Prevent dropout by asking the right questions

June 16, 2015
David I. Geffen, OD, FAAO

Dr. Geffen is interested in refractive surgery and contact lenses. He discloses relationships with Alcon, Bausch + Lomb, Eyecare Live, Johnson & Johnson Vision, Novartis, Sun Pharma, and TearLab.

Patients do not decide suddenly to drop out of lens wear. It is a progression that may occur over months or years.

The main reason for contact lens dropout is discomfort and dryness, according to a survey done by Richdale.1 The latest data on contact lens dropouts is approximately 16 percent annually.2

Given these two statistics, one may assume that dryness and discomfort are the primary cause of our patients dropping out of contact lens wear. Patients do not decide suddenly to drop out of lens wear. It is a progression that may occur over months or years.

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The strugglers

The progression of contact lens discomfort starts with those patients we will call strugglers. These are the patients who come in to the office and will tell you their contact lenses feel “fine.” Unless we ask more open and in-depth questions, we will not discover that these patients may have some fluctuating vision. They may be noticing some visual disturbances.

Next, we move on to the patient who may still say his contact lenses feel “fine,” but if we ask the right questions, we may uncover that the patient is experiencing reduced comfortable wearing time.

He will tell you he wears his lenses all day, but unless we ask the right questions, you may not find out the last three hours of wearing time is dry and uncomfortable. The next step in the progression is reduced wearing time.

The patient may still tell her contact lenses feel “fine,” but she takes her lenses out the minute she gets home from work. Next is the temporary discontinuation of lens wear.

Now, the patient may tell you her lenses are not as comfortable, and she doesn’t wear them to work and may wear them only for weekends or going out.

Finally, we have the total discontinuation of lens wear and the dreaded contact lens dropout.

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Taking responsibility for dropouts

The process may take months or even years, but the result is often the loss of a patient and tens of thousands of dollars of lost revenue to the practice. Most of us do not even realize the patient has stopped wearing his lenses. How would we know? Do we look at our contact lens patient recall numbers, and if they have not returned in 13-14 months do we call and find out where they are? Whose fault is it?

Most of us say the patients’, but I believe we, as doctors, need to take more responsibility for this. We need to be proactive in our practices to insure our patients are receiving the most up-to-date technology, which may be better to address the changing lifestyles of our patients.

Keeping the patient in the same lenses year in and year out because it’s not broken is not in the patient’s or the practice’s best interest. We know the patient will come in and tell us his lenses feel “fine.”

If we do not change anything after three or four years, patients may feel that they will just buy their lenses online the next year because the doc isn’t changing anything, and they might as well save some money.

Next: Stopping the progression to dropout

 

Stopping the progression to dropout

What we ask our patients about their lenses is critical to stop the progression of the dropout. If we ask more probing questions, we will find out about the visual disturbances early on in the process, and we can make the necessary adjustments to bring the patient back to the comfort they want and deserve. Here are a few examples:

• Do you feel like you want to remove your lenses as soon as you get home from work?

• Are your contacts as comfortable at the end of the day as when you put them in?

• How would you rate your contact lens comfort on a scale from 1-10 at the beginning of the day as compared to the end of the day?

• Do you think your contact lenses are as comfortable as they could be?

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These questions are much more likely to tell us the patient is on the road to discomfort or dropout. Why do patients tell us their lenses feel “fine?” Our patients often think this is how lenses should feel-they don’t know any better. Also, the patient may be afraid if she complains, we will tell her to stop wearing her lenses.

By asking the right questions, we will give patients confidence that we are looking to help them feel the best possible with contact lenses.

Another major disconnect is the fact that 97 percent of our patients were interested in trying a new contact lens technology. However, only 20 percent expect to learn about new technology during their visit to their eye doctor.This I find to be an amazing statistic in doctors’ failure to be more proactive for our patients. So, go in to work tomorrow, and start asking the right questions!

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References:

1. Richdale K, Sinnott LT, Skadahl E, et al. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007 Feb;26(2):168-174.

2. Rumpakis J. New Data on Contact Lens Dropouts: An International Perspective. Rev Optometry. Available at: http://www.revoptom.com/content/d/contact_lenses_and_solutions/c/18929/.

3. Rah, MJ, Reindel, W, Mosehauer, G. Interest and acceptance of a new contact lens technology in today’s practice. Poster session presented at: 118th Annual AOA Congress; 2015 Jun 34-28; Seattle, WA.

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