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The Contact Lens Patient Knows Best
There I was, Friday afternoon, reflecting on a week comprising of mainly routine refractions but with the few interesting cases that kept my brain active. However, one area of clinical practice that I had observed during the week worried me:
Contact lens wearers seem to know best!
Imagine my disbelief when on asking to remove their contact lenses during a contact lens check, two thirds of my patients just “pulled��? them out without washing their hands. A small point, I know, but if this is happening, then is the patient really keeping to the advised wearing times? Are they really not sleeping in their conventional hydrogel lenses?
Is it poor communication on my part that causes this?
I asked one of the patients (a contact lens trial) after he had committed the aforesaid crime, “When we saw you last week, did we go through care and handling of your soft lenses; how to rub and rinse the lenses when cleaning; the importance of washing and drying your hands before you touch the lenses and your eye, and how not to go near tap water with the lenses?��?
The reply - “Oh yes you did all that��?.
My next patient had the option to wash their hands. “Could you take your lenses out for me, there’s a sink with soap over there if you want to wash your hands and I have a case and solution in case you have forgotten your own��?
“Oh no, I’ve got a case in here somewhere��? was the reply as the patient went furrowing through her Mary Poppins handbag and pulled out a grubby contact lens case into which she put the lenses without washing her hands.
Here I am, trying to keep eyes healthy, but sometimes it feels like an uphill battle, when hearing comments like “Young man, I’ve not had an eye infection in 20 years of lens wear��?. But I am sure I would be the first to know if she did have an infection,
The final patient of the week restored my faith in the public. A young lapsed wearer asked for a case as she forgot hers and whilst I found her one, washed her hands and dried them. As I was writing my notes, thinking at least one person follows our advice, she pointed to a poster on my wall of contact lens complications due to dirty lenses, asking “Is that what happens if you over wear the lenses?… Yuk!��?
We all have times when we don’t follow advice or best practice. We cannot force our patients to comply, but we can, using different communication styles, reinforce key points and ideas to benefit everyone.
Our days are happiest when instructions are followed; just speak to a lens solution manufacturer!
Jane Macnaughton // Mar 13, 2007 at 12:29 pm
Hi Peter, great to have you on board.
I thought that poor compliance in contact lens wear was becoming a thing of the past, especially with a majority move towards daily disposable lenses. With all the press coverage over the past few years of contact lens complications due to poor hygiene, there are still a number of patients who are ignoring the advice?
How do you tackle the problem?
Priya Morjaria // Mar 14, 2007 at 1:06 pm
One solution to this would be to get a cl wearers in for more regular check ups. In the ideal world every 3 months and we could ‘keep an eye on them’. Unfortunately commercial restraints and the amount of chair time it takes does not make it a practical solution.
Today I did an after care on a young patient who started wearing daily disposables a year ago. My history and symptoms with her were of a perfectly compliant patient. However, once on the slit lamp the scenario was completely different. I could have sworn she had been using those lenses for over a week.
Where do you start? What do you say? Sometimes it’s like banging your head against a brick wall.
Peter Chapman // Mar 14, 2007 at 2:18 pm
Hi Jane.
I agree that with the development of daily disposable lenses compliance has greatly improved. Maybe as practitioners we are also better at understanding patients and their lifestyles/personalities, and,with a wider range of lens types and modalities in our armourment we are able fit more appropriate lens modalities/types to specific patient groups.
Priya - I think you make a very valid point in that however much we want to believe a patient, their eyes and lenses can tell a different story. Frequent aftercare is an option but as you say is costly. Is it actually improving complience though?
There is not always a solution, but as practitioners all we can do is try to make our case. Don’t forget, we are the keeper of the contact lens specification, so, as a worse case scenario, can say that a lens or wear modality is not suitable.
Reinforcement of key points and patient education is the strategy i choose.
1. From the outset i explain that contect lens wear, although small, carries risk but these are minimalised by careful care of the lenses and following our advice.
2. Patient’s sign a declaration after a trial that they have been taught how to care for lenses and other key points. This is usually done by the member of staff who does the teach (not neccessarily me!). This is beneficial as that although as a practitioner i go through care and complience, a different person is reinforcing key points and so it not appearing to be a contiuous lecture from one person.
3. At aftercare appointment , i explain what i am checking e.g. lens condition, looking for new vessel growth, but more importantly, why i am doing this. Even is a patient has no complications, it’s an opportunity for reinforcing key areas, congratulating the complient pateint but also educating the non complients and offering advice as you can relate their condition or complication to a cause.
4. Posters - i believe that ” in sight is in mind”. If posters/charts are on the wall, people will look at them part out of curiosity and part interest. It then starts an opportunity for conversation.
5. Use your conact lens manufacturers. One manufacterer now makes solution with packaging aimed at refreshing key points of lens care. We are attracted to new/different appearences and so hopefully will be curious to the new packaging that their lenses and solutions have come in and read the information. This also gives another opportunity to discuss verbally the ideas as the solution is handed across.
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