How to prescribe contact lenses while keeping your patients’ adherence to the rules in mind.

Eighty five. That’s the percentage of subjects who perceived themselves as following proper contact lens care in a 2011 study evaluating two populations of contact lens wearers. However, using an anonymous questionnaire to evaluate actual compliance, the researchers found that only 2% of the subjects met the terms of proper contact lens care, while just a tiny portion (0.5%) of subjects were fully compliant.

These are disturbing statistics, and this behavior is not confined to the U.S.. A Croatian study published in 2014 showed very similar behavior patterns, and the most common behaviors were in areas of lens care that are most crucial for maintaining lens sterility and preventing infection. Patients who were veteran lens wearers tended to become less compliant over time.

Another study found that patients in two-week modality lenses were less likely to replace lenses on the prescribed schedule. They also found that individuals who failed to replace lenses on the prescribed schedule were also less compliant in lens care protocols. As we know, failure to adhere to prescribed contact lens replacement schedules and lens hygiene may have severe consequences.

How do we convince and coax contact lens patients to do “the right thing” for themselves? British nurses have devised the AIDES system that promotes better compliance (see box below). In our office, we have taken liberty to revise this concept for contact lens adherence in our patients.

The AIDES method for improving adherence to contact lens care and maintenance
Assessment Assess all aspects of lens care including specific cleaning and disinfection protocols
Individualization Individualize the regimen for the patient’s lifestyle and lens type
Documentation Document salient ocular surface changes, actual replacement interval, care system
Education Provide easy-to-understand education regarding the risks of poor lens care
Supervision Provide ongoing evaluation of ocular surface health and reinforce correct lens care

In reviewing a contact lens care regimen with a patient, it is often useful to use open-ended questions. So, rather than ask, “Do you rub your lenses?” a better approach might be to say, “Tell me exactly how you care for your lenses after you remove them.” Replacement intervals are often an issue; it is common for patients to stretch out their replacement cycle to reduce cost, or when they are simply running low on lenses. Instead of asking patients if they replace lenses every two weeks, ask how often they replace their lenses, leaving the question open-ended.

Studies of non-compliant contact lens patients reveal several salient facts. When patient education is able to explain contact lens instructions in a positive and enthusiastic manner, compliance increases. Compliance is more likely if the patient is satisfied with the office visit, their expectations are met and if the doctor interacts with the patient in a friendly manner. Studies reveal that within minutes of leaving the office patients forget a significant extent of verbal instructions; providing written instructions helps to reinforce that information.

Studies that evaluate how well patients maintain a doctor-dictated schedule for medications or devices frequently use the terms, “compliance” and “adherence” interchangeably. There are actually subtle but important differences between the two.
“Compliance” literally means following (or complying with) doctor’s instructions for medication dosing, implying a paternalistic role for the physician and a passive role for the patient. In contrast, “adherence” insinuates that the patient takes responsibility for “adhering to” an agreed upon dosing schedule and therefore assumes a degree of accountability for their own health.

In some instances patients simply do not comply, regardless of the amount or quality of information presented to them. Daily replacement lenses are an excellent option for these individuals who simply cannot or will not do what is best for their own ocular health. There are a lot to choose from, including Dailies Total1 and Dailies AquaComfort Plus from Alcon, ACUVUE OASYS 1-DAY brand contact lenses from Johnson and Johnson Vision Care, clariti 1 day from Cooper-Vision and Biotrue Oneday from Bausch + Lomb. Several brands are now available in an ever-expanding range of designs, from spherical lenses to multifocal and toric modalities.

Non-adherent behavior is part of every facet of healthcare. Optometrists can use clinical skills, patient education and ancillary staff to demonstrate the benefits of appropriate lens care and wear.

William Townsend, OD, FAAO, is in private practice at Advanced Eye Care in Canyon, TX.


Alcon laboratories
800.451.3937  |
Bausch + Lomb
800.828.9030  |
CooperVision, Inc.
800.341.2020  |
Johnson and Johnson Vision Care, Inc.
800.843.2020  |


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