How to Turn Around Non-Compliance Contact Lens Wearers into Daily Disposable Contact Lenses Believers

Anyone practicing optometry has undoubtedly run into a patient who abuses their contact lenses by overwearing them. Some patients will come straight out and admit to stretching their monthly lens two, three, even six months. Others will state they faithfully replace their lenses every month, but their last eye exam was three years ago and they only bought a year's supply of lenses. It’s amazing how well a slit lamp can function as a truth serum; I cannot tell you how many times a patient has suddenly admitted to overwearing their contact lenses while under the scrutiny of that bright examining light.

 It’s amazing how well a slit lamp can function as a truth serum; I cannot tell you how many times a patient has suddenly admitted to overwearing their contact lenses while under the scrutiny of that bright examining light.

Some may call it adherence, others may call it compliance, but at the end of the day, we as practitioners all want the same thing: a patient who sticks to the prescribed treatment plan. It makes our lives, and our patients’ lives, a bit easier. Good contact lens care and regularly scheduled replacement means a reduced risk of infection, less lens discomfort, and better visual acuity. There will also be increased revenue for providers when patients buy the prescribed amounts of lenses. So how do we encourage our patients to adhere to our contact lens replacement regimens? The first step is to understand some of the underlying causes of patient noncompliance.

When it comes to non-adherence, some of the most commonly cited reasons reported by patients include:

·         Misunderstanding of instructions

·         Poor memory or forgetting instructions

·         Inconvenience

·         Financial concerns

·         Poor past personal experience

·         Intentional noncompliance or lack of patient buy-in

The first three concerns can be addressed in a similar fashion. If you make the treatment as simple as possible, patients will be more likely to adhere to it. When it comes to contact lenses, this can usually be achieved by refitting a patient into daily disposable contact lenses. With daily disposables, patients don’t have to keep track of how long a lens has been open. There is also less temptation to overwear the lens because one day is a firm deadline. For some reason, a month feels less definite, and patients don’t feel bad wearing the lens a few days longer than the month period. Unfortunately, what usually starts as just a few days of overwear tends to evolve into a week or more of overwear, or worse. Telling a patient “you wear this lens one time and then throw it away” takes away all the guesswork.

Daily disposable lenses are the peak of convenience. You don’t need any cases to store them, you don’t need any contact lens solution, and you don’t have to keep track of how many days you have worn them. Patients usually love traveling with daily disposables because you don’t have to check your bag or fit in a travel-size bottle of solution in your suitcase.

As a personal wearer of daily disposable contacts, I will relate with my patients the convenience of the lenses when I tell them about how I often will lay down in bed to read before sleep. When I find myself ready to sleep, I don’t have to crawl out of bed in order to go store my lenses in a case and then stumble my way back to bed. Instead, I just take out my lenses and toss them without even having to come out from under my comforter. It may not be the perfect solution (one should always wash their hands before handling lenses), but it is a better option than sleeping in the lenses or overwearing them.

With daily disposable contact lenses, the elephant in the room is almost always the cost. There’s no getting around it: wearing daily disposable contact lenses every single day for a year is going to cost anywhere from two to three times the cost of a monthly contact lens. If you suspect your patient is stretching his or her monthly contact lens due to financial reasons, offering a more expensive option is probably not going to be the best solution. Instead, you need to take a different approach.

If your patient is concerned with cost, you might boost compliance by offering incentives for buying a year supply versus a 6-month supply or less. Many contact lens companies already offer rebates, but you can sweeten the deal by adding on an offer to ship the contacts for free directly to the patient (which also addresses a potential inconvenience barrier) or an additional discount.

Allowing patients convenient ways to restock on contact lens supplies through your office can help boost compliance. This may mean offering direct shipping or the ability to request an order via text message or an online portal. Send patients reminders when their supply is likely to be running low. If you can make it easier for patients to acquire the lenses they need, they will be less tempted to overwear them.

One of the other major components to patient noncompliance when it comes to overwearing contact lenses is simply a lack of buy-in. Patients may not believe that a doctor is telling the truth when stating the replacement schedule for lenses and think it is just a scam to push more product. Some patients think they have found a hack in the system and many report to me that they faithfully wear their contact for only 30 days, but that 30-day period is just stretched over several months. They wear the lenses for a 2-hour event, store them for a few days, wear them for a day, store them, wear them for another 6 hours. In this patient’s mind, they have worn the lenses for 2 days, even though well over a week may have passed.

We need to be clear when explaining what we mean by a 30-day replacement schedule so that patients don’t misunderstand and don’t assume we are trying to pull the wool over their eyes. An analogy I often use with my patients is comparing the contacts to a cup of yogurt in the fridge. The yogurt has an expiration date. Whether you eat the yogurt or not, it will expire. Contact lenses are similar. Once you open the lens, you have 30 days (or whatever the replacement schedule is for the lens) to use it. Whether you wear it or not, that lens will “expire” and is no longer safe to wear.

Again, these patients who are patching together a wearing schedule might benefit from being refit into a daily disposable contact lens. If the patient is only getting a handful of safe wears within a monthly period of time, it is safer and it may even be more cost-effective for the patient to shift into a daily disposable modality.

In conclusion, when it comes to contact lens non-adherence, it is helpful to consider the underlying motivations causing the patient to abuse the contact lenses. Depending on the patient’s reasons, you can tailor an approach to target their concerns and keep them both safe and satisfied.