Contact lenses have been around longer than
many of you reading this article. They're proven safe and effective as a means
of visual correction. Plus they offer many advantages over other corrective
alternatives, such as clearer vision, fewer aberrations, no frames in the way
and no fogging in cold weather, to name a few.
Surprisingly then, that only about 1 in
every 10 Americans wears contact lenses � that�s far fewer than the potential
number who could benefit. Certainly, a huge number of your patients qualify as
candidates for contact lens wear, but something's holding them back.
We conducted an informal study to determine
what barriers keep patients from wearing contact lenses. Read on to find out if
one of those barriers is you.
To determine why patients elect to stay in
glasses, third-year students enrolled in the introductory contact lens course
at the Illinois College of Optometry were given an assignment. They interviewed
a non-contact lens wearer and had to determine why he wasn't wearing contact
lenses. Or, if the patient had worn lenses in the past, students were to
determine the reason he'd dropped out of lens wear.
The students also identified fears the
interviewees expressed regarding contact lenses. Each student then submitted a
report explaining his findings.
Key findings: the terrible 20
Of the 159 people whom the students
interviewed, more than one-third (56) had at least tried wearing contact lenses
in the past. Although many patients had multiple reasons for not wearing
lenses, the students identified 20 key reasons from their interviews. Each
reason was grouped into one of five broader categories: physical, financial,
psychological, lifestyle or practitioner-related (see "Terrible 20"
for a complete list).
This article will review the most common
reasons for discontinuing or not wearing lenses, broken down by category. We've
also suggested ways to gain these patients as part of your contact lens
Physical or physiological
It's not surprising that more dropouts than
non-wearers reported physical or physiological reasons for not wearing contact
lenses. Even less surprising is the fact that the most common reason for
dropping out of contact lens wear was discomfort, although dry eyes and reduced
visual acuity were other prevalent reasons (see "Physical/Physiological
Reasons" below ).
� A patient whose reasons fall into this camp may just
need proper education to convert her into a happy contact lens wearer. Explain
that her concerns were problems in the past, but that modern technology has
solved many of them.
� The patient who wore annual replacement lenses that
created comfort problems because of dirt and debris on the lens surface may
find that clean, comfortable disposable lenses are just the motivation she
needs to return to lens wear.
Among nonwearers, fear of discomfort was
also the leading reason for staying with their spectacles. But don't assume
that these patients know what they're talking about!
One patient told the interviewer that he
didn't wear contact lenses because they hurt. Apparently, when he was a
teenager, he'd tried on his cousin's rigid gas permeables (RGPs). He knew
first-hand that contact lenses were uncomfortable based on that experience. But
a little education might convince him to try a professionally fitted pair of
Price does seem to be a barrier to contact
lens wear for a portion of the population -- more so for those who've never
worn them. Some reported that they'd had prices quoted previously and simply
found the fees to be too steep. While some maintain that contact lenses are a
financial burden, the reality is that these days, contact lenses are a bargain
compared to hi-index ophthalmic lenses in a designer frame.
In most cases, the patient has no basis on
which to judge the relative value of contact lens wear compared to the
financial outlay. For these patients, disposable lenses and the opportunity to
experience lens wear without significant cost are the answer.
Consider letting the patient wear her trial
lenses out in her own environment for a few hours before having to make a
financial commitment to them. Most patients will quickly find them well worth
As any longtime fitter knows, one of the biggest
obstacles to contact lenses (and the hardest to get the patient to admit to) is
fear. As shown in "Psychological Reasons", the most common
psychological reason for not wearing contact lenses is a patient's fear of
touching her eyes. This is one of the hardest hurdles to overcome.
� Many experts suggest telling patients that they won't
actually be touching their eyes, but that the lens will "float on a sea of
If this approach were truly effective, the majority of the population would now
be contact lens wearers. But there may be hope. If a patient sounds at all
promising, you can try desensitizing her.
� Dr. Julie Ryan, a private practitioner in southern
California who specializes in pediatrics, is used to dealing with patients fearful
of lens wear. Her method is to dispense several bottles of artificial tears to
the child's parent and have the parent instill drops several times a day until
the child is used to the sensation.
� This approach works with adults as well. Dr. Arthur
Epstein of Roslyn, New York, takes this approach one step further. He asks a
patient to practice by placing a drop of CelluVisc on her finger and touching
it to her eyes using a mirror to monitor her progress.
In our experience, truly motivated, yet fearful patients are generally better
at removing lenses than applying them.
� If your technician is willing, you might consider
having her repeatedly place the lens on the patient's eye, then having the
patient remove it each time.
Once the patient becomes adept at removal, it's time to tell her that
application is a breeze compared to removal. When she realizes she's mastered
the hard part, she should be comfortable enough to learn application and go on
to become a successful wearer.
� One of the most surprising fears reported was that
the lens could somehow roll behind the patient's eye and end up in her brain.
The educated practitioner knows all about the conjunctival anatomy, but the
patient doesn't. Simply showing the patient the inferior conjunctiva cul-de-sac
by pulling down her lower lid may alleviate this fear. Other fears, such as
getting an infection and the horror stories they've heard from friends, are
simply a matter of patient education. Comparing the risk of a severe contact
lens complication to that of other life occurrences may put things in
perspective. For example, the patient earning more than $50,000 annually is 17
times more likely to be audited by the IRS than to develop a contact lens
associated ulcerative keratitis.
Fear is a complex emotion and you'll never
win over all the fearful patients you encounter. Time, tact and a drop of
ingenuity can help many patients overcome trepidation.
Interestingly, nonwearers and dropouts agree
completely that the hassles of lens care and handling are significant reasons
not to bother with contact lenses (see "Lifestyle Reasons"). You
might motivate these patients by making them aware of daily disposables, which
cost about $1 per day.
With regard to the students' detailed
interviews, it's evident that some patients are unaware of modern, multipurpose
solutions and daily disposal contact lenses. Again, good patient education is
the key to turning these individuals into contact lens wearers.
Other lifestyle factors isolated were
laziness, busy lives, dusty or dirty work environments and a preference for
wearing spectacles for fashion purposes. Additionally, a disproportionate
number of the individuals interviewed wore their spectacles part-time and
wouldn't be appropriate candidates for contact lens wear. Unless their lives
change significantly, you shouldn't try to change their attitudes.
Are you doing your part?
The most disturbing finding of our study was
that the most common practitioner-related reason for not wearing contact lenses
was that the practitioner never suggested them to the patient. Evidently, a
number of patients would be open to contact lens wear if their doctors
� One way to boost your contact lens practice is to
suggest this option to every reasonable candidate. This is a simple change to
make to your routine, and at the end of a year, you'll find you have a
healthier contact lens practice.
� Staff follow-through is also important. A number of
patients reported that they didn't wear contact lenses or quit wearing them
because they weren't adequately trained.
One interviewee explained, "They gave me the lenses and some stuff to take
care of them, but they never showed me how to put them in or what to do with
all the supplies, so I never wore them."
Use what you've learned
"Why aren't you wearing contact
lenses?" seems to be a simple question, but as ICO's class of 2002 found
out, the answer is sometimes quite complex.
If you're looking to grow the contact lens
portion of your practice, pay extra attention to the reasons why your patients
say they don't wear them. It'll help you increase the number who do.
Dr. Jurkus is a professor at Illinois
College of Optometry in Chicago. Dr. Schwartz is a contact lens consultant in
Vista, Calif., and is editor of Specialty Contact Lenses: The Fitter's Guide.
Both Drs. Jurkus and Schwartz are members of Optometric Management's editorial
The Terrible 20
3. Poor vision
5. Dry eye
8. "Roll into head"
9. Fear of infection
of touching eye