It is a routine practice to ask patients to return annually for a contact lens check. Some patients view this appointment as an inconvenient but necessary step to enable the continued supply of their contact lenses, while some practitioners feel this appointment takes valuable chair time away from other practice commitments. This can result in contact lens aftercare appointments being short and mundane, with limited added value for either the patient or the practitioner.
In my time as an Optometrist I have witnessed the routine ‘double-booking’ of contact lens aftercare appointments. This was to mitigate the reality of patients not attending on the day. So disengaged were they with the need to be seen that more often than not, at least one of those bookings would regularly not come. I have also experienced the practitioner’s definition of a successful aftercare being where no ‘problems’ are reported or discovered, and with no action needing to be taken, the patient is able to leave the premises within ten minutes of arriving.
On a more positive note, however, I have worked in environments where contact lens aftercare is viewed very differently. It is these experiences which are outlined below, and it is this approach which turns routine contact lens ‘aftercare’ into an exceptional contact lens ‘review’. By doing so, delivering continued care to existing contact lens wearers becomes one of the highlights of the daily clinic, with all concerned – patient, practitioner and the practice – reaping rewards.
Changing the Mindset
To deliver a ‘value-added’ contact lens review it is important to approach the appointment with the right mindset. The deliberate use of the word ‘review’ rather than ‘aftercare’ is part of that psychology. While the latter implies a more passive approach, maintaining the patient after their purchase, the former suggests something of greater depth, an investigation of sorts. It places the onus on the practitioner to probe all aspects of the patient’s contact lens and care regime performance, anterior eye health and compliance; anticipating the discovery of a hidden issue until proven otherwise.
This distinction is important. An approach where one hopes and expects to find no problems will be less likely to get to the truth. Conversely, seeing each contact lens review as the potential to uncover even the smallest concern and take proactive steps, often improving the wearing experience before a patient is having regular issues.
It is crucial to optimize contact lens wear for patients. The most common reasons for ceasing contact lens wear are well quoted in the literature: dryness, discomfort and poor vision.1 The increasing availability of new materials, prescriptions and treatments mean that often these issues can be addressed. Practitioners must stay up to date with new technologies and by doing so, drop-out may be prevented and practice revenue protected.
A Chance to Talk
The reality, however, is that contact lens wearers are not always forthcoming about their problems. There are many reasons for this, such as a concern that if the patient reports problems then they may be taken out of contact lenses, or sometimes, a misplaced belief that contact lens wear is inherently uncomfortable and cannot be improved.
Clear communication is key. An open and relaxed dialogue with the patient creates a space where they feel comfortable sharing accurate feedback. Ask good questions to build a picture of their wearing experience. Total wearing time is not enough. Understand when the lenses go on, come off and for how long in the day they are comfortable. Those patients with a two hour or greater gap between comfortable and total wear time are struggling and at greater risk of dropping out. Discover what your patient ideally seeks from their lenses. Does the lens comfort, vision and modality meet their expectations? Always question yourself: can I make this better?
Let the patient know there are many contact lens options available, including new innovations that may have come to market since their last appointment. Either now, or in the future, there may be alternative lenses they can try. I am a keen advocate of ensuring the patient knows that to remain in contact lenses long term often means to change materials, modality and other factors over time. By understanding that this is normal, the patient becomes less cautious of talking openly, more interested in new technology and willing to try other options. At the last practice I worked in, our contact lens patients would routinely ask, “What’s new?” and, “Is there anything else I can try this time?” I was always delighted to hear that. It didn’t come from a point of view of dissatisfaction with their current lenses, instead they were engaged with their visual correction, and excited by the next new technology they could try.
Recommending Alternative Contact Lenses
This touches on another important area: trialling new lenses. Having used careful questioning techniques and a thorough clinical review, a particular problem with the current lenses may have been established. This is the obvious time to suggest trialling an alternative. However, in our practice we would do something else: we would routinely offer new trial lenses to perfectly happy contact lens wearers. Sometimes they would report a preference for their existing lenses and continue as before, perfectly happy. Sometimes though, they would return, delighted with a wearing experience which surpassed their previous lens type.
How do you know you are lying on the most comfortable mattress in the bed store? They’re all pretty good, but the only way to truly tell is to try more than one and compare the experience. It’s no different with contact lenses. Moreover, when it comes to contact lens discomfort, it is often difficult to find any clinical signs to explain patient-reported symptoms. The message is clear: even in the absence of clinical signs, and particularly when sub-optimal performance is occurring, if you know of an alternative lens the patient can try, then recommend it!
Adopting this approach to contact lens reviews is rewarding; part detective, part new technology evangelist, complete professional. The benefits for your patients are clear: they understand they have received a thorough review, have been made aware of alternatives, and they trust you will work hard to keep their contact lens wear optimized. Their enhanced experience should make them more likely to return for future contact lens appointments, maintain their loyalty to your practice overall and minimize the risk of them dropping out from contact lens wear. Proactive, enthusiastic, value-added contact lens reviews: a win-win for both patients and practitioners.
- Dumbleton, K., Woods, C. A., Jones, L. W. & Fonn, D. (2013). The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens 39, 93-9.
Karen Walsh, MCOptom
Karen Walsh, BSc(Hons) PGDip MCOptom FIACLE Medical Research Fellow Phone: (519) 888-4567 ext.37548 Email: firstname.lastname@example.org Karen graduated in Optometry from Cardiff University, Wales in 1997. She subsequently worked in the UK across all forms of clinical practice, along with supervising undergraduate contact lens clinics at Aston University, Birmingham. Following seven years of working with Brian Tompkins in his independent practice that specialized in contact lenses she joined Johnson & Johnson Vision Care as a Professional Affairs Manager for the UK & Ireland in 2007. Karen has authored clinical articles and educational training programmes on both contact lenses and UV radiation; she has lectured internationally, and has taught at the VISION CARE INSTITUTE™ of Johnson & Johnson Vision Care in both Prague and the UK. She holds a post graduate diploma in Clinical Optometry from City University, London and is a Fellow of the International Association of Contact Lens Educators. She joined the CCLR in 2015 and currently holds the post of Medical Research Fellow.