CONTACT LENS TRAINING

TRAIN STAFF TO DECREASE CL DROPOUT

PROPER STAFF TRAINING CAN DRAMATICALLY INCREASE PATIENT COMPLIANCE AND SUCCESS

Paul Velting, O.D., Deerfield, Ill.

EVERY YEAR, somewhere between 16% to 30% of patients decide they no longer want to wear contact lenses, according to recent research done by John Rumpakis, O.D., M.B.A. Given that contact lens technology is continuously improving, perhaps it’s time that we, as optometrists, evaluate how much training and education we provide our contact lens-wearing patients vs. scrutinizing the latest products. Not convinced? Consider this: A total of 31.8% of patients who discontinued contact lens wear reported reasons for dropout that can be directly correlated to problems with contact lens education and training, reveals industry data.

Now, you might be thinking, “I barely have time to convince my patients not to sleep in their lenses or wear the same pair for a year, let alone spend time explaining proper handling and care.” Guess what? A well-trained staff can do this for you and help you fight the battle against contact lens dropout.

Here, I discuss the areas to provide staff training, so you can dramatically increase contact lens wear success.

PATIENT HISTORY

This is where it all starts. Train your staff to dig deep when asking about contact lens comfort. Specifically, in addition to asking “How many hours per day do you typically wear your lenses?” have them follow up with “How many hours can you comfortably wear your lenses?” and “Do you feel relief when removing your lenses?” The answers to these follow-up questions are important, as they can alert you to patients who may be heading for dropout. You can also use this information when deciding whether to prescribe a new contact lens or solution.

Further, when a new patient replies “no” to “Are you interested in contact lens wear?” instruct staff to ask “why?” to determine the reason for that answer. Frequently, “no” means “I’ve been told I’m not a good candidate for contact lenses because . . .” or, “I tried contact lenses 10 years ago, and they felt terrible!” Both answers enable your staff to educate patients about new lens types and more comfortable materials that are now available. Such education can prompt these patients to give the latest contact lenses a try. (Keep in mind that 77% of people who previously dropped out of contact lenses were able to be successfully refit, reveals a 2002 study in Ophthalmic and Physiological Optics.)

INSERTION AND REMOVAL

It can be very easy for staff members who have worn contact lenses for a long time to forget how it felt to put on a contact lens for the first time. Remind staff of this and that being impatient, pushy or unable to empathize (or at least sympathize!) with a patient can be a quick way to discourage him or her from contact lens wear. In other words, patience is key.

Educate staff that, although many insertion and removal (I&R) techniques are the same, patients are not. Special considerations must be taken with certain patients.

For example, when it comes to children, staff must know that many times children need to get excited about contact lenses to overcome their fears of bringing those pieces of plastic near their eyes. In this case, have staff remind children how exciting it will be to see clearly without their glasses. (It’s easy for children to forget this motivation in the heat of stressful I&R training.)

Also, explain to staff that it may be necessary to modify I&R techniques for elderly patients who have limited dexterity, special needs patients or even patients with excessively long fingernails. Staff must understand that there is no single technique that will work for everyone. (See http://tinyurl.com/insertion-and-removalCL.)

Next, instruct staff to have patients return for additional I&R training if the initial training lasts more than 20 minutes. The reason: Not only will most patients begin to become frustrated, but that much pulling, tugging and poking at the eyes is bound to cause some irritation.

In our practice, technicians make patients aware of this 20-minute time limit at the beginning of I&R. This way, patients don’t feel like the staff is giving up on them. If a patient needs to come back, he or she is sent home with homework before returning. This can vary from simply holding the lids open, to placing a drop of viscous artificial tears on a clean finger and touching the drop to his or her eye. (Patients are never sent home with lenses unless they have completed several successful insertions, and most importantly, removals.) (See staff “Online Training/Education,” above.)

SOLUTIONS/HYGIENE

Proper education regarding contact lens solution and hygiene is not only important for a patient’s initial success, but also a main component of his or her long-term, continued success. Both impact the contact lens and the eyes every single day. Therefore, you want to train staff to educate patients on the proper use of the prescribed solution and hygiene.

• Multi-purpose solution. Have staff explain to patients the “rub and rinse” step. (A 2011 study published in Optometry & Vision Science shows significantly greater disinfection efficacy was observed with the “rub and rinse” regimen as compared with the “rinse only” regimen, while the “no rub no rinse” regimen resulted in the greatest load of microorganisms remaining on lenses.)

• Hydrogen peroxide. With great cleaning power, comes great responsibility. Have staff explain to patients that this solution has a low concentration of hydrogen peroxide, which is completely neutralized to a safe, sterile, saline solution through four to six hours by the little gray disk at the bottom of the solution-provided lens case (depending on the brand). This way, the patient will better understand why the solution cannot be placed directly in the eyes, why using the provided lens case is essential and why the case must be filled with new solution every day. Also, have staff stress that un-neutralized hydrogen peroxide can cause an episode of chemical keratitis (“a swollen cornea” in patient speak), which could dissuade a new contact lens patient from lens wear altogether.

In addition, have staff educate patients on the dangers of topping-off their solutions. Using the example of a bathtub can be very effective: “Would you leave some water in the bathtub after taking a bath, then add a little bit a fresh water before getting in the next time?”

• Storage cases. The AOA recommends replacing storage cases at least every three months, while contact lens manufacturers suggest a greater frequency. A 2011 study published in Contact Lens & Anterior Eye reveals that the median frequency for storage case replacement among contact lens wearers was four to six months, with almost half of lens wearers replacing their cases only once per year or less.

Train staff to educate patients on replacing their lens cases at least every three months, and that not doing so can significantly increase their risk for severe eye infections. Patients need to understand that the consequences of non-compliance can be much worse than “pink eye.” Although a minor consequence in the doctor’s eyes, telling patients that they need to discontinue lens wear until an infection heals can be a powerful motivating factor for good lens and lens case hygiene.

Teaching insertion and removal techniques is one way to increase contact lens wear success.

• Wear schedule. I have found that this aspect of contact lens compliance is mostly abused by patients looking to save money. Make sure staff explains to patients that while it seems money can be saved by wearing their lenses longer than prescribed, it only takes one complication from lens over-wear to reverse these savings and cost them more in the long run. For example, knowing that it’s possible to cause a potentially sight-threatening corneal ulcer by over-wearing lenses will make most people think twice about wearing that lens an extra month.

MAKING IT WORK

Adequately teaching staff to deliver the necessary training and education to keep patients in contact lenses cannot be accomplished by a one-and-done training session. Instead, you must provide continuing education of some kind. Many practices implement office meetings of various frequency (weekly, monthly, etc.), making sure these meetings are focused and goal-oriented. Many times your contact lens reps will be happy to provide a “lunch and learn” session for your staff, especially when a new technology is being introduced. These can be very informative and can boost office morale as well. The point is staff training and reinforcement of what has already been learned should never stop if you want to keep more of your patients happy and healthy in contact lenses. OM

DR. VELTING is co-director of contact lens services at North Suburban Vision Consultants, and an adjunct faculty member at the Indiana, Illinois, UMSL and Salus University Colleges of Optometry.