I stand corrected
Until we started asking patients
about wearing schedules, I thought we didn't have a large extended-wear
practice. We told our two-week replacement lens patients, "Don't sleep in your contact
lenses." We assumed they left our office committed to compliance with our removal
and replacement instructions.
What we found from asking our patients
about their wearing habits, however, was that about 60% sleep in their lenses on
a somewhat routine basis. Nine percent report routinely sleeping at least one or
two nights a week in their lenses whether they are approved for overnight
wear or not and more than 50%
report occasionally sleeping in their lenses. We learn this by asking a series of
questions, starting with, "Do you sleep in your lenses at all?" If they answer yes,
we ask how often. "Do you nap or sleep in them overnight sometimes?" If they answer
overnight, we ask how often.
Our technicians in pre-testing and
the O.D. during the exam each ask these questions. We've found that when patients
admit to staff that they occasionally
sleep in their lenses, they are more likely to spill the complete truth to the
We keep a database of our patients' responses. We categorize patients by everything
from age to prescription (myopia, astigmatism, presbyopia, type of contact lens
worn, etc.). We can perform surveys that help us serve our patients better, as well
as improve our practice's performance.
Getting to the root of it
We also found that about 80% of our
patients extend the life span of their lenses beyond the stated replacement schedule.
So patients disregarded our instructions. How, then, could we impress on patients
the need for compliance? We analyzed the problems and perceptions and created steps
to counter those.
Eyelids. Most of the complaints we hear are about contact lens discomfort. In my
experience, this discomfort is often times related to eyelid changes caused by an
unclean contact lens. We invert the patient's eyelid, take a digital photo and let
them compare it to a photo of a healthy eyelid with no papillary changes. We can
almost see the light bulbs illuminate over their heads. They understand intuitively
that when their eyelid surface is compromised, contact lenses may be uncomfortable.
This one image has done more to impress the need for compliance than anything else
Cost. For some reason, patients hang onto the perception that contact lenses are
expensive and that it's wasteful to dispose of them on the schedule. It's human
nature. We've probably all failed to replace our tires when the manufacturer recommended.
In some regard, we've brought this problem on ourselves by telling patients that
new contact lenses are so much better than the early soft lenses.
But the overall cost of contact lenses
on a per-day basis is remarkably low. Find a way to illustrate that point. In our
community of 39,000 people (22,000 of whom are college students) we learned that
66% of all meals are eaten out. We tell patients, "You're spending $5 to $10 a day
eating out; that's much more expensive than the cost of a daily disposable, monthly
replacement or the breathable silicone hydrogel
lenses that are approved for either six nights, or up to 30 nights of continuous
Switch lenses. All of this leads up to our final presentation. We aggressively move
patients into a daily disposable lens, or hyper-Dk/t silicone hydrogel lenses approved
for extended wear.
For those who report only occasionally
sleeping in their lenses, we recommend the only silicone hydrogel two-week replacement
lens approved for up to six nights extended wear. For those who prefer or report
sleeping in their contact lenses for up to 30 nights, we recommend the monthly replacement
silicone hydrogel lens.
Our one-two punch
In our practice, it's simple
if patients want to sleep in their lenses overnight, we want them in the lens with
the highest oxygen transmissibility level. If they want to wear contact lenses occasionally
or strictly on a daily-wear basis, we encourage daily disposable lenses and use
the eyelid photos as an incentive to replace lenses. When a patient tries to get
a second day of wear out of a daily disposable lens, and it feels uncomfortable,
the image of those bumps on their eyelids may be enough to scare them straight.
In addition to our frank discussions
about the benefits of healthy contact lens wear, the second part of our two-pronged
approach is to disabuse patients of the notion that contact lenses are costly. Compare
it to the price of a soda from a vending machine or a cup of coffee. At the same
time, move them into a contact lens that is a healthy option for their eyes.
Over the past year, this new approach
has been very effective. Patients return on time, replace lenses more regularly
and, with the eyelid photo, have received an entirely new education on eye health
and contact lens compliance. Put another way, recommending healthy contact lenses
options for our patients has been not only good for our patients, but also good
for our practice. It starts with knowing how contact lens patients wear their
lenses. That requires asking them whether they are occasionally,
frequently, routinely or never sleeping in their lenses.
Dr. Cockrell is in private practice.
You can reach him at Dacockrell@cockrelleyecare.com.
Optometric Management, Issue: July 2005