DROPOUTS, DRYNESS AND DROPS
Mastering Dropouts, Dryness and Drops
Even with the newest technology available, you need to use all your tools to keep patients happy in their contact lenses.

Thomas G. Quinn, OD, MS, FAAO (Moderator): Our panel today represents a variety of practice settings across a wide geographic area of the country. We're all in the trenches every day deciding what's best for our contact lens patients.

As you know, discomfort is a leading cause for contact lens dropouts. The newer silicone hydrogels can offer patients improved comfort, but we still need to safeguard against dropouts. Does that concern you?

William J. Lapple, OD: According to Health Products Research data, each year, 3 million patients enter the contact lens market, and 2.7 million leave. The most frustrating patients are those who get uncomfortable and drop out with no ocular signs. Most likely, their contact lenses feel dry at the end of the day. We can treat existing issues like dry eye or allergies, but patients can still go home, get uncomfortable and drop out.

William J. Lapple, OD

COMFORT DIFFERENCES

Dr. Quinn: What creates a comfort problem with contact lenses? Is it hypoxia? Dryness? Solution sensitivity? Conversely, what makes a contact lens comfortable?

Loretta Szczotka-Flynn, OD, MS, FAAO: The surface treatment affects deposit formation, and some patients wearing silicone hydrogels have a lipid deposit problem, which results in perceived blur and discomfort. Patients may use the term "dryness," but what they sense is a physical discomfort.

Milton M. Hom, OD, FAAO: I agree, but the preponderance of data show that silicone hydrogels are actually better for patients whose eyes feel dry. It can be a bit confusing. Hydrogel wearers with end-of-day dryness tend to do better in silicone hydrogels; it's the patients who are happy in hydrogels who sometimes have dryness after the transition.

You know the best test for dryness? The sample contact lens. A simple sentence like, "Wear this lens for a week, and tell me what you think," goes a long way. The best compliance program and care products won't keep uncomfortable patients in contact lenses. They'll drop out, and we won't see them again. It's best to recognize the issue early and keep the patient in contact lenses.

Dr. Szczotka-Flynn: Poor fitting is another reason for discomfort and dropouts. Silicone hydrogels need more attention to fitting than low-Dk hydrogels. Silicone hydrogels have a higher modulus and won't just drape over
the cornea. Without a proper fit, a patient might feel some edge awareness after 3 or 4 hours. If one base curve doesn't work, try another.

I don't stop until a patient is comfortable because I can't ask him to go home and see if his contact lenses get more comfortable in a few weeks. I'll keep the patient happy if I try a few different contact lenses in the office and he walks out comfortable.

PAIRING LENSES AND SOLUTIONS

Dr. Dawn Miller

Dr. Quinn: To keep patients comfortable enough to continue wearing their contact lenses, how important is the right solution? How do you handle this choice in your practices?

Dr. Szczotka-Flynn: Choosing the proper solution is very important. I used to let my staff choose the solution sometimes, but I can't do that with silicone hydrogels. When I walk the patient out, I tell the technician which solution I'm prescribing.

Dr. Miller: We actually write solutions on patients' charts now. We had gone to almost all multipurpose solutions with traditional hydrogels, but silicone hydrogel patients seem to get less lens coating with hydrogen peroxide, so I see us transitioning back.

Dr. Szczotka-Flynn: I also recommend rewetting drops to keep the lenses more comfortable throughout the day, for use during application and to flush out some of the debris if the patient sleeps in the lenses.

Dr. Quinn: What about "no-rub" solutions? Do you find you're doing some education with those?

Thomas G. Quinn, OD, MS

Dr. Miller: We teach patients there's no such thing as a "no-rub" solution. We discuss it when reviewing the health benefits of silicone hydrogels and reiterate the message during lens care training.

John Kaminski, OD, FAAO: I predict "no-rub" will soon be history. We're going to go back to once again educating our patients to rub their lenses, particularly as the market share for silicone hydrogels grows. Contact lenses are changing, and we need solutions to change.

I think we'll use more hydrogen peroxide-based solutions (the only true form of a "no-rub" solution), but there isn't one perfect solution. We're moving toward better solutions for silicone hydrogels, and that's going to help patients in terms of health, comfort and staying with their lenses.

Dr. Quinn: It seems we are embracing all this new contact lens technology and are excited about the benefits that come along with it. But make no mistake, this is not a no-brainer. As contact lens professionals, we have to be thoughtful in decision-making as well as troubleshooting. We have all this wonderful technology and materials at our fingertips; we just have to be judicious in how we use it.