Alisa Sivak, MA(Ed) manages the development of educational publications produced by the Centre for Contact Lens Research at the University of Waterloo’s School of Optometry, Canada.
Studies show poor levels of patient compliance with eye care practitioner (ECP) and manufacturer recommendations for safe contact lens wear and care. The following list of strategies for encouraging better patient compliance is based on a 2011 British Contact Lens Association session dedicated to this issue, in which Kathy Dumbleton, Fiona Stapleton, Lyndon Jones and Charles McMonnies weighed in on the extent of the problem and explored strategies for encouraging better compliance.
Sympathize with your patients
Study participants at the Centre for Contact Lens Research often cite forgetfulness as the reason for poor compliance.
♦ Write a “prescription” for contact lens wearers, to underline the importance of using the assigned solution and to help patients keep track of instructions.
♦ Consider starting compliance instruction at the prescribing visit, to reduce learning burden at the instruction and delivery visit
♦ Regularly review appropriate wear and care procedures with patients. Do note, however, that studies have reported this strategy to have limited impact1-2.
♦ Suggest that patients label each bottle of contact lens solution with its expiry date.
♦ Healthy Soft Contact Lens Habits 3, developed by the American Association of Contact Lens Educators provides a list of illustrated instructions suitable for sharing with patients during review as a hand-out. Available in English, French and Spanish.
>Develop a system to help you recognize which patients are most likely to be non-compliant
According to Carnt, et al.4, identifying patients who are risk takers may be a better predictor of non-compliance than relying on demographic factors, including age or gender.
♦ Identify non-compliant patients by asking open-ended questions (“How often do you clean your case?” instead of “Do you clean your case?”).
Ensure that patients are informed
Adapting the Health Care Belief Model, Sokol et al.1 and Claydon et al.5 note that ECPs should explain the potential serious consequences of non-compliance to patients, including dryness and discomfort, chronic red eyes, inferior vision, infection and permanent loss of vision.
♦ Explain why each step in contact lens maintenance is important, and convey the potential consequences of non-compliance.
♦ Increase frequency of communication with patients about compliance strategies and the consequences of non-compliance.
Emphasize patients’ role in their own success with contact lenses
Non-compliance can lead to less than optimal vision, discomfort and complications—conditions that breed dissatisfaction with lens wear.
♦ When reviewing wear and care guidelines, use wording that emphasizes wearers’ own role in maintaining a positive lens wear experience.
♦ Suggest that patients keep a diary or calendar to help them remember when their lenses or care system needs replacing.
Contribute to ongoing professional dialogue about compliance
In addition to talking about why, when and how patients decline to follow recommendations, think about the ways in which eye care professionals, manufacturers and the United States Food and Drug Administration (FDA) fail to present patients with consistent information and guidance.
♦ Eye care professionals and the contact lens industry need to ensure that they are aware of the most recent research findings relating to compliance, and that ECP advice matches manufacturer guidelines and research-based guidelines.
REFERENCES
1. Sokol JL, Mier MG, Bloom S, Asbell PA. A study of patient compliance in a contact lens-wearing population. CLAO J 1990;16:209-13.
2. Yung AM, Boost MV, Cho P, Yap M. The effect of a compliance enhancement strategy (self-review) on the level of lens care compliance and contamination of contact lenses and lens care accessories. Clin Exp Optom 2007;90:190-202.
3. AOCLE. Healthy Soft Contact Lens Habits.
4. Carnt N, Keay L, Willcox M, Evans V, Stapleton F. Higher risk taking propensity of contact lens wearers is associated with less compliance. Contact Lens Anterior Eye.
5. Claydon BE, Efron N. Non-compliance in contact lens wear. Ophthalmic Physiol Opt 1994;14:356-64.
