Building a Culture of Compliance in Contact Lens Care

I am an eye care provider and the optometric clinical director at Blinking Owl Eyecare in Pinecrest Florida, which is one of six Blinking Owl locations in the greater Miami area. At our location in a one-lane sublease inside a Target Optical in a middle-to-upper-class neighborhood, our team consists of two optometrists and support staff. We treat approximately 3,500 patients annually, from age 6 to 100+ years old, who are from diverse backgrounds, including a significant population of Hispanic Americans. 

Contact lenses have always composed a healthy part of our business. Each year, we sell approximately 900 contact lens units. Of that total, an estimated 73% are premium lenses. 

ADDRESSING NON-ADHERENCE TO CONTACT LENS CARE
We optometrists know that life can easily become busy, especially around the holiday season, and responsibilities can often be forgotten. Yet, we can’t let our patients neglect their contact lens care. While non-adherence in contact lens wear and care is somewhat common, it is both clinically risky and financially consequential for practices. In this article, I will discuss the ways in which my team and I build a culture of compliance through identifying the top drivers of non-adherence, our patient education protocols to reduce it, and its business impact. 

DEFINING CONTACT LENS CARE NON-ADHERENCE
I define contact lens non-adherence as a patient’s failure to follow prescribed wear and care guidelines. This includes over-wearing lenses, improper cleaning, using expired solutions, and missing replacement schedules; all actions that can compromise patients’ ocular health as well as their visual quality. Unfortunately, this is a common issue, particularly among reusable lens wearers. Two of the riskiest lens behaviors I hear in the clinic are patients sleeping and showering in their lenses; these are among the biggest contact lens no-no’s, in my opinion (see the sidebar, Case Vignette). 

TOP DRIVERS OF NON-ADHERENCE
In my experience, there are a few key reasons why patients do not adhere to contact lens guidelines. 

• Patient-reported cost sensitivity. As doctors, we can't prejudge our patients on how much they're willing to spend on contact lenses. Our role is to educate them and listen to their needs to fit them into a contact lens that is going to be suitable for their lifestyle and their budget. 
• Misinformation about contacts. Some patients have long-standing misconceptions about their lenses (like thinking one pair of contacts can last for 6 months). This knowledge gap is often tied to habits from their youth, so it’s important to continuously educate all patients about the importance of properly wearing and caring for their lenses. 
• Convenience/laziness. Many patients simply do not want to take the time required to safely remove or store their lenses nightly.
• Modality switch. Some contact lens wearers might benefit from a modality switch. In my clinical experience, I strongly advocate for daily disposables as the default lens for most patients. I shift to reusables only when a patient explicitly prefers it or their prescription is not available in a daily lens. 

THE FINANCIAL CONSEQUENCES OF NON-ADHERENCE
Non-compliance is not only clinically risky for our patients, but it can also have a financial impact on practices. When patients stretch the use of their lenses—especially reusables—it decreases revenue from product sales and decreases patient retention. Patients who overwear their lenses miss their yearly exams and may delay them by 2 to 3 years. If we optometrists are not proactively recommending yearly supplies of contacts lenses, our practices will see a financial impact not only in sales, but also on eye exams. 

The availability of new automated systems has enabled us to pre-appoint or remind patients to schedule their annual exams, in addition to the reminder letters we mail to our patients. Additionally, we have a broad inventory of trial lenses to provide patients with trials at their visits. I find that trial lenses aid in compliance because patients can actually test the comfort of the lenses in their natural environment (home/ work), providing real-world experience and decreasing lens drop-out. 

At checkout, we supply all patients with a contact lens kit that includes a case and solution. 

For daily lens wearers, this gives them a safe, hygienic place to store their lenses in situations where they need to remove them during the day—such as before showering or napping. This helps prevent premature disposal and allows them to better pace their yearly supply. 

For reusable lens wearers, the case and solution serve as a gentle reminder and incentive to remove their lenses before sleeping, promoting healthier wearing habits. 

Also, we routinely offer extra contact lens cases, as we advise patients to replace their case every 3 months to reduce the risk of contamination and maintain proper hygiene. 

We work closely with our optical team to create discounted bundles and provide rebates to patients, especially those who have yearly contact lens supplies. For example, we offer the largest discounts when patients order glasses and contacts together, and another significant discount when patients order a yearly supply of contact lenses. 

We use manufacturer discounts that include free lens shipping as an added level of convenience for our patients to help prevent lapses in adherence. We have even shipped lenses to hotels of patients who ran low on contacts while traveling. We do our best to make lens adherence as seamless as possible for our patients. 

TAKING TIME TO EDUCATE
In my experience, one of the most important ways to combat patient non-compliance is to educate patients on the importance of contact lens care. During an eye exam, I first complete a preliminary intake form to understand the patient’s occupation, contact wear frequency, nightly lens removal likelihood, symptoms of dryness, and expectations for vision and comfort. Next, I explain the different modalities to choose from (dailies vs weekly/biweekly/monthly lenses) and the maximum daily wear time of each lens (approximately 12 to 16 hours, depending on the lens); I make sure to emphasize that not all lenses can last 16 hours. I also review proper lens-handling hygiene protocols with patients, such as handwashing before touching contacts and not using expired lens solution for cleaning. I stress to my patients that over-wearing contacts reduces their oxygen transmissibility, and I liken it to putting a piece of plastic with no breathability on their eye. 

For my patients in reusable lenses, before they leave my chair, I ask them to take out their phones and open their calendars. Together, we create on-the-spot calendar automations for weekly, biweekly, or monthly lens disposal reminders on patients’ phones. I have found this personal approach drives behavior change with previously non-compliant patients and leaves them feeling supported by their doctor. Patients will even return excited to report how helpful those reminders have been with lens care compliance. 

After the exam, our technicians and optical staff reinforce these key points with patients as they leave our office. Our goal is to create as many educational touchpoints as possible to give our patients every opportunity to succeed in their contact lens journeys. 

PRACTICAL PEARLS
When patients adhere to proper lens wear, they have better outcomes, fewer complications, and a more positive perception of their experience. This education translates into higher retention, better reviews for the office, and an increased sale of annual supplies. My advice to fellow eye care providers who want to become more proactive about preventing patient non-adherence is to: 

• Create a culture of compliance. This includes training staff members on lens modalities and their care regimens, so messages to patients are consistent beyond the exam room.
• Lead with education. Education drives trust, and trust builds the practice via outcomes, reviews, and annual-supply sales.
• Equip patients. Provide a contact lens kit for reusables wearers at checkout and ensure trial lenses are provided for those in dailies. This is important for patients to feel cared for, and it reinforces good hygiene and wear habits.
• Be nonjudgmental and relational. Patients may under-report risky behaviors such as leaving their lenses in to sleep and shower. Keeping a friendly, honest, and supportive tone elicits truth and better influences behavioral change. 

As doctors, it is our duty to set our patients up for success and incentivize them to prioritize their ocular health, even when life gets busy.