contact lenses

Create a Patient

To assuage a new wearer's lens-wear fears, ensure compliance to your instructions and preclude dropouts, provide patients with these seven tools.

The perfect and, therefore, happy contact-lens (CL) patient is one who complies with our wear and care instructions and designated follow-up visits. The problem: These patients are a rare breed. As a result, they may present with CL-related ocular issues associated with non-compliance, such as mild allergy or severe inflammation. This, in turn, often prompts these patients to drop out of CL wear, preventing them from experiencing the true benefits of this important vision-correction device and causing our practices to lose valuable income.

The good news: You have the ability to foster the creation of perfect CL patients and, therefore, preclude CL-related adverse events and dropouts. How so? By providing your newly fit, very excited, yet somewhat apprehensive, novice CL wearer with a well-designed and thoughtfully constructed CL Tool Kit.

The CL Tool Kit is the new wearer's survival guide and, as such, functions as a critical patient-management aid. It provides, among other things, a concise and handy review of all the information you and/or your conscientious CL technician meticulously impart to your patient at the dispensing visit. Considering just how much (or little) additional information a patient who is nervously and self consciously practicing CL insertion and removal can simultaneously absorb in a typical half-hour session, this take-home kit is invaluable for instilling compliance to your wear and care instructions. While the kit should include the same basic components for all wearers, customize it according to CL type (wearing modality) and care regimen (i.e. solution), as both determine appropriate wear and care.

Because patients appreciate convenience and organization, you can further facilitate compliance to your instructions by providing your new CL patient with a compact, gender-neutral and easy-to-carry pouch or shopping bag, where he or she can store the various components of the kit for easy access. your practice's CL Tool Kit pouch or shopping bag can work as an effective external marketing tool for your practice if it displays your practice's name and logo.

Here, I discuss the essential components of an effectively constructed CL Tool Kit.

1. Starter CL-care kit

This is comprised of a small box from the CL-solution manufacturer, containing a sample of your prescribed solution along with a fresh CL case.

Contact Lens Tool Kit

SUSAN RESNICK, O.D., F.A.A.O., New York

After you and/or your CL technician verbally review with the patient the instructions pertinent to the particular care regimen, remind him or her that the instructions are printed on the box for handy reference.

Also, be sure that you and/or your CL technician provide the patient with a piece of paper that has the names of at least one or two local retail establishments where the patient can purchase the prescribed solution. This promotes compliance to your prescribed lens-care regimen, as it reminds the patient of the danger (corneal staining) of substituting his or her solution for a different one.

2. CL care and handling manual

Because we, as a society, are beyond busy juggling the tasks of work, home and childcare, among other responsibilities, an additional way to ensure compliance to your wear and care instructions, and, therefore, prevent CL dropout is to provide the patient with a concise, reader-friendly, illustrated guide to CL insertion and removal. You can design your own or download the basic information from a variety of practitioner CL Web sites, such as www.gpli.info/professionals/ordering.htm or www.aoa.org/documents/OrderDeptCatalog.pdf.

The manual should include:

► instructions on hand-washing and hand-drying. This section should remind the patient to avoid soaps that contain moisturizing agents, as the CL attracts the soap's oils from one's fingers, resulting in CL surface smearing and blurred vision. At my practice, we suggest patients use a mild, transparent liquid soap.

This part of the manual should also remind the patient to use lint-free towels for hand drying because when lint is transferred to the CL, CL insertion becomes extremely uncomfortable.

► an illustration depicting the difference in appearance between a correctly oriented lens with an inside-out one. This passage should remind the patient that wearing CLs inside out can result in a loose-fit, which may cause CL awareness and fluctuating vision.

► a page in which your technician can fill in the blanks with personalized information regarding wearing schedules during the adaptation period and use of solutions. Because "I forgot" often goes hand-in-hand with non-compliance, this part of the manual works as a helpful reminder of your specific directions. An example: "I, Dr. Resnick, have prescribed a GP lens to you, Jane Smith. Wear your new CLs for four hours on the first day, and add two hours each additional day for a maximum wearing schedule of 12 hours until returning for your CL exam."

By writing the specific directions, you decrease the patient's chance of non-compliance and, therefore, adverse events, which could cause him or her to discontinue CL wear.

► a concluding passage that reinforces what you and/or your CL technician have told the patient about what he or she should expect to feel and experience during normal adaptation vs. signs and symptoms that indicate an adverse event and warrant a phone call or urgent visit to your practice. This passage reminds the patient of the importance of reporting symptoms, such as light sensitivity and signs, such as blatant red eye, so you can quickly solve the problem and return him or her to CL wear fast. Remember: If you can solve the problem quickly, you'll minimize dropout.

3. Safe-wear review sheet

As with the CL care and handling manual, draft the substantive content of the safe wear review sheet in a concise and easy-to-read format, such as a bulleted list. Remember: If the format is simple and convenient, your patient will be more likely to comply with what is written.

The safe-wear review sheet should include:

► the patient's CL replacement schedule. This point reminds the patient of the dangers of exceeding his or her replacement schedule, such as accumulation of deposits, which can cause irritation and allergic reactions.

► directions to clean the CL case with a specified cleaning solution after each use and to keep the case open and dry between use. This point reinforces to the patient that not doing so can result in CL-case microbial growth, which can migrate to the CL, increasing the risk of bacterial or fungal infection.

► your recommended CL-case replacement interval. This point reminds the patient of the risks associated with using a case beyond the American Optometric Association (AOA)-recommended replacement interval of a minimum of three months. The risks: growth of virulent strains, such as acanthamoeba, fusarium and pseudomonas, which may be transferred to the CL resulting in infectious keratitis.

► a warning about topping off or reusing solution and non-compliance to CL storage time. These points reinforce to the patient that topping off or reusing solution and non-compliance to the storage guidelines outlined in the prescribed CL-solution's package insert can result in microbial contamination of the solution and case, causing infectious keratitis.

► directions to avoid tap water to clean CLs and to cease wear in the shower, hot tubs or during swimming. These points remind the patient about acanthamoeba, which lurks in tap water, chlorinated swimming pools and hot tubs and can lead to acanthamoeba keratitis.

► directions to discontinue CL wear immediately, should the patient experience a sudden change in vision, comfort or ocular appearance, such as red eye. This point reinforces that successful CL wear is contingent on the patient looking good (their eye's appearance), seeing good and feeling good (lens wear).

4. Guide to cosmetics

Because some cosmetics can affect the success of CL wear, it's imperative you provide the new wearer with information about using these products during CL use. I've had great success in using a one-page sheet that instructs the patient to:

► insert CLs prior to applying cosmetics. This point reminds the patient that CL insertion post-makeup application can result in the transfer of the makeup from the hands to the CL, resulting in surface smudging, causing blurry vision.

► take off makeup after removing CLs. This point reinforces to the patient that makeup removal can result in the deposit of makeup in the eye and therefore onto the CL, altering vision.

► avoid applying eyeliner or eye pencil on the inner lid margins. This point reminds the patient that eyeliner in these areas can block the meibomian glands, leading to the creation of sties and dry-eye disease. In addition, this application makes the CL surface more susceptible to makeup deposits, which can enter the tear film.

► wear non-water-proof mascara and use powdered makeup as opposed to creams. This point reinforces to the patient that makeup that easily washes away is less likely to get under the CL, causing minor corneal abrasions, and/or to come in contact with the CL surface, compromising vision.

► replace their liquid eye makeup every three months. This point reminds patients that being vigilant about replacing liquid eye make-up reduces the possibility of bacterial contamination.

You need not be a female O.D. to provide this useful information. (Visit: www.allaboutvision.com/contacts/contact-lens-tips.htm#make up, www.aoa.org/x5236.xml, or www.contactlensdocs.com/Cosmetics%20and%20Contact%20Lenses.htm for more information.)

5. CL ID card

The patient should carry this in a wallet or purse. One side should display your customary business-card information (your name, practice address, phone/fax numbers and Web site). The other side: blank spaces where you or your CL technician can write the patient's name, emergency contact number and CL prescription. In providing this card, I've found that the patient is apt to respect the CL as a prescription device, which helps promote compliance to my wear and care instructions. Bonuses: The card provides a helpful reference, should an ocular emergency arise. And, it enables you to comply with the Federal Trade Commission's (FTC) Fairness to Contact Lens Act.

6. Technician's calling card

When you transfer your patient to a well-trained technician for education on care and handling, that technician becomes the patient's mentor, advisor and advocate.

My technicians take a personal interest in the new wearer's on-going progress because, as I do, they genuinely care about the patient's well being and ocular health. As a result, my technicians supply these patients with their business cards and invite patients to call with questions. This tool has instilled compliance and has prevented CL drop out for two reasons: First, in knowing that my technicians and I have a genuine interest in the success of their wear, we find that they're more likely to comply with my instructions. Second, the invitation to call with questions has enabled many of my new wearers to avoid some common mistakes, such as using the wrong solution, ensuring a comfortable, safe and, therefore, enjoyable CL-wearing experience.

7. Appointment card

Upon your patient's check out at the end of the dispensing visit, have your administrator provide him or her with an appointment card (usually on the reverse side of a business card), which displays the patient's follow-up visit and a written note to wear his or her CLs to the appointment. Then, place it in the patient's Kit pouch or shopping bag. This tool is an effective reminder of the importance of the follow-up visit. As a result, it works to foster patients' compliance to the scheduled appointment, so you can assess the position of the CL on the eyes, their cleanliness, the vision they provide and the health of the ocular surface. The examination of all these components ensures successful CL wear, precluding the patient from dropping out.

As I pass our busy contactlens dispensing rooms on a daily basis, I often hear our newly instructed wearers say: "Can I take you home with me?" It's reassuring that our patients feel so well attended to by our caring technicians, but it also reaffirms the uncertainty and trepidation they feel as new wearers.

A professionally designed and user-friendly CL Tool Kit is not only invaluable in allaying patient fears, but in fostering compliance to our instructions, ensuring safe and comfortable wear and less of a likelihood of dropouts. OM

Dr. Resnick is a principal in the New York City-based practice of Drs. Farkas, Kassalow, Resnick and Associates — a contact-lens specialty practice celebrating its 50th anniversary. E-mail her at Susanr58@aol.com.