CLINICAL

  ANTERIOR

STEP UP TO THE PLATE

TO PREVENT CONTACT LENS DROPOUT, YOU MUST BE AN INNOVATOR IN CARE

INNOVATION CAN come from anywhere, at anytime. Often times, it comes from someone noticing a gap in the market, looking to fill an unmet need, a frustration, or from the desire to improve something. It all starts with an idea born from these inspirational motivating factors.

For example, drive-thru windows at fast-food restaurants were born out of the need to eat on limited time. In the contact lens industry, dry eye disease (DED) has been one of the driving forces behind innovations in materials and designs.

Here, I explain why and how we, as optometrists, must step up to ensure our contact lens-wearing patients remain in their lenses.

WHY

Every year there is a growth rate of about 16% for new contact lens wearers, but the market stays flat because an even number of patients dropout annually at the same time. The number one reason for this is discomfort. And guess what — a great deal of this discomfort is due to untreated ocular surface disease, primarily DED.

In fact, recent increases in DED research has elevated the awareness and understanding about the condition to an all-time high in contact lens companies. This has led to the firestorm of innovation we have seen recently in the creation of advanced technology contact lenses aimed at stopping contact lens dropouts.

Daily disposable contact lenses made of silicone hydrogel, in particular, have been the focus of contact lens companies because both the modality and material allow them to be extremely comfortable, while being breathable to ensure optimal corneal health and thus, prevent contact lens dropout.

This patient presented wearing a monthly contact lens and complained of discomfort and having to remove his contacts after six hours of wear. He was diagnosed with meibomian gland dysfunction and dry eye and was prescribed lid hygiene QD, warm compresses QD, Omega’s PO, artificial tears PRN, cyclosporine BID OU, and a combination topical steroid/antibiotic drop BID OU x 2 weeks. After treating the meibomian gland disease and dry eye for four weeks, he was then refit in a daily contact lens, giving him better comfort and increased wear time.

OUR ROLE

Despite the research and innovations in contact lens technologies, we, as optometrists, are not actively looking for and managing DED. In fact, 52.7% of contact lens wearers report symptoms of ocular dryness. Do we treat 52.7% of our contact lens patients for DED? As a profession, I don’t think we get anywhere close to that number.

When I first began practicing, I ignored DED. I didn’t think it was important. I would offer patients two or three different artificial tear samples and say, “See you again in a year.”

About five years into my career, however, I attended a lecture about DED that challenged my opinion on the condition. In fact, it made me feel uncomfortable, as I realized I had been ignoring DED and not practicing to the highest standard of care. I knew that I had to learn more about DED and stay abreast of current treatments. This led me to read everything I could get my hands on, such as the DEWS report. Soon, I adopted the International Task Force Guidelines to assess and treat dry eye patients. This shift in the way I practiced has helped my practice tremendously, especially when it comes to my contact lens-wearing patients.

Above, a two-week contact lens patient with superior punctate keratitis from untreated dry eye. This patient was diagnosed with dry eye and then treated with artificial tears PRN and cyclosporine BID OU for two weeks prior to switching modalities to a daily contact lens, which gave her improved comfort and wear time.

HUGE LESSONS

A few years ago, I did a retrospective chart review of my multifocal contact lens-wearing patients older than age 50, specifically looking at the number of office visits these patients had for contacts lens fittings and check ups during a one-year period. This review revealed that when I ignored DED in my early years of practice, I saw patients from this subset an average of 4.5 times a year. As a contact lens fitting can only be billed once a year, I was wasting valuable chair time seeing patients multiple times for free. Once I began treating DED and other forms of ocular surface diseases, such as ocular allergy, however, I decreased the average number of office visits to just under two visits per year.

In addition, while I realized patients had dropped out of contact lens wear due to ocular dryness, I had no idea just how much of an impact this made on my bottom line until I read an article by John Rumpakis, O.D., M.B.A. Specifically, the article revealed that just one contact lens dropout costs $24,000 throughout a lifetime.

WHAT ARE YOU WAITING FOR?

It’s no secret that contact lens sales comprise a significant portion of our practice revenue. Though innovations in contact lens materials and modalities have helped to stem the tide of contact lens dropout, we, as optometrists, have a part to play as well. This means making a point of diagnosing and managing these patients to improve contact lens comfort and increase wear time. The contact lens companies can’t do it alone. OM

JOSH JOHNSTON, O.D., F.A.A.O., practices at Georgia Eye Partners. He focuses on ocular surface disease and has extensive experience in comanaging cataract and refractive surgery patients. Email him at drj@gaeyepartners.com, or visit tinyurl.com/OMcomment to comment.