:
“In addition to the mail-in rebate, I’ll give you an instant savings on your contact lenses today too.”
For patients who may question “what if...?” or who want their CL prescription, provide a document called “Reasons Patients Choose Us For Their Contact Lens Provider,” and include your policy on prescription changes before the annual supply is finished, damaged lenses, emergency diagnostic lenses, etc.
If after all this, the patient says, “I’m sorry, but I just can’t afford an annual supply right now,” reply:
“I may be able to spread your total cost over six months, interest free through an option called CareCredit. This is a health-specific plan that allows you to get your complete supply and even sunglasses too. Sound good for you?”
In the event the patient isn’t eligible for CareCredit, simply say:
“Kathy, I checked, and CareCredit isn’t lending right now. Would you like to use a credit card instead, and we’ll break the total cost into three monthly installments so you can take advantage of the savings?”
5 Train team members.
I am convinced that CL compliance is low because of inadequate personnel training. For example, I still hear wellmeaning personnel ask patients, “How many boxes do you want to get?”
Schedule strategic training and role-play practice with office team members to ensure knowledge and consistency regarding the four tips outlined above. Specifically, develop patient scripts, and have staff practice them every week until you are satisfied. Then, revisit this training every three months (quarterly measures get the best response), and retrain when you add new team members.
For instance, front-office staff should be trained to ask CL patients scheduling appointments to present with their current CLs, CL case and any solutions and/or eye drops they are using. This way you, their doctor, can look for signs of non-compliance, such as telltale “rings” in the case, which indicate solution “topping off.”
A work in progress
The tips illustrated above can dramatically increase patient adherence, reducing patient risk of CL-related adverse events and therefore, the likelihood of CL dropout — a win-win situation. “Top of the morning to you” is more pleasant to say than “I see you’re topping off.” OM
Mr. Hinton, CEO and president of eYeFacilitate, was in private practice and is a practice management strategist and communication expert. He travels, lectures and works with private practices. E-mail him at firstname.lastname@example.org, or send comments to optometricmanage email@example.com.