Article

CLINICAL: CONTACT LENSES

DEALING WITH NON-COMPLIANCE

STRATEGIES TO SUCCESSFULLY DISCUSS LENS CARE WITH PATIENTS

“ON MONTH three, Doc!” a contact lens patient exclaims. He is in a monthly disposable lens that has never been removed!

Whether this describes a recent patient or a nightmare that woke you up in a cold sweat, you can combat this behavior by providing the reason to be compliant.

Many patients think contact lenses pose no risk to their eyes. Meanwhile, they want to conserve money or don’t want to get out of bed to remove their lenses. Provide these patients with a motivating reason, compelling them to overcome these desires: their ocular health. Specifically, take the time to discuss why compliance benefits the patient and what could happen without proper contact lens care.

There are three strategies I utilize with patients, organized by degree of intensity, from a soft to firm discussion. (Whichever strategy you choose, reiterate that your practice is committed to the patient’s eye health.)

  • Advise the patient about safety issues with contact lens wear
  • Scare the patient about possible bad outcomes
  • Deny the patient the contact lens prescription

Corneal ulcer. Dr. Miller shows patients examples of bad contact lens-care events, such as corneal ulcers and infections.
Courtesy of Jason Miller, O.D.

ADVICE ON SAFETY STRATEGY

Once I know the patient is practicing poor compliance, I use a nice, but firm, voice to say:

“My job is to keep your eyes healthy and happy for a long, long time. I want you to be able to wear contact lenses for the rest of your life, if you desire to. For that reason, we need to discuss how you are wearing your contact lenses. When you wear your lenses in a dangerous fashion, for example, past their wear cycle or overnight, you put yourself at risk for bad things to happen.”

SCARE STRATEGY

The soft approach may work for some, but others may need more of a nudge on how and why to make good decisions with contact lens wear. Employ this tactic when your patient is not responding to the safety strategy.

Additionally, take your communication strategies a step further, be a bit more firm, and utilize some scare tactics. For example, “Because you are wearing your contact lenses this way, your eyes are at a high risk for developing a serious problem. You may not have any now, but this behavior can lead to nasty infections and/or corneal ulcers.”

Explain how ulcers and infections can leave scars, even if treated in a timely fashion. The best way to achieve this strategy is with pictures, for example, the corneal ulcer, at left, and conjunctival injection, next page.

Conjunctival injection due to a contact lens-related infection is shown.
Courtesy of Jason Miller, O.D.

DENY STRATEGY

When the patient demonstrates signs of persistent non-compliance and recurrent contact lens-related issues, this strategy comes in handy. It is the most strenuous plea for the patient to be compliant because you are actually denying the patient his or her contact lens prescription for a period of time.

To do so, take the patient out of contact lenses while the condition is treated and the eye(s) heal. This impresses on the patient the severity of the situation. If possible, show him or her a picture of the eyes with the exact complication.

I might say: “Because you wore your contact lenses this way, your eyes have responded negatively. In order to get them healed, we need to remove you from contact lens wear for a period of time and employ this treatment plan. It is critical to follow these instructions to get your ocular health back to normal.”

This is not the first choice, but if a patient is going to continue to cause damage to his or her eyes, then we, as eye care professionals, have no choice.

MINIMIZE COMPLICATIONS

To have a thriving contact lens practice, maintaining proper ocular health is critical. Proactively discuss compliance with all of your contact lens patients to minimize complications. It is impossible to completely eliminate non-compliance contact lens-related problems, but it starts by educating your patients and, at times, having tough conversations to safeguard their eye health. OM