Reinforce the importance of the contact lens wearing schedule you prescribe

“At Issue” asked: A healthy, successful daily wear contact lens patient returns for an annual exam that reveals no concerns. However, the patient says he is wearing a lens that is indicated for 2-week replacement for an entire month instead. How do you counsel him?

Stress importance of replacement schedule

Steven I. Bennett, OD, FAAO: I first ask patients if they actually know why it is important to replace their lenses at the appropriate time. When they shake their head to signify they have no idea, I begin my discussion.

Steven I. Bennett

When you wear contact lenses, a lot of the debris, mucus, bacteria and everyday crud can be absorbed into the lens. Even if you clean the front surface of the lens you cannot remove that stuff.

I then ask patients if they notice that their eyes feel better when they put on a fresh lens. They always say yes. Then I explain that for the optimum health of their eyes they should not notice a difference when they put a fresh lens on. When they notice a difference, that means the lens was worn too long.

I then recommend that we refit the patient in a monthly replacement lens. They already are replacing their lenses at 1 month. So now they can continue doing that and be safe at the same time. My job is to fit the patient with the best lenses available and to keep their eyes healthy. I ask them to choose a day of the month that has some significance, such as paying bills, and replace their lenses on that day.

I also might add that depending on the patient’s lifestyle and how often they actually wear their contact lenses, I am a big advocate for daily disposable lenses. They offer great health benefits and are extremely convenient to use.

For more information:

Steven I. Bennett, OD, FAAO, can be reached at Bennett Optometry, 117 South Main Street, Ann Arbor, MI 48104; (734) 665-5306; fax: (734) 665-5522; e-mail: sbennett@bennettoptometry.com.

Explain that soft contacts are like sponges

D. Penn Moody, OD: I believe it is important for the long-term health of our patients’ eyes to change their lenses frequently. Because a soft contact acts like a sponge, absorbing many materials with which it comes into contact, the qualities of oxygen transmission, matrix integrity and smoothness of surface will be compromised over time. Therefore, I always recommend a patient follow the U.S. Food and Drug Administration-approved replacement schedule, regardless of how the patient presents on that visit.

D. Penn Moody

As an eye care professional, I believe it is my job to recommend what is best for my patients for both the short and long run. Over my 30+ years in practice I have seen many patients with seemingly no problems develop significant pathology over the ensuing years. This can be similar to the progressive nature of diseases such as glaucoma.

My protocol would be as follows:

• Explain to the patient that his corneas appear healthy.
• Explain that soft lenses are like sponges and absorb materials with which they come into contact, such as oils from the fingers, mucus from the tears and materials in the air.
• Explain that this can also make the surface of the contact lens rougher, which can cause a slight abrasion to the corneal surface, reducing wearing comfort.
• Explain this can also lead to greater dryness at the end of the day. Many patients will admit to having dry eyes as a symptom when asked.
• Strongly recommend that he decrease his replacement interval to 2 weeks, as recommended.
• Tell him it will cost very little, usually about $100 a year, to take better care of his eyes.

For more information:

• D. Penn Moody, OD, can be reached at Moody Eyes, 8936 Southpointe Drive, Suite C-5, Indianapolis, IN 46227; (317) 883-1122; fax: (317) 883-1139; e-mail: penn@moodyeyes.com; Web site: www.moodyeyes.com.

Provide a system to help them remember

Thomas M. Bobst, OD: Patients who are noncompliant with their replacement schedule are almost always noncompliant in all areas of their contact lenses. Therefore, I almost always find some amount of ocular change such as corneal staining, neovascularization or lid changes. I use the slit lamp camera to show patients their own cornea and educate them about the physiology of the cornea and the reason it is normally clear and avascular. This creates the motivation to be compliant and instills the desire to replace their contacts every 2 weeks.

Thomas M. Bobst

I then give patients a system to help them remember when to replace their contacts. Studies that show monthly replacement patients are much more compliant than 2-week patients are somewhat flawed. The studies never give the 2-week patients a way to remember when to replace their lenses. The monthly patients do not have to remember when they first put their contacts in; it occurs on the same day each month (for example the 1st of each month). Two-week patients are left wondering exactly what day they began lens wear, and may end up wearing them longer.

The way to achieve equal compliance is to give patients a system for replacement. The most simple system is to replace on the 1st and 15th of the month.

Another system is the Acuminder by Vistakon (Jacksonville, Fla.). It will send a text reminder to the patient’s phone, a reminder to their Facebook page or a regular e-mail to their inbox. Acuminder has the added benefit of sending an exam recall reminder to return to your office after 12 months. When you give patients the motivation and equip them with a system, patients will be compliant with the 2-week regimen.

I do not discuss this with patients, but the most important reason to replace at 2 weeks is the denaturing of lysozymes on the surface of the lens. Lysozymes are naturally present in the tear film and perform essential antimicrobial duties. However, when they denature, complications (such as giant papillary conjunctivitis) increase dramatically, according to Donshik. Studies by Suwala and colleagues show that this denaturing rapidly increases after 2 weeks. This is the reason the manufacturers chose the 2-week interval and the reason the vast majority of contact lenses used in the United States are 2-week replacement systems.

For more information:

• Thomas M. Bobst, OD, can be reached at 24130 Lorain Rd., North Olmsted, OH 44070; (440) 734-9920; fax: (440) 734-2870; e-mail: tombobst@usa.com. Dr. Bobst is a professional affairs consultant to Vistakon.

References:

• Donshik P. Contact lens chemistry and giant papillary conjunctivitis. Eye Contact Lens. 2003;29 (1 suppl):S37-S39, discussion S57-S59, S192-S194.
• Suwala M, et al. Quantity and conformation of lysozyme deposited on conventional and silicone hydrogel contact lens materials using an in vitro model. Eye Contact Lens. 2007;33(3):138-143.

Show photos of infection resulting from overwear

Roy A. Kline, OD: The first concerns I would discuss with the noncompliant patient are the reasons he should be replacing his lenses in a timely manner. I use photos of corneas that have infections and inflammatory events from overwear of contact lenses. This sets up a visual picture for the patient to emphasize why replacement at the recommended time is necessary.

Roy A. Kline

I tell the patient that although he has gotten away with stretching his wear time, he is putting himself at an increased risk potentially for a serious complication to occur. By using these visuals, I have found that compliance does increase. At each office visit patients need to be reminded when and why they should be replacing their lenses.

The next point that I would bring up is that I am a firm believer in either 1-day or 1-month planned replacement schedules for my patients. With that being said, I would talk to that patient about both of these lens types to persuade him to switch to one of these modalities. Depending on a number of different factors including convenience, lifestyle, work environment, hobbies and whether the patient naps or sleeps in his lenses, I would recommend that the patient make a change in his lenses. The key points in the last sentence are understanding your patient’s lifestyle and recommending the type of lens you feel is best.

I do not discuss costs at this point, nor do I provide a menu of choices and let him choose; I simply recommend the lens modality to the patient and proceed from there. Once given the verbal agreement, I will have the lenses in stock to fit 90% of my patients and have the patient leave wearing the new modality.

For more information:

• Roy A. Kline, OD, can be reached at 41 S. Western Ave., Glens Falls, NY 12801; (518) 792-2345; fax: (518) 792-1361.