Recently, several incidents that were described in the news have illustrated the importance of patients’ compliance in following the recommendations of their eye care practitioners. With the current pop-culture trends, it is more important than ever to instill in our patients respect for contact lenses as medical devices.
Casual Use of Medical Devices
For instance, Lady Gaga’s eyes in the “Bad Romance” video captivated young men and women so much that many attempted to mimic the singer’s wide-eyed look. They tried to buy so-called “circle” contact lenses, which exaggerate iris shape and size, without a valid prescription. In a previous editorial, I mentioned another instance where several people who apparently acquired lenses from alternative sources without proper fitting and lens care instruction. They were purchasing lenses at a local fair from a vendor who was selling ophthalmic devices next to a livestock exhibit. An article in the journal Pediatrics describes a number of children under the age of 21 who presented to the emergency room with medical device adverse events. Twenty-three percent of these events were related to wearing contact lenses. The adverse events ranged from minor abrasions and annoying conjunctivitis to ulcerative keratitis.1 Fortunately, most of these children’s adverse events were not sight threatening. Nonetheless, the patient can avoid many of these ocular events by adhering to appropriate wearing schedules, heeding practitioner guidelines for replacement frequency and following recommended care instructions.
Contact lenses remain a very viable option in correcting refractive errors. But, these news stories make it clear—patients must be cognizant of the possibility of an adverse event when using any medical device, and they must be aware that some adverse events may even be sight threatening.
Join in the Effort
The concept of shared responsibility holds manufacturers, patients and practitioners accountable for doing their part to strive for excellence in eye care. Manufacturers must continue to market safe and effective products; patients must treat all these medical devices with respect and be compliant in the care of their lenses; and practitioners must educate patients about lens care and avoiding adverse events and properly fit each patient who desires an alternative to spectacles. When manufacturers, patients and practitioners hold up their share of the responsibility, adverse events will be dramatically minimized.
Discovering the Source of Non-Compliance
What we should do if patients don’t comply is a whole different discussion. Until we determine the reason for non-compliance, eye care practitioners can’t assume patients are willfully negligent. For example, financial difficulty can be an important factor in non-compliance. But if, after investigation, the patient is clearly negligent, it is crucial to carefully document acts of non-compliance, explaining how patients are potentially harming themselves and others.2
Keep in mind: it is morally and ethically wrong to dismiss a patient who is deemed to be non-compliant. Nevertheless, this difficult task occasionally has to be done. If so, it is important to provide the patient with a list of alternate providers in an effort to avoid any abandonment concerns.2
Working Together for Lens Wear Success
Despite these aforementioned concerns, contact lens wear remains a safe and effective way to correct refractive errors. Let’s make sure we are doing our share in cultivating eye care excellence. When responsibility is shared by manufacturers, practitioners and patients, we can all rest assured that lens wear can be enjoyed with a minimal risk of adverse events.
1. Cunlin W, Hefflin B, Cope JU, et al. Emergency department visits for medical device-associated adverse events among children. Pediatrics. 2010;126(2):247-59.
2. Realini T. Firing the non-compliant patient. EyeWorld. 2010 Feb:29.