Whats the number one reason why patients discontinue contact lens wear? Discomfort, say about half of all contact lens dropouts.1
The second reason? The hassle factor. About 45% of dropouts cite too much bother as a cause for dropping lens wear.2
These may be the reasons for dropout, but they dont have to be. You can nip many discomfort and hassle problems in the bud, which will keep those patients in your practice. The trick is to realize that the statisticswhich may seem to clump patients into discomfort or hassle pigeonholesdo not tell the whole story.
Contact lens dropout is the sum of contributing factors, says optometrist Arthur B. Epstein, of Roslyn Heights, N.Y. And one of the most important factors is patient communicationor the lack thereof, Dr. Epstein says. By probing patients for problems right from the start, you can avert many of those discomfort and hassle issues. This, in turn, will keep those patients in lensesand in your practice.
This article, the second installment of Review of Optometrys three-part series, Take Back Your Contact Lens Practice, examines the contributing reasons for dropout, provides pointers to prevent patients from dropping out, and includes some tips on how to recover those patients who have disappeared from your contact lens practice.
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| Patients may tell you why they dropped out, but only if you ask them. Source: Vistakon Attitude and Usage Study of Vision Corrected Consumers, 2002. |
Five Percent Lost Each Year
Why bother to reach out to potential and current dropouts? Because these patients are not just dropping out of contact lenses, theyre dropping out of your practice, Dr. Epstein says.
Consider: As of December 2004, some 22% of Americans wore contact lenses at least occasionally, according to Jobson Optical Research. Thats 48.5 million people. Meanwhile, as many as 2.7 million drop out of lenses each year.3 If your practice is comparable to the general population, youre losing more than 5% of your contact lens patients each year to dropout.
Three Underlying Problems
Contact lens wearers may phrase their complaints differently, but there are three fundamental reasons why they drop out, says Janice Jurkus, O.D., M.B.A., of Illinois College of Optometry. These include physiological problems, visual complaints and psychosocial issues. (These problems may overlap.) The solution to figuring out any of these reasons hinges on sufficient patient communication for successful lens wear.
Lets look at each reason in turn.
Physiological problems. If discomfort is the principal reason for dropout, then dryness causes at least half of the discomfort issues.4 Dryness breaks down into two categories: existing dry eye and contact lens-induced dry eye, says optometrist Kenneth Lebow, of Virginia Beach, Va.
For every patient, he says, thoroughly evaluate the precorneal tear film for dry eye. Staining is essential. Conditions such as meibomianitis, blepharitis, rapid tear break-up time, epithelial basement membrane dystrophy and lagophthalmos all can play a role in the dry eye individual, Dr. Lebow says. Treating those conditions prior to fitting contact lenses is an excellent way to minimize the problems of contact lens dropout.
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| Before fitting a patient with a lens, be sure to thoroughly evaluate the tear film for dry eye-related problems. |
But in many dropouts, dryness occurs only after the lenses are fit and worn. Contact lens-induced dry eye is often characterized by shorter-than-expected lens wearing times and dryness at the end of the day, Dr. Lebow says.
Visual problems. About 13% to 22% of contact lens dropouts say that problems with vision lead them to discontinue lens wear.1,2 This may be due to practitioners who prescribe an inappropriate lens for the patients refractive error, says Dr. Lebow. Sometimes we have patients with
-0.75D to -1.25D of cylinder wearing spherical lenses, and they dont see particularly well, he says. Or, they tried toric lenses a few years ago and failed, and havent returned to contact lens wear.
Psychosocial issues. A patients lenses may be just fine when you initially fit them, but as the patients lifestyle changes, the lenses may no longer meet the patients needs, Dr. Jurkus says. For example, a young woman may discontinue daily-wear lenses after she has a baby; glasses are much easier to put on in the middle of the night. The solution? Suggest a continuous-wear lens, which is even easier than fumbling around for glasses on the bedside table, Dr. Jurkus says.
Regardless of whether the problem is related to comfort, vision or lifestyle, you might never find out about these problems if you dont specifically probe for them. Many practitioners simply ask, How are your contact lenses? All too often, the patient automatically says, Fine. And we leave it at that, Dr. Jurkus says. Its like someone asking, How are you? If we dont probe past that Fine, the patient could drop out.
Whenever you take a patients history, ask if the patient currently wears or has ever worn contact lenses. If the patient reveals previous contact lens wear, ask why he or she quit, Dr. Jurkus says. New products might meet that patients current needs, but you wont know unless you ask.
| Who Are the Dropouts? Heres a short field guide to patients likely to become contact lens dropouts. New wearers. About 45% of contact lens patients who dropped out wore lenses for one year or less before returning to glasses.4 Middle-aged women. Middle-aged menopausal females tend to have more of a problem with dry eye than do younger individuals, says Kenneth Lebow, O.D. This complicates contact lens wear. Young adult men. A lot of men in their late 20s to 30s tend to drop out, not necessarily because of dry eye, but because of inconvenience, says Arthur B. Epstein, O.D. Indeed, only 38% of contact lens wearers are men, according to Jobson Optical Research. |
For current contact lens patients, keep tabs on their comfort at every visit, Dr. Epstein says. Establish a method to quantify the patients experience. For example, he says, include a comfort scale on your patient intake form that asks the patient to rate different parameters (such as discomfort, dryness and redness) on a scale of 1 to 100. You might also include specific questions about end-of-day dryness and changes in lens care systems.
Realize that many patients who drop out do so within the first year of contact lens wear. Closely evaluate new wearers comfort and vision. This shows that you truly care about their experience. No patient has ever left a doctors office because the doctor tried too hard, Dr. Epstein says. Patients leave a doctors office when they feel the doctor doesnt care.
Another way to heighten communication with patients: Explain exactly what youre doing in the exam, Dr. Jurkus says. Tell the patient why and how youre evaluating the tear film and the ocular surface. If you talk the patient through it, theyll understand more of what youre doing and theyll appreciate the value of what youre doing, she says. It also gets patients more involved in their own care.
Tips for Retention
Here are some other ideas to keep contact lens patients in your practice, or to recover patients who have dropped out. Many involve continued communication.
Offer the newest lenses. Practitioners need to be knowledgeable and willing to try new products, Dr. Lebow says. For one, silicone hydrogel materials offer a quantum leap in delivering oxygen to the corneal surface, he says. For another, better fitting toric lenses are now available. (Indeed, torics now equal 18% of all contact lens wear, according to Jobson Optical Research.) So, a patient who didnt succeed in a toric lens as recently as five years ago might happily wear the lenses now.
Likewise, emerging presbyopes may drop out of lens wear if you dont offer to change them to multifocal lenses, Dr. Jurkus says. (Take note that the number of multifocal and bifocal lens wearers increased by 11% in 2004, according to Jobson Optical Research.)
Give simple instructions. Many doctors make lens care more complicated than it needs to be, Dr. Epstein says. To minimize the hassle factor, provide patients with the simplest possible instructions and care regimen.
Stand by your solution. Patients are notorious for switching brands of lens care solution, Dr. Epstein says. Emphasize that not all are the same, and continue to ask patients what theyre using. For patients who experience discomfort, switching the solution to one with greater wettability (rather than switching the lens) can improve the length of wearing time, Dr. Lebow says.
Keep supplies available. Dont make your current patients wait too long for a new supply of lenses or make it too difficult to obtain them, Dr. Jurkus says.
You make the call. Occasionally set aside a half hour to call patients who have discontinued contact lens wear, Dr. Epstein says. Ask if they had a problem, or why they dropped out. It could be due to the lenses, he says, or it could be due to an unpleasant staff member.
1. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt 2002 Nov;22(6):516-27.
2. Vistakon Attitude and Usage Study of Vision Corrected Consumers, 2002.
3. Health Products Research, Inc. Vision Information Services (VIS) Contact Lens Report, 2002.
4. CIBA Vision study on soft contact lens dropouts. Optom Vis Sci 2004 Nov;81(11):814.
