I will admit that during a certain portion of my exam routine, I turn on the autopilot and simply go through the motions. Be honest, how many times have you been lost in thought, maybe about your plans after work, or started putting together your grocery list while your attention should be focused on refracting? With that said, it should have come as no surprise to me when—without any thought at all—I handed my nine-year-old daily disposable contact lens patient a contact lens case to remove her lenses before dilation.
“What’s that?” she innocently asked. “Well,” I started, “it’s a case to store contact lenses in when they are not being used.” At this point her face instantly crinkled up as she blurted out, “Why would anyone ever want to do that? Yuck! Just throw them away.”
Kids Say the Darndest Things
It was at this point that I realized she was looking for ways to achieve compliance. This young lady was still pure and untainted by the everyday non-compliance drivers of the world: money, time and laziness. Here I was—the protector of her eyes—telling her that it was OK to put the lenses back in after they had been removed. No fresh pair, no lens disinfection, no hand cleaning. I had offered her a pass for non-compliance.
This led me to ask myself the question: how many times have I done this in the past? And is this really as bad as I’m making it out to be? Should I be prepared with two sets of lenses for every exam—one for the fitting and one for after the dilation? Do the contact lens manufacturers consider these factors when calculating the number of diagnostic lenses they give us?
Also, what should I tell patients when they ask me, “Is it OK to take my lenses out when swimming and then put them back in again?” Should I dispense solutions to daily disposable wearers, knowing it will increase the risk of extended wear, which would encourage non-compliance? When I ask these questions to most practitioners, this is exactly what they instruct their patients to do. Yet they also believe that wearing a daily disposable contact lens more than once is a non-compliant behavior, one that puts their patients’ eye health at risk.
The question of length of wear in lens care also requires some attention. Is wearing and cleaning a daily disposable lens for two to four days and then throwing it away any worse than wearing and cleaning a traditional disposable lens for two to four weeks, or sometimes even longer? Which system generates more deposits? Which modality poses an increased risk of infection?
Give them an Inch…
Is the real problem that we generally don’t offer our daily disposable patients cleaning products, which leads them to disregard cleaning or disinfecting their lenses? Despite the benefit daily disposables provide in obviating the need for lens care, patients sometimes do still wear them for several days. Are we worried that if we give them cleaning products, the patient will then take the next step and wear their single-use lenses for upwards of two to four weeks? Is it best, as some practitioners have told me, to wait until the patient brings up cleaning/storing to have the conversation with them about disinfecting and proper lens care?
In general, I educate my patients on what I believe are the safest ways to wear their contact lenses. I tell my daily disposable wearers that the lens is always most comfortable and cleanest right out of the packaging, and to avoid wearing them beyond their recommended replacement frequency. If the patient needs to take the lens out for any reason, it is best to simply put a new lens on. If that is not an option, as sometimes is the case, then the lens must be disinfected before it can be reinserted into the eye, but it most likely won’t feel as comfortable as the first wear. I tell all my patients that there is no shortcut to safety—one way or another, the lens must be clean when it is reinserted in the eye.
In general, I don’t worry much about the number of times a patient wears a lens. Daily disposable patients want to be comfortable, and as a result, are generally more compliant than traditional disposable lens wearers. I don’t pretend to have all the answers, but this reminds me—I need to stop at the grocery store after work today.