A sobering report this past summer by Centers for Disease Control and Prevention (CDC)’s Morbidity and Mortality Weekly Report highlighted that “one-third of lens wearers recalled never hearing any lens care recommendations–even though most eye care providers reported sharing recommendations always or most of the time with their patients.”¹ There is hope that we will continue to provide ongoing  proper lens care education in order to ward off potential risks of complications, especially serious eye infections, but how will the estimated 45 million contact lens wearers in the United States listen?

As eye care professionals, we are acutely aware that improper wearing schedules and poor care behaviors may pose devastating risks to patients wearing contact lenses. Adding another dimension, engaging in hazardous behaviors does not appear to be totally related to a general lack of knowledge.² Risky behaviors in lens wearers unfortunately abound, even when seemingly appropriate and adequate knowledge of lens care exists. The most common reasons for non-compliance in lens wearers are saving money and forgetting the recommended lens replacement schedule.² How quickly patients seem to forget or shrug off our warnings.

Nevertheless, non-compliant behavior continues to pose risks to our patients and hinders efforts to maximize safety.³ Historical rates of non-compliance in lens wearers range from 40% to 91%, but one model found that only 2% of patients surveyed demonstrated “good” compliance and only 0.4% were “fully” compliant.³ 

Fortunately, these behaviors are modifiable with continued efforts from all of us. So, continue to stress the risks of: 

• improper wearing schedules 
• not complying with recommended lens replacement frequencies
• not washing and drying hands before inserting and removing lenses
• re-using or “topping-off” lens care solutions 
• not cleaning properly and replacing lens storage case properly or regularly 
• not rubbing or rinsing lenses with approved lens care solutions 
• swimming and showering in contact lenses and exposing them to contaminated water  
• sleeping in lenses when not approved to do so

The CDC and others have done a fabulous job in providing educational resources and other communication materials about healthy lens care habits that can be displayed in the office and handed or shown to patients. Employing both verbal and written messages seems to be a more effective in communicating with patients and consumers.² 

In addition, the CDC has designated a week in August (prior to students returning to school) the past few years as Contact Lens Health Week to emphasize the importance of healthy behaviors in lens care. The CDC recommends combating poor compliance by using techniques that are easy to understand and specific to the message intended, such as repeating messages that minimize jargon and checking for patient understanding of the presented points.¹ 

Practice newsletters, text messages and email missives to your patients may serve as reminders on how to avoid risky behaviors, as well as why compliance is important and the risks of not complying. Unfortunately, the strongest message is heard when a patient experiences a complication, which then provides an opportunity to get that patient’s attention by reviewing what might have contributed to their lens-related complication.

We must continue compliance campaigns with ongoing pertinent messages that sustain and encourage healthy behaviors. Only then can we potentially avoid the tragic complications that often result in sight-threatening experiences for our patients. Future studies will judge just how effective compliance campaigns really are. Can they be totally effective? Probably not, for a whole host of reasons—but the fight must go on. It’s just too important not to make this a major crusade!

1. Konne NM, Collier SA, Spangler J, Cope JR: Healthy contact lens behaviors communicated by eye care providers and recalled by patients-United States, 2018. MMWR Morb Mortal Wkly Rep. 2019;68(32):693-7. 2. Steele K. Contact lens compliance: a review. Contact Lens Update. contactlensupdate.com/2018/10/26/contact-lens-compliance-a-review. October 26, 2018. Accessed October 3, 2019. 3. Robertson DM and Cavanaugh D: Non-compliance with contact lens wear and care practices: a comparative analysis. Optom Vis Sci. 2011; 88(12):1402-8.