GP Lens Case Grand Rounds Troubleshooting Guide – 13

Poor Patient Compliance (An Overview): Doug Benoit, OD, FAAO & Ed Bennett, OD, MSEd

Background

One of the bigger challenges practitioners face each day is the issue of non-compliance. Many studies have shown that patients fail to follow instructions about 50% of the time, even when it is for a medication that is necessary to sustain life. It is little wonder then that contact lens patients fail to care for their lenses appropriately. We often have patients presenting with problems of comfort, vision, wearing time, etc., that are directly related to how they care for their lenses.

Many patients do not clean their lenses upon removal, but wait until the next day to clean them just prior to insertion. Some do not clean their lenses on a daily basis, they just soak them. The lenses only get cleaned when they cause irritation or decreased vision.

Numerous patients change solution brands with no regard for how one product might interact with another. This practice can cause reactions related to toxicity and allergy, which decrease comfort, etc. Worst of all, some patients do not change their soaking solution each day. They simply “top off” the case each time the fluid level gets low. Many patients do not clean and/or replace their lens case on a regular basis. The latter two situations can potentially lead to infection, sometimes with severe consequences.

In all honesty, sometimes practitioners are as much to blame as the patients for this type of behavior. When we delegate care instructions, we lose some of our control over the patient. The importance of the task seems diminished to them when the doctor is not directly involved.

Patient Consultation/Education

Based upon the above information, the following steps should optimize compliance for GP wearing patients:

  1. It is prudent for practitioners to review the lens care regimen/instructions with each patient and then have the technician reiterate and reinforce the message.
  2. The practitioner should give written instructions to each patient prior to the education provided by a staff member.
  3. Hand washing needs to be emphasized and reviewed with the patient at each visit.
  4. A demonstration of proper technique for handling (insertion and removal) and ensure mastery of these procedures prior to leaving the office. As it is the lid margins that eject the lens and with the knowledge that today’s designs are typically larger with a lower edge clearance than their predecessors, it is important that the fingers are positioned over the lashes and that the lid margin is taunt against the eye prior to moving the lids to eject the lens.
  5. Also, showing the patient how to properly clean a lens to ensure complete removal of debris without changing the lens parameters over time, can be invaluable.The lenses should be cleaned immediately upon removal in the palm of the hand.
  6. Review the need to discard any solution remaining in the lens case after the lenses are inserted each day. Rinsing the case out with warm tap water and leaving it open to air dry are also necessary steps in the process.
  7. Explain why a particular solution/system is being prescribed. Advise the patient not to switch to a different brand without consulting with you or your office staff. One method to ensure they stay with the prescribed care regimen is to provide them with a 2-3 month supply at dispensing such that they are accustomed to using the recommended system.
  8. The care instructions need to be reviewed by the doctor at each visit. This helps to reinforce the message and gives it greater credence.

Summary

The difference between success and failure with a new GP wearing patient oftens pertains to how well they comply with instructions and, more important, how well they were educated. If patients are shown how to do something, told why it is necessary to do it properly, and the issue is revisited often, the likelihood of them complying will be high. This will result in happier, more satisfied patients and practitioners.

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