Contact lenses have been around longer than many of you reading this article. They're proven safe and effective as a means of visual correction. Plus they offer many advantages over other corrective alternatives, such as clearer vision, fewer aberrations, no frames in the way and no fogging in cold weather, to name a few.

Unseen barriers

Surprisingly then, that only about 1 in every 10 Americans wears contact lenses � that�s far fewer than the potential number who could benefit. Certainly, a huge number of your patients qualify as candidates for contact lens wear, but something's holding them back.

We conducted an informal study to determine what barriers keep patients from wearing contact lenses. Read on to find out if one of those barriers is you.

The investigation

To determine why patients elect to stay in glasses, third-year students enrolled in the introductory contact lens course at the Illinois College of Optometry were given an assignment. They interviewed a non-contact lens wearer and had to determine why he wasn't wearing contact lenses. Or, if the patient had worn lenses in the past, students were to determine the reason he'd dropped out of lens wear.

The students also identified fears the interviewees expressed regarding contact lenses. Each student then submitted a report explaining his findings.

Key findings: the terrible 20

Of the 159 people whom the students interviewed, more than one-third (56) had at least tried wearing contact lenses in the past. Although many patients had multiple reasons for not wearing lenses, the students identified 20 key reasons from their interviews. Each reason was grouped into one of five broader categories: physical, financial, psychological, lifestyle or practitioner-related (see "Terrible 20" for a complete list).

This article will review the most common reasons for discontinuing or not wearing lenses, broken down by category. We've also suggested ways to gain these patients as part of your contact lens practice.

Physical or physiological

It's not surprising that more dropouts than non-wearers reported physical or physiological reasons for not wearing contact lenses. Even less surprising is the fact that the most common reason for dropping out of contact lens wear was discomfort, although dry eyes and reduced visual acuity were other prevalent reasons (see "Physical/Physiological Reasons" below ).

�         A patient whose reasons fall into this camp may just need proper education to convert her into a happy contact lens wearer. Explain that her concerns were problems in the past, but that modern technology has solved many of them.

�         The patient who wore annual replacement lenses that created comfort problems because of dirt and debris on the lens surface may find that clean, comfortable disposable lenses are just the motivation she needs to return to lens wear.

Among nonwearers, fear of discomfort was also the leading reason for staying with their spectacles. But don't assume that these patients know what they're talking about!

One patient told the interviewer that he didn't wear contact lenses because they hurt. Apparently, when he was a teenager, he'd tried on his cousin's rigid gas permeables (RGPs). He knew first-hand that contact lenses were uncomfortable based on that experience. But a little education might convince him to try a professionally fitted pair of contact lenses.

Finances

Price does seem to be a barrier to contact lens wear for a portion of the population -- more so for those who've never worn them. Some reported that they'd had prices quoted previously and simply found the fees to be too steep. While some maintain that contact lenses are a financial burden, the reality is that these days, contact lenses are a bargain compared to hi-index ophthalmic lenses in a designer frame.

In most cases, the patient has no basis on which to judge the relative value of contact lens wear compared to the financial outlay. For these patients, disposable lenses and the opportunity to experience lens wear without significant cost are the answer.

Consider letting the patient wear her trial lenses out in her own environment for a few hours before having to make a financial commitment to them. Most patients will quickly find them well worth the expense.

Psychological factors

As any longtime fitter knows, one of the biggest obstacles to contact lenses (and the hardest to get the patient to admit to) is fear. As shown in "Psychological Reasons", the most common psychological reason for not wearing contact lenses is a patient's fear of touching her eyes. This is one of the hardest hurdles to overcome.

�         Many experts suggest telling patients that they won't actually be touching their eyes, but that the lens will "float on a sea of tears."
If this approach were truly effective, the majority of the population would now be contact lens wearers. But there may be hope. If a patient sounds at all promising, you can try desensitizing her.

�         Dr. Julie Ryan, a private practitioner in southern California who specializes in pediatrics, is used to dealing with patients fearful of lens wear. Her method is to dispense several bottles of artificial tears to the child's parent and have the parent instill drops several times a day until the child is used to the sensation.

�         This approach works with adults as well. Dr. Arthur Epstein of Roslyn, New York, takes this approach one step further. He asks a patient to practice by placing a drop of CelluVisc on her finger and touching it to her eyes using a mirror to monitor her progress.
In our experience, truly motivated, yet fearful patients are generally better at removing lenses than applying them.

�         If your technician is willing, you might consider having her repeatedly place the lens on the patient's eye, then having the patient remove it each time.
Once the patient becomes adept at removal, it's time to tell her that application is a breeze compared to removal. When she realizes she's mastered the hard part, she should be comfortable enough to learn application and go on to become a successful wearer.

�         One of the most surprising fears reported was that the lens could somehow roll behind the patient's eye and end up in her brain. The educated practitioner knows all about the conjunctival anatomy, but the patient doesn't. Simply showing the patient the inferior conjunctiva cul-de-sac by pulling down her lower lid may alleviate this fear. Other fears, such as getting an infection and the horror stories they've heard from friends, are simply a matter of patient education. Comparing the risk of a severe contact lens complication to that of other life occurrences may put things in perspective. For example, the patient earning more than $50,000 annually is 17 times more likely to be audited by the IRS than to develop a contact lens associated ulcerative keratitis.

Fear is a complex emotion and you'll never win over all the fearful patients you encounter. Time, tact and a drop of ingenuity can help many patients overcome trepidation.

Lifestyle

Interestingly, nonwearers and dropouts agree completely that the hassles of lens care and handling are significant reasons not to bother with contact lenses (see "Lifestyle Reasons"). You might motivate these patients by making them aware of daily disposables, which cost about $1 per day.

With regard to the students' detailed interviews, it's evident that some patients are unaware of modern, multipurpose solutions and daily disposal contact lenses. Again, good patient education is the key to turning these individuals into contact lens wearers.

Other lifestyle factors isolated were laziness, busy lives, dusty or dirty work environments and a preference for wearing spectacles for fashion purposes. Additionally, a disproportionate number of the individuals interviewed wore their spectacles part-time and wouldn't be appropriate candidates for contact lens wear. Unless their lives change significantly, you shouldn't try to change their attitudes.

Are you doing your part?

The most disturbing finding of our study was that the most common practitioner-related reason for not wearing contact lenses was that the practitioner never suggested them to the patient. Evidently, a number of patients would be open to contact lens wear if their doctors suggested it.

�         One way to boost your contact lens practice is to suggest this option to every reasonable candidate. This is a simple change to make to your routine, and at the end of a year, you'll find you have a healthier contact lens practice.

�         Staff follow-through is also important. A number of patients reported that they didn't wear contact lenses or quit wearing them because they weren't adequately trained.
One interviewee explained, "They gave me the lenses and some stuff to take care of them, but they never showed me how to put them in or what to do with all the supplies, so I never wore them."

Use what you've learned

"Why aren't you wearing contact lenses?" seems to be a simple question, but as ICO's class of 2002 found out, the answer is sometimes quite complex.

If you're looking to grow the contact lens portion of your practice, pay extra attention to the reasons why your patients say they don't wear them. It'll help you increase the number who do.

Dr. Jurkus is a professor at Illinois College of Optometry in Chicago. Dr. Schwartz is a contact lens consultant in Vista, Calif., and is editor of Specialty Contact Lenses: The Fitter's Guide. Both Drs. Jurkus and Schwartz are members of Optometric Management's editorial board.

The Terrible 20

PHYSICAL/PHYSIOLOGICAL REASONS

1.      Headache

2.      Pathogens/allergy

3.      Poor vision

4.      Discomfort

5.      Dry eye

FINANCIAL REASONS

6.      Loss/damage

7.      Cost

PSYCHOLOGICAL REASONS

8.      "Roll into head"

9.      Fear of infection

10.Heard "horror" stories

11.Dislikes change

12.Fear of touching eye

LIFESTYLE REASONS

13.Poor environment

14.Prefers glasses

15.Too lazy

16.Too busy

17.Part-time wear

18.Care hassle/handling

PRACTITIONER-RELATED REASONS

19.Not suggested

20.Poor training