Changing Habits One Patient at a Time

This fall is a great time to educate patients and your local community about safe, healthy contact lens wear.

By Michael S. Mayers, OD

We know that many patients are noncompliant, not only with replacement schedules, but with almost every step in the contact lens care regimen.1,2 British tabloid newspapers recently reported the story of a 23-year-old student who was particularly cavalier about her contact lens hygiene. After leaving her daily-wear contact lenses in continuously for 6 months, she developed Acanthameoba keratitis and lost her eyesight. The headlines screamed hyperbole (Girl Blinded When Bug Eats Her Eyes!), but because social media spread this story far and wide, it can serve as an effective entry point for talking to patients about contact lens hygiene.

The topic of lens hygiene is often neglected, especially with established wearers who are presumed to already be educated about lens wear and care. But the reality is that doctors need to emphasize the importance of properly caring for contact lenses at every visit.

Most importantly, patients should adhere to the modality they have agreed upon with their doctor. If they are wearing a reusable lens, that means not only following the recommended replacement schedule but also performing all of the required steps associated with the care of their contact lenses before, during, and after wear.

In fact, some of the worst patterns of compliance are not related to replacement at all, but are centered around aspects that are known to increase the risk of microbial or sterile keratitis such as contact with water, poor hand washing, and poor case hygiene.3-5 These are all behaviors that patients can be reminded about fairly quickly.

TALKING TO PATIENTS ABOUT HYGIENE

For example, just slightly more than half (56%) of contact lens wearers say they wash their hands with soap before handling lenses in the morning.1 They may not know that they should also take care to dry their hands thoroughly and ensure there is no residue from creams or lotions that could be absorbed by the contact lens material.

Current patterns of contact lens case cleaning are very much misaligned with what we know to be good practice. Few patients are replacing cases quarterly or cleaning them daily, as recommended. When their doctors tell them to “clean” the case, it is perhaps not surprising that the majority (72%) do this the way they wash their hair or dishes— with tap water.1 It may be a logical interpretation until they realize that using tap water can expose soft contact lenses to water-borne bacteria.

Changing established patterns of behavior is not easy, which is why education and repetition have to go hand in hand. A good resource that doctors can share with patients is Healthy Vision & Contact Lenses, which includes a list of dos and don’ts about contact lens wear and hygiene (see Additional Resources).

“It’s our job to convince patients to do the right thing,” says Dawn Hartman, OD, a clinical instructor at The Ohio State University who practices in both retail and multispecialty group settings in central Ohio. She believes that how you present a change in habits makes a huge difference in whether the change is adopted. Dr. Hartman likes to tie her advice both to the patient’s stated needs and to what she is seeing clinically. Here is a scenario that is all too common:

Patient: “But doctor, I’ve always slept in my lenses, and I’ve never had a problem.”

The response: “Well, that makes me a bit nervous that your luck is about to run out! Seriously, I’m really glad you haven’t noticed any problems yet, but I can see that your eye is starving for oxygen, and you have a lot of buildup on these lenses. You’ve told me how much you enjoy being able to go out on the weekends and exercise without glasses, so I want to make sure you can continue to do that comfortably. You can really improve the performance of your contact lenses and help keep your eyes looking white and healthy if you remove and clean the lenses before sleeping.”

The alternative: “If that’s really too much of a hassle, we can fit you in a daily disposable lens that you can simply throw away at night.

In fact, daily disposable contact lens wear is a very healthy way to wear contact lenses because it avoids many of those challenging cleaning and storage issues altogether. In one recent study, daily disposable lenses had a 12.5-fold lower risk of inflammatory events compared with reusable daily wear lenses.6 In another, wearers of etafilcon A daily disposable lenses reported a low incidence of adverse events, with only three minor contact lens-related adverse events in 471 years of patient wear (0.6%/year) and no symptomatic corneal infiltrative events.7

WEIRD, WILD, AND SHARED

Halloween presents another good opportunity to talk about contact lens safety and hygiene. At this time of year, we always see interest spike in cosmetic lenses, popularized by movies and TV shows, that create special effects such as tiger eyes or bloodshot eyes. Patients sometimes buy or order such lenses from nonmedical sources, and end up getting a product for which they don’t have a prescription, and that may not even be approved for sale by regulatory authorities.

There are a number of potential problems with these cosmetic lenses not obtained through proper channels. The packaging solution might not be sterile, or the lenses might not be compatible with cleaning solutions. In addition, they may contain unapproved dyes (colorants) that could leach out onto the cornea.

Dr. Giedd says he sees patients every year who admit they’ve borrowed someone else’s colored contact lenses and liked the way they looked. “We really stress the importance of a proper fitting in the doctor’s office, not as part of a costume or makeover. Although to my knowledge I haven’t treated any outright bacterial infections from unapproved lenses, I have treated patients with red, inflamed eyes resulting from wearing lenses that weren’t prescribed for them,” he says. “The biggest problem is that they are using a medical device without appropriate insertion and removal training and without getting any of the important information we routinely give in educating about cleaning, care, and replacement.”

For patients who are interested in enhancing the look of their eyes, a better option would be a professional fitting performed using one of the FDA-approved brands of colored or cosmetic lenses.

Practitioners and patients should look for cosmetic lenses that have very similar properties to their clear counterparts. These properties would include transmitting the same levels of oxygen, similar comfort, handling, visual performance, fitting characteristics and, ideally, the pigment in a cosmetic lens should be enclosed within the lens matrix so it doesn’t come in contact with the ocular tissues (cornea, conjunctiva, or lids) at all during wear.

It is no surprise that patients are motivated by beauty and style. Optical shops have long catered to individual styles with a wide range of designer frames and sunglasses. Patients can indulge their creative side in contact lenses, too, but we need to educate them about wearing only approved lenses prescribed for their eyes and adhering to best practices for healthy contact lens wear and care.

Michael S. Mayers, OD, is manager of global strategic medical affairs for Johnson & Johnson Vision Care, Inc. Dr. Mayers may be reached at (904) 443-3252; mmayers@its.jnj.com.

  1. Hickson-Curran S, Chalmers RL, Riley C. Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases. Cont Lens Anterior Eye. 2011, 34(5):207-215.
  2. Morgan P. Contact lens compliance and reducing the risk of keratitis. March 2008. www.siliconehydrogels.org. www.siliconehydrogels.org/editorials/mar_08.asp. Accessed July 7, 2014.
  3. Radford CF, Minassian DC, Dart JK. Acanthamoeba keratitis in England and Wales: incidence, outcome, and risk factors. Br J Ophthalmol. 2002;86(5):536-542.
  4. Radford CF, Minassian D, Dart JK, et al. Risk factors for nonulcerative contact lens complications in an ophthalmic accident and emergency department: a case-control study. Ophthalmology. 2009;116(3):385-392.
  5. Stapleton F, Edwards K, Keay L, et al. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology. 2012;119(8):1516-1521.
  6. Chalmers RL, Keay L, McNally J, Kern J. Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates. Optom Vis Sci. 2012 Mar;89(3):316-325.
  7. Chalmers RL, Hickson-Curran SB, Keay LJ, Gleason W. Safety of hydrogel and silicone hydrogel daily disposables in a large post-market surveillance registry – The TEMPO Registry. Invest Ophthalmol Vis Sci. 2014;55:E-abstract 862.