I’m a firm believer that contact lenses can enhance my patients’ quality of life. My commitment is to ensure that in offering contact lenses I also remain accountable for the changes induced on the ocular surface by the contact lens. It does no good to offer the patient momentary freedom from glasses at the sacrifice of his long-term ocular comfort. In order to properly care for our contact lens patients, we have to take responsibility for the changes that are occurring in the tear film under the lens.
Related: Fitting ortho-k lenses
Dropping out of lens wear
Not only will this type of accountability create better outcomes for our patients, it will ultimately benefit our bottom lines. If you have attended any contact lens dinner in the past several years, you have likely heard about the dropout rate. It has been quoted to be 16 percent to 22 percent depending on the study—this number has not decreased over the past 20 years despite advances in technology.
Every study seems to point to discomfort as the main reason patients discontinue lens wear. Specifically, we know that 50 percent of contact wearers have concomitant dry eye disease.1 Moreover, up to 90 percent of contact lens wearers report experiencing dry eye symptoms at some point.2,3
Do you think you have contact lens patients dropping out? Whenever this question is asked, most doctors don’t see it as a significant problem within their practices. However, one easy way to conceptualize this is to ask yourself if your contact lens numbers have been pretty steady since this date from last year and the year before. Most doctors will agree that they are. That may sound like a reassuring thought, but it is actually far from it
We all have new fits on our schedule weekly, even daily in some offices. So how is it that our numbers are flat-lined? It’s because of the “revolving door” within our contact lens practice. While we aren’t usually involved in the exit, it is certainly happening. We constantly search for new marketing and promotional ideas and incur expenses to drive new patients through the door. But logistically we know it’s more cost effective to keep an existing patient than to recruit a new one. If only we could predict which patients are more likely to drop out (without our knowledge).
Maybe we can. Let’s shift our focus to why patients leave and how to better equip them to stay.
1. Doughty MJ, Fonn D, Richter D, Simpson T, Caffery B, Gordon KA. A patient questionnaire approach to estimating the prevalence of dry eye symptoms in patients presenting to optometric practices across Canada. Optom Vis Sci. 1997 Aug;74(8):624-31.
2. Nichols JJ, Ziegler C, Mitchell GL, Nichols KK. Self-reported dry eye disease across refractive modalities. Invest Ophthalmol Vis Sci 2005 Jun;46(6):1911-4.
3. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007 Feb;26(2):168-74.
4. Glasson MJ, Stapleton F, Keay L, Sweeney D, Willcox MD. Differences in clinical parameters and tear film of tolerant and intolerant contact lens wearers. Invest Ophthalmol Vis Sci. 2003 Dec;44(12):5116-24..
5. Arita R, Itoh K, Inoue K, Kuchiba A, Yamaguchi T, Amano S. Contact lens wear is associated with decrease of meibomian glands. Ophthalmology. 2009 Mar;116(3):379-84.
6. Ong BL. Relation between contact lens wear and meibomian gland dysfunction. Optom Vis Sci. 1996 Mar;73(3):208-10.
7. Korb DR, Henriquez AS. Meibomian gland dysfunction and contact lens intolerance. J Am Optom Assoc. 1980 Mar;51(3):243-51.
8. Paugh JR, Knapp LL, Martinson JR, Hom MM. Meibomian therapy in problematic contact lens wear. Optom Vis Sci. 1990 Nov;67(11):803-6.