Whether you practice in private practice, an ophthalmology practice, retail, or a commercial lease, one fact about contact lens (CL) wear is universal: Keeping patients happy, comfortable, and wearing their CLs long-term can be a challenge.
Given that CL wear can improve a patient’s visual satisfaction, the ability to play sports, and increase overall self-perception1 — creating patient loyalty and referrals — and that a portion of an optometric practice’s revenue comes from CL services and sales, this is a challenge that is well worth overcoming.
A recent literature review by Pucker and Tichenor, published in Clinical Optometry, reviewed the most common reasons for CL dropout, finding that it is mostly attributed to discomfort (e.g., irritation, dryness, etc.) in established wearers, and dissatisfaction with vision by new wearers. Incidentally, when it comes to new wearers, the first two months are critical: Specifically, studies show that 26% of new wearers dropout of their lenses by the one-year point, and 50% of those dropouts happen in the first two months.2
Although preventing CL dropout completely is impossible, I have found that the following steps, which are solutions to these most common reasons, can decrease it dramatically.
DISCOMFORT
I have discovered that the following action steps can overcome discomfort in wear:
- Evaluating the health of the ocular surface. CL dropout is significantly higher in patients who have meibomian gland dysfunction, so identifying this condition and treating the patient proactively before starting CL wear may improve CL retention rates. I recommend utilizing peer-reviewed and tested questionnaires, like SPEED and CLDEQ-8. Determining whether a patient is symptomatic can be done utilizing a tech-led survey and zero doctor time. Requiring a survey, administered by your technician, of all established CL wearers reinforces to patients that we are here to help uncover issues, so that we can meet their needs. (See “Combat Complacency in Established Wearers,” p.38.) In terms of treatment, I actively prescribe photobiomodulation, IPL, and warm compresses to ensure patients have healthy glands that will allow them to wear CLs for as long as possible.
- Prescribe lenses that have a high modulus and improved edge design. We want CLs that live and can breathe in the tear film and leave no indication they were ever there. A few thoughts: Modulus matters. Patients in my clinic want a lens that is easy to handle but not so thick that there is lens awareness on the eye. Material may not prove to matter in the studies, but my experience is that the surface technology of a lens can be felt and appreciated by my patients. In recent years, lenses that deter lipid resistance have proven to result in more successful CL wear and satisfaction in my clinic. I’ve had great success with high-water content lenses, especially in patients who have had past giant papillary conjunctivitis and dry eye disease (DED). As high-water content technology becomes more accessible with the release of new reusable lenses, I’m excited to see how that impacts CL dropout rates.
Combat Complacency in Established Wearers
WHEN IT COMES TO ESTABLISHED CL WEARERS, WE MUST STAY AHEAD OF PATIENT COMPLACENCY.
Specifically, I have found that there is a tendency for these patients to normalize their symptoms or fear that their provider may take them out of lenses if they “complain” or mention any perceived difficulty in wearing lenses. However, if these undisclosed symptoms worsen, some patients may choose to opt out of contact lens wear altogether, rather than notify the doctor of their difficulties. For these reasons, it’s especially important in this patient population to elicit symptoms.
There are a ton of “right” ways to elicit good CL wear histories and finding the one that feels natural to your practice is key. I have discovered that pointed history questions help to bring forth the true wearing experience of our patients. Much has been said about how to elicit these relevant histories from our patients, so I will share a few of my favorite ways to get to the truth of a patient’s wearing experience. Here are my top three questions to ask:
- Are your lenses as comfortable at the end of the day as at the beginning?
- Is there anything you would change if you could about your current contact lenses?
- Do you decide when to take out your contact lenses, or do they decide for you?
Never be afraid to introduce patients to new CL technology. Patients are used to always trying something new when it comes to technology. How many people do you know who have had the same phone for 10 to 15 years? Approaching established wearers from the perspective of trying to help them find their perfect CLs by always adapting to new technologies and offering patients new lenses creates a “What’s new this year?” culture that is conducive to patients who expect and welcome change.
DISSATISFACTION WITH VISION
I have found that the following action steps can overcome patient dissatisfaction with the vision provided by CLs:
- Scrutinize the prescription. For example, I recommend fitting torics whenever indicated. Recent advancements in toric lens designs give new toric CL wearers the vision they desire, thus preventing dropout from poor vision concerns.When considering toric vs. spherical equivalent, I do a quick in-phoropter test of whether a patient notices their astigmatic correction. I find this very useful, but I also keep in mind the studies that show correcting even low amounts of astigmatism achieve the vision patients want and need to keep them in CLs, especially new wearers.
- Schedule a one-week follow-up. This step ensures that any issues with vision are rectified quickly. At my practice, we also actively use “courtesy calls” for all patients who have prescription changes, new material, etc. These scheduled calls are placed on our “walk-in” schedule and are performed by a team member. It takes no doctor time and minimal staff time to complete these calls, while enhancing the patient care experience and allowing for patients to disclose when their lenses are not meeting their needs.For presbyopes, both discomfort and poor VA are the primary reasons for dropout. Therefore, we should consider DED in this population. Always set realistic expectations for visual outcome when fitting multifocal lenses, and embrace new designs.
Additional Reading
There are many factors associated with combating contact lens dropout. Below are summaries of two additional articles containing more information on contact lens dropout; both articles are from OM’s sister publication Contact Lens Spectrum (clspectrum.com ).
- “DROPPING THE DROPOUT RATE”: In their summary of their 2020 GSLS presentation, Eef van der Worp, BOptom, PhD, James S. Wolffsohn, BSC (OPTOM), MBA, PhD, and Lyndon Jones, PhD, DSC, FCOptom, review the dropout challenges faced by soft contact lens patients. While there are many factors that can determine dropout, there is one that eye care practitioners have ultimate control over: lens fit. Their GSLS session focuses on the questions, “Can we do better when fitting our soft lenses?” and “When was the last time that you actually fitted a soft lens?” For the full article, see https://bit.ly/3n488Ri .
- “PREVENTING CONTACT LENS DROPOUTS”: This article cites two reasons for dropout or abandonment: discomfort and inconvenience. When addressing inconvenience, Desmond Fonn, distinguished professor emeritus, University of Waterloo School of Optometry & Vision Science, said, “Inconvenience can be overcome by daily disposables, which eliminate care and maintenance, or extended wear of high-Dk silicone hydrogels, which offer a form of permanent correction and partial elimination of handling and care.” For the full article, see https://bit.ly/3yxVHBV .
For more information in this issue, read how Demodex can affect CL dropout in “Bugging Out of Contact Lenses,” p.48.
DECREASING THE DROPOUTS
Again, it’s impossible to put an end to all CL dropouts, but the action steps illustrated above, which are solutions to the most common reasons for dropout, can definitely make a dent in this ongoing challenge.
REFERENCES
- Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci. 2009;86(3):222–232. doi:10.1097/OPX.0b013e3181971985
- Pucker AD, Tichenor AA. A Review of Contact Lens Dropout. Clin Optom (Auckl). 2020; 12: 85–94. Published online 2020 Jun 25. doi: 10.2147/OPTO.S198637.
