ANNUAL CONTACT LENS ISSUE

PRESCRIBE CONTACT LENSES FOR A LIFETIME

THE KEY IS TO ANTICIPATE CHALLENGES AND STRATEGIES FOR SUCCESS AT THE OUTSET

Susan Kovacich, O.D. Bloomington, Ind.

WHEN STEVE Jobs designed the iPhone, he said he didn’t want people to merely use the phone, he wanted them to love it, reveals the book “Creativity Inc.: Overcoming the Unseen Forces That Stand in the Way of True Inspiration.” Similarly, optometrists don’t want to just prescribe contact lenses, they want patients to love their lenses, and therefore, continue wearing them. One way to accomplish this is to anticipate challenges and provide strategies for success at the outset.

Here, I discuss the contact lens challenges associated with the different patient populations and how you can overcome them from day one.

CHILDREN (8 TO 12 YEARS)

A generation ago, one rite of passage was to have braces removed and contact lenses fit the summer before ninth grade. However, the 2007 CLIP (Contact Lenses in Pediatrics) Study demonstrates that children (ages 8 to 12) can achieve similar successful contact lens wear as teenagers (ages 13 to 17) when a little more time is spent teaching contact lens insertion and removal at the beginning. Eye care practitioners are now routinely prescribing contact lenses to patients younger than before. It’s important to note, however, that the younger patients’ success in the study was contingent on that extra time spent on insertion and removal, revealing that immaturity remains an issue for successful contact lens wear. In fact, immaturity can bring with it several challenges, including the unwillingness to be fit with contact lenses and the inability to wear and take care of them.

Strategies for success: After receiving parental consent for the child’s contact lens wear, which is required for any patients under the age of 18, assess the child’s attitude toward contact lenses before prescribing them. Specifically, ask the child whether he or she is interested in contact lens wear. If the child replies, “My parents think it’s a good idea,” wait for the child to come to the realization that contact lens wear will be beneficial before fitting, as an indifferent or unwilling participant will likely have the same attitude when it comes to lens handling. If, however, the child answers, “Yes! I’m excited to wear them,” he or she has indicated he or she may be more inclined to follow your directions.

In addition, educate the child’s parents about the “built-in” compliance that comes with daily disposable lenses: “As the lenses are replaced daily, the problems that come with non-compliance of lens care and disinfection solutions are eliminated.” If, however, the parent opts for a two-week or monthly modality, let him or her know that contact lens wear success often depends on the parent supervising contact lens handling until the child becomes competent and comfortable with contact lens management, as poor compliance can result in sight-threatening ocular infections and other complications, such as corneal inflammation.

ADOLESCENTS TO COLLEGE (13 TO 22)

This patient population remains the most common for initial fits, according to the “Clinical Manual of Contact Lenses.” The challenges with these patients: With their growing independence comes less parental supervision and, thus, an elevated risk of non-compliance-caused complications. In addition, many engage in risky behavior, believing nothing bad will ever happen to them, reveals the Journal of Early Adolescence. With regard to contact lens wear, this is evident when these patients sleep in low Dk lenses, fail to replace their lenses, as instructed, top off disinfection solutions, and the list goes on.

Strategies for success: While waiting for the frontal lobe of the brain to develop and mature in these patients, constant education — from the initial fit through every follow-up and annual visit — is the key to increasing the likelihood of a lifetime of compliance habits and thus, wear.

Also, as is the case with children, discuss the built-in compliance of daily disposable lenses. Should the patient choose a two-week or monthly replacement lens, prescribe one approved for extended wear to protect the patient’s eyes, should he or she sleep in the lenses. Finally, because this patient population has more near demands than younger patients, it is important to correct for astigmatism to prevent asthenopia.

ADULTS (23 TO 40)

As the refraction is fairly stable in this patient population, one would think it would be the easiest group to manage with contact lenses. But, in fact, research shows that contact lens wear starts to drop off before age 40, according to Alcon research.

Strategies for success: Ask about and listen for complaints regarding discomfort and end-of-day dryness. Also, let these patients know that as they approach age 40, presbyopia will set in, requiring a different lens. This way, you can offer different lens materials, peroxide disinfection solutions, the option of occasional wear and multifocal lenses, when the time comes. While a regular schedule of contact lens wear is important in younger patients (due to the need for a routine), this patient population is mature enough to utilize contact lenses on an “as needed” or flexible basis. Lifestyles that include weekend athletic activities and intermittent social events can benefit from sporadic contact lens wear.

PRESBYOPES (40 TO 60 YEARS)

A total of 91% of contact lens wearers age 35 to 55 say they are committed to continuing to wear contact lenses, says a 2003 issue of Review of Optometry. The challenges to keeping this patient population in lens wear: ocular dryness, which increases with age and affects contact lens comfort, and presbyopia itself. For example, while two distance lenses are an option for presbyopes, this system requires the use of readers at near and appeals to a minority of these patients, as many desire contact lens wear alone without the additional need for glasses.

Also, monovision affects binocularity, which can affect night driving and other tasks. Further, there are many more multifocal contact lenses available that offer better optics than ever before, but some patients’ visual expectations may not be met by the current technology.

Strategies for success: Assess the patient for ocular dryness beforehand, so beneficial lens materials can be prescribed, obtain a good visual result early in the process to encourage patients to stick with the adaptation to multifocal lenses, set realistic expectations, and follow the contact lens manufacturer’s fitting guide.

MATURE PATIENTS (60 AND OLDER)

These patients live active lifestyles (gardening, tennis, golfing, etc.) that can benefit from contact lens wear, though the issues of aging, such as arthritis, anatomical lid changes and blepharitis, can be hurdles.

Strategies for success: If a patient can no longer wear soft contact lenses due to dryness or handling problems, contemplate prescribing GP lenses, which are made of durable material and, thus, are easier for this patient population to handle. For anatomical lid changes, such as redundant and/or sagging eyelid tissue, a contact lens plunger can help with GP lens removal. In patients who have blepharitis, prescribe warm compresses, lid scrubs, Omega 3 supplements (2 mg/day) and, if required, oral doxycycline (20 mg to 50 mg/day). Also, be open to trying different lens options, as discomfort due to dryness is a subjective experience. When the dry eye patient is unable to wear soft and corneal GP lenses, consider prescribing scleral lenses, as the tear reservoir behind the scleral lens may not only be used for therapeutic use in severe dry eye but also for providing better comfort for contact lens patients who have moderate dry eye problems.

SPREAD THE LOVE

When you anticipate challenges and provide strategies for success at the outset, you give patients the best chance to wear contact lenses for the duration of their lives. Learn about the challenges and how to solve them, and you can promote a love of contact lens wear OM

DR. KOVACICH is an Associate Clinical Professor in the Cornea and Contact Lens Clinic at Indiana University School of Optometry, a Fellow of the AAO and has been active in the Association of Optometric Contact Lens Educators. Send comments to tinyurl.com/OMcomment to comment.