CREATING A CULTURE OF CL CARE AND COMPLIANCE

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Alcon’s CLEAR CARE PLUS
features HydraGlyde, a proprietary
wetting technology that surrounds
lenses to maintain moisture.

Patients’ failure to wear, clean, and store contact lenses correctly can increase the risk of eye infections and dropout.

Eyecare providers continue to battle with patients about contact lens over wear, lackadaisical lens cleaning, and the resulting ocular side effects, yet we are better equipped than ever to combat these problems. The issue likely lies within the disconnect between what we believe is the best””the healthiest soft contact lens on the market””and what we actually prescribe. It’s time to bridge these disparate modes of practice””and practice what we preach.

THE LATEST LENSES
There are myriad options today in soft contact lenses. Gone are the days of three-month replacement and low-Dk conventional lenses. The latest technology directly addresses the number-one cause of contact lens dropout: discomfort. Lens manufacturers are tuned into the importance of tear film health and its interaction with contact lenses, and are continuously improving lens treatments and developing new materials that help maintain a healthy ocular surface.

The revolutionary Alcon Dailies Total1′ created a new category of silicone hydrogel lenses with the company’s water gradient technology. The lens approaches near 100% water toward the outermost surface.

CooperVision’s MyDay’ features Smart Siliconeâ„¢ chemistry, which allows for optimal oxygen permeability and helps create a naturally wettable lens that has the lowest modulus of any silicone hydrogel daily disposable.

Bausch + Lomb’s BioTrue ONEday’ daily disposable contact lenses use HyperGelâ„¢ on the outer surface of the lens to mimic the lipid layer of tear film, helping to prevent dehydration of the lens during a day’s wear.

Johnson & Johnson Vision Care, Inc. has just released a one-day disposable lens in its ACUVUE’ OASYS’ family of lenses””ACUVUE OASYS Brand Contact Lenses 1-Day with HydraLuxeâ„¢ technology. This lens features a tear-infused design to complement all layers of the natural tear film each day.

SOLUTIONS FOR SOLUTION
For patients who wear non-daily disposable contact lenses, it’s important to recommend and educate them on the best disinfecting solutions and proper cleaning techniques. This is critical since data has shown that nearly 35% of patients don’t wash their hands before handling their lenses and 42% leave them wet with tap water after “washing” their hands when inserting their lenses. In addition, 34% of patients handle their lenses during the day in some way without disinfecting them.

We have tested proper cleaning techniques in our office and realized that following the instructions would require using about 1 oz. of a multi-purpose cleaner per lens. That equates to about three bottles a month. We have yet to have a patient at our practice confirm they even use one bottle a month, let alone three. What’s more, research also shows that over 50% of patients place their lenses directly in the case after removal with no rinse or soaking, and only 16% of patients rub, rinse, and soak their lenses. We have seen compliance dramatically increase in patients using hydrogen peroxide cleaners, as patients have to follow the manufacturer’s instructions or risk stinging upon insertion.

Alcon’s CLEAR CARE’ PLUS features HydraGlyde’, a proprietary wetting technology that surrounds lenses to maintain moisture. Bausch + Lomb’s PeroxiClear’ makes strides in the cleaning time with its hydrogen peroxide solution, disinfecting lenses in four hours versus the conventional six hours for other peroxide solutions.

TROUBLESHOOTING
We all hear the typical contact lens wearer in our exam chair who says, “I just want to update my same contact lenses.” But, just because the patient isn’t symptomatic for issues secondary to contact lens wear, doesn’t mean there aren’t any. It’s easy to miss the signs if you don’t specifically look or ask for them. A mild papillary reaction on the palpebral conjunctiva, corneal staining, or changes to the meibomian gland secretions should all be red flags, and should signal that you need to re-address contact lens care and lens choice.

To flush out problems in patients””even those who are happy with their current lenses””we ask them to rate their comfort on a scale of one to 10 for beginning of the day (BOD) and then from one to 10 for the end of the day (EOD). We simply write the corresponding number in our chart followed by BOD and EOD. These two questions really start to open patients up to sharing their issues with their lenses. Some patients report that they love their contact lenses but when asked about BOD and then EOD, the number drops substantially. It’s as if all of a sudden they are taken back mentally to when they remove their lenses and how unhappy they truly are.

— Bausch + Lomb’s BioTrue ONEday helps
prevent dehydration of the lens.
— MyDay from CooperVision features
Smart Silicone chemistry, which allows
for optimal oxygen permeability.

PROBLEM SOLVING
In our office, we have converted over 90% of our patients into single-use contact lenses. We have found that this has dramatically decreased the “issues” that we faced with less frequent replacement lenses. We have seen a significant reduction in the number of contact lens-related red eye in our office, for example. We attribute this to the change we have made toward single-use lenses.

Many practitioners claim that patients are not willing to convert to single-use lenses because they over wear their lenses in an effort to save money. We have found, however, that the number-one reason people over wear their lenses is because they forget the day in which they are supposed to replace them. By converting to a single-use lens, we simplify this process significantly.

In our opinion, we should always suggest the best available contact lens for each patient and make no assumptions about their purchasing abilities. We began doing this three years ago and have seen our single-use numbers soar.

COST FACTORS
When we discuss re-fitting into a daily disposable lens, predictably patients ask about cost. We use this opportunity to reeducate patients on the proper cleaning technique for other modalities, the expected number of bottles of solution used, and how that cost is eliminated when switching to a single-use lens. In addition, complications from contact lens-related issues are costly, especially when topical steroids or fourth-generation antibiotics are indicated.

Daily disposables may be the healthiest option for the patient, which ensures they can be long-term contact lens wearers, thus improving your bottom line.

David L. Kading and Charissa D. Young are in private practice in Kirkland, WA.

 

WHERE TO FIND IT:
Alcon Laboratories, Inc. •800-451-3937 •alcon.com

Bausch + Lomb •800-828-9030 •bausch.com

CooperVision, Inc. •800-341-2020 •coopervision.com

Johnson & Johnson Vision Care, Inc. •800-843-2020 •ACUVUEProfessional.com

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