Studies have estimated that contact lens hygiene non-compliance is as high as 80 per cent of all wearers, although detecting non-compliant behaviour can be tricky…
Late on Friday afternoon your receptionist buzzes through, “John Citizen, one of our contact lens wearers is here with a really red, sore eye,” she says. “Can you squeeze him in?”
“Yes”, you sigh as you look at your watch – its 4.30pm. In comes John. “Did you sleep in your lenses? Any breaks to hygiene?” you ask.
“No, no,” he emphatically replies.
eliminating obstacles, is about looking for solutions. How can we make it easier for John to be compliant when jogging? Could he take a different route? …….. Use daily disposable lenses and carry a spare set when jogging?
“Anything unusual happen today?”
“Well, it was hurting when I was jogging at lunch time, so I took it out, spat on it and put it back in. It didn’t feel better, but I needed to see,” John says.
“What!” you scream in your head, “Do you not realise you have put all those germs from your mouth into a scratched and ready-to-be infected cornea!”
Obviously John doesn’t realise and it is only because he now has a problem that he mentioned it. Apparently this has been happening quite frequently lately as he has been jogging past a building site quite often, but as he had not experienced a problem before, he thought spitting on his contact lenses must be fine. John was a contact lens complication waiting to happen.
Proper contact lens hygiene, you might believe, simply requires common sense, but it is clear from this type of behaviour that wearers often do not think of contact lenses as foreign bodies that have the potential to cause eye disease.
The Right Approach
It has been shown that an empathetic approach produces the best results in achieving compliance1, 2. For example, enquiring, “How often do you use saliva to clean your lenses?” rather than the more accusational, “Do you clean your lenses with saliva?”
Also, asking open-ended questions while acting in an authoritative manner and trying to build a rapport with the patient will increase hygiene practices. It is also important to back up these questions with the consequences. For example, “Did you know that good hygiene can decrease the risk of eye infection by nearly one third?”3
The Health Belief Model
Chances are, you are on track with the Health Belief Model4 of thought processes that drive non-compliant behaviour, even though you probably don’t realise it. The first step is getting the wearer to recognise that they are susceptible to disease due to poor hygiene. The second is that your explanation of the potential consequences of a severe case of infection is enough to elicit concern from the patient. For instance, you could say to John, “Eye infections result in pain and can lead to loss of vision and hospitalisation, even loss of the eye in the worst circumstances.”
The next two steps in the model ensure wearers realise the benefits of, and eliminate obstacles to, being compliant. The first of these could be addressed for John by suggesting, “If you lost your vision, or had problems with glare, you might not perform as well in that triathlon you are training for, John.”
The second, eliminating obstacles, is about looking for solutions. How can we make it easier for John to be compliant when jogging? Could he take a different route? Not go past the building site? Carry a case with saline on him? Wash his hands before jogging or carry pocket size antibacterial gel? Use daily disposable lenses and carry a spare set when jogging?
However, it’s now 5pm on Friday and you have another patient waiting. One way to condense compliance education is through aids such as pamphlets.
We know also that five minutes after education, most wearers forget what they have learnt. John is going to be more likely thinking about a few beers at the pub with his mates, not contact lenses, as he walks to his car.
In an ideal world, when John’s wife wakes up the next morning she’ll see the pamphlet on the kitchen table and will quiz him. And ideally, next time he goes jogging, she will have a case and the antibacterial gel ready for him at the front door as he leaves. The following week, John comes back in to see you. “I think I will try those daily disposables”, he says. He may not have let his wife win but at least he will be less likely to have contact lens complications.
The Brien Holden Vision Institute and School of Optometry and Vision Science, in conjunction with RANZCO, OAA and NZAO, have developed a concise pamphlet that reinforces the most significant risk factors associated with hygiene and overnight wear, confirmed by the Microbial Keratitis Surveillance Study conducted in Australia and NZ in 2003-2005.
For more details on the pamphlet or to obtain copies, contact Donna LaHood by email: firstname.lastname@example.org.
Nicole Carnt, B. Optom (hons) is a PhD candidate at the Brien Holden Vision Institute and School of Optometry and Vision Science, University of New South Wales.
Professor Fiona Stapleton, PhD, is a Senior Research Associate at the Brien Holden Vision Institute and Head of the School of Optometry and Vision Science, University of New South Wales.
McMonnies CW. Behaviour modification in the management of chronic habits of abnormal eye rubbing. Contact Lens & Anterior Eye. 2009;32(2):55-63.
Donshik PC, Ehlers WH, Anderson LD, Suchecki JK. Strategies to better engage, educate, and empower patient compliance and safe lens wear: compliance: what we know, what we do not know, and what we need to know. Eye Contact Lens. Nov 2007;33(6 Pt 2):430-433; discussion 434.
Keay L, Edwards K, Stapleton F. An evidence-based brochure to educate contact lens wearers about safe contact lens wear. Clinical & Experimental Optometry. 2009;92(5):407-409.
Sokol JL, Mier MG, Bloom S, Asbell PA. A study of patient compliance in a contact lens-wearing population. Contact Lenses Assocation of Ophthalmologist Journal. 1990;16:209-213.