I recently saw a patient wearing soft toric multifocal contact lenses. She had significant astigmatism and enjoyed excellent vision at all distances with this modality. At this time, there are no daily disposable soft multifocal options with toric parameters on the market, so this monthly replacement lens was her best option.
She reported good replacement compliance but noted that the lenses “didn’t seem to last” as long as they used to. She occasionally replaced the lenses before their scheduled replacement date due to discomfort.
We chatted about how she cared for the lenses and discovered she was not rubbing the lenses before storing them each night. Additionally, her case was over a year old. I educated her about the importance of digital rubbing with solution to clean the lenses and appropriate case replacement intervals. She seemed genuinely surprised at these instructions and recalled no one ever discussing proper case replacement with her.
Improving patient communication on reusable contact lenses
The contact lens market has seen a continual increase in daily disposable prescribing rates thanks to expanded product and parameter options. Daily disposables are the modality of choice for eyecare providers (ECPs) and patients due to their convenience and decreased risk of complications.1-3
While the majority of soft contact lens wearers have a daily disposable option, factors like parameter availability, financial concerns, and other unique circumstances may occasionally preclude a patient from daily disposables and require a reusable (monthly, biweekly replacement) soft contact lens.
When you find yourself reaching for a reusable option, consider some of the following communication strategies to ensure your patient maintains the best vision, comfort, and ocular health.
1. Offer suggestions for contact lens solutions.
With reusable lens wear, contact lens solutions have a major impact on comfort and ocular health. The steps associated with solution use, however, make wearers vulnerable to opportunities for non-compliance, like topping off and not rubbing/rinsing lenses, which can lead to complications.4-6
The first step to successful solution use is to identify a brand that works for the patient and stick with it. Multipurpose solutions (MPS) work well for most wearers,7 but it is important to note that each MPS uses different combinations of preservatives and active ingredients, as well as different pH and buffers.
If an MPS is working well for a patient, they should stay with that formulation to ensure their comfort is maintained. If wearers seem to struggle with comfort and/or irritation regardless of MPS type, a preservative-free hydrogen peroxide-based solution is a great option.6
Once a solution is identified that works well for the patient, appropriate use is essential. For MPSs, the “rub and rinse” step is crucial for removing deposits and reducing biofilms.8,9 This step may have extended the comfortable life of the lenses for the patient I described above.
With hydrogen peroxide-based solutions, while the opportunity for non-compliance is arguably less,6 describing and demonstrating proper usage and time to neutralization is necessary for comfortable, healthy wear.
2. Provide clear communication on replacement schedules.
Daily disposable wearers are most likely to be compliant with replacement schedules.10 For reusable replacement wearers, it may be difficult to recall the appropriate interval for contact lens replacement, putting wearers at risk for complications.4 It is unclear if certain replacement intervals are better than others.
It has been reported that 2-week replacement wearers are most likely to be non-compliant with replacement,4,10 but it’s also been reported that lenses prescribed for longer replacement intervals can lead to more extreme stretching of lens life.11
Evidence does suggest that effective compliance communication between ECPs and patients is associated with greater compliance with recommended lens replacement frequency.12 This means that a verbal reminder and/or including the lens replacement schedule on the finalized prescription can be effective in ensuring proper lens replacement and preventing complications associated with overwear.
Making a case for case hygiene
Replacement communication doesn’t end with contact lenses. Reusable lens wearers have an accessory—the contact lens case—that daily disposable wearers don’t have to manage. Wearers’ understanding of how to care for and replace their contact lens cases is very poor.5,10,13
It has been reported that 40 to 90% of wearers have some level of non-compliance with case hygiene or replacement.10,11,13-15 Even wearers who are compliant with other factors like lens replacement and overnight wear tend to have poor case compliance.10
Up to half of the cases of microbial keratitis in contact lens wearers could be avoided with better case hygiene and replacement practices.16 It is imperative, therefore, that patients wearing reusable contact lenses have an understanding of the best case hygiene practices.
Recent recommendations for case hygiene
Depending on what resource is referenced, both ECPs and patients might find differing information on how to best care for a contact lens case.17 Published recommendations for case replacement range from 1 to 6 months.17-19 A recent review suggested that a Food and Drug Administration (FDA) recommendation of monthly case replacement could be impactful in improving compliance.7
When considering case replacement, therefore, suggesting monthly replacement or replacing the case with each new bottle of solution is a good place to start. When it comes to cleaning the case, remind patients that the case should never come into contact with tap water but instead be rinsed with a multipurpose solution, wiped with a clean tissue, and left to dry upside down on a clean surface.
3. Invest time in effective patient education.
The suggestions above involve effective patient communication to maintain and/or improve compliance with regular replacement lenses. Even with good in-office communication, patients often forget the instructions they receive regarding proper contact lens use,7,20 so it is important to be intentional about how you educate your reusable soft contact lens wearers about the factors discussed above.
Continue to have these conversations during follow-ups and annual evaluations, as regular reminders support good compliance. Communication strategies that describe the specific risks associated with non-compliance may be more effective to some degree.21
Being specific about consequences surrounding solution or case non-compliance (eye irritation, pain, infection, etc.) might help drive the message home. Some evidence has reported that strategies that utilize regular visual reminders (i.e., communication on packaging, stickers, etc.)22 might also encourage better compliance.
Conclusion
Daily disposable options occasionally are not the best realistic option. When a reusable soft contact lens is needed, so is additional communication about lens care.
Confirming wearers understand effective care strategies and appropriate lens and case replacement strategies will ensure they are able to enjoy long-term, comfortable, healthy contact lens wear.
