Dr. Mile Brujic practices in Bowling Green, OH. He also owns Optometric Insights, a service providing career coaching to optometrists. He has received honorarium for speaking, writing, participating in an advisory capacity or research from: Akorn, Alcon L
Dr. Kading owns a two-location, three-doctor practice in Seattle. He specializes in dry eye and contact lenses with an emphasis on keratoconus and meibomian gland dysfunction. He also owns Optometric Insights, a service providing career coaching, with Dr.
Obsolescence happens. If you are not familiar with it, it is the act of becoming obsolete or out of date.
The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.
Obsolescence happens. If you are not familiar with it, it is the act of becoming obsolete or out of date. With contact lens-wearing patients, the conversation we ODs have with them needs to center around obsolescence and how it is inevitable.
When a patient starts contact lens wear, regardless of how he wears his contact lenses, obsolescence will likely happen one way or another. Patients’ contact lens-wearing experience inevitably may come to an end.
In fact, as we all have seen in our practices, many times patients stop wearing contact lenses before age 42. In fact, only about 30 percent of all lens-wearing patients are wearing their lenses after they reach age 42.1 For them, obsolescence occurs far sooner than they may want.
Previously from Dr. Brujic and Dr. Kading: 3 tips to better fit keratocones with sclerals
When discussing why patients stop wearing lenses, discomfort and dryness come in as the top two reasons at my practice. In order to avoid obsolescence, we must discuss it with our patients.
Human beings are rarely compliant. Parents routinely talk about noncompliance with their children. We call it disobedience with children, but that does not sound right when discussing the behavior of an adult who makes his own decisions.
Rather than talking about obedience and disobedience, we discuss compliance and non-compliance with patients. In both cases, disobedience and noncompliance can lead to consequences.
We believe that one major cause of discomfort and dryness in contact lens wear is due to the prolonged and gradual damage upon the ocular surface.
It seems that the ocular surface is robust enough for a period until it is not. The contact lens cycle of gradual discomfort, mild irritation, reduced wear time, occasional wear, and then stopping contact lens wear all together is initiated.
During our travels, we asked fellow practitioners what was the healthiest contact lens modality. Every physician we spoke to agrees it is a daily disposable contact lens. The number one reason people do not replace their lenses as often as prescribed is because they forget.2
With a daily disposable lens, ODs generally do not have the problem of patients forgetting to change their contact lenses. Discarding the lenses every night becomes part of the routine-planned obsolescence.
A general argument we hear from fellow ODs is that they are unable to fit their patients into daily disposable contact lenses because of cost. Box-for-box, disposable contact lenses certainly do cost more money than a two-week or monthly replacement option.
With the introduction of contact lens solutions and replacement compliance, the difference in price is negligible. In the end, patients may find daily disposables to be less expensive.
We hear from practitioners, “But I cannot expect my patients to be compliant with cleaning their contact lenses and replacing them to the degree that daily contact lenses would be cost effective.” To that we make the argument that there is an unintentional planned obsolescence in your practice.
We encourage you to share with your patients how obsolescence will occur with contact lens wear. Being compliant and replacing lenses as prescribed is critical to long term lens success and may delay the action of contact lens dropout.
Planning for obsolescence on a daily basis may very likely be the critical step that we need to take to make contact lens-wearing obsolescence-obsolete.
1. Nichols JJ. 2014 Annual Report: Contact Lenses 2014. Contact Lens Spectrum. January 2015. Available at: https://www.clspectrum.com/issues/2015/january-2015/contact-lenses-2014. Accessed 11/15/17.
2. Riley C, Young G, Chalmers R. Prevalence of ocular surface symptoms, signs, and uncomfortable hours of wear in contact lens wearers: the effect of refitting with daily-wear silicone hydrogel lenses (senofilcon A). Eye Contact Lens. 2006 Dec;32(6):281-6.