I’ve heard plenty of patients complain about the cost of contact lens care over the years. Many frequently cite the cost of contact lens solutions as a barrier to exercising proper compliance.1
However, most patients do not even know when they are engaging in non-compliant behavior. For example, one study found that 85% of patients perceived themselves as compliant.2 Of this number, only 2% could demonstrate good compliance, and just 0.4% were fully compliant.
It is worth noting that nearly 3% of people who drop out of contact lens wear blame their dropout on difficulties in lens care.3
Of course, as eye care practitioners, we know that being non-compliant increases the risk of adverse events. Complications from non-compliant behavior can range anywhere from simple discomfort to microbial keratitis. In fact, it is estimated that patients who top off the lens case are three times more likely to contract microbial keratitis.4
According to the FDA, at least 45% of lens wearers will top off their solutions.5 Therefore, we can see a legitimate cost for non-compliance. When compared side-to-side with the cost of compliance, it is understandable why patients often make this cost choice.
It is our responsibility as primary care practitioners to remind and to educate our patients on the risks of poor compliance at every visit.
What We Can Do
There are many strategies to achieving proper compliance, but let’s take a look at just a few of the tangible steps that involve lens care products. This includes rubbing and rinsing the lens after removal (which should be a five-second rinse, according to package instructions and FDA approval) and completely filling the lens case wells with fresh solution each time the lenses are stored.
The average cost of a 10-ounce bottle of the most current generation multipurpose solutions at a big-box retailer is $9.00. For adequate rubbing and rinsing, approximately 5mL of solution (2.5mL/lens) should be used. The average case well holds 2.5mL of solution, the amount necessary to properly disinfect the contact lens.
This breaks down to roughly three cents/mL of solution—just 30 cents per day for compliant use of multipurpose solutions.
Generic solutions can pose a threat to contact lens comfort. Generic solutions are formulated with past lens materials in mind, before the push for synergistic biocompatibility with the ocular surface. This makes many generics unsuitable for use with modern contact lenses. In addition, the solution in the generic container may actually change as the product goes up for bid and the manufacturer changes.
However, the cost savings of generics will continue to appeal to consumers. At only $3.25 per 10-ounce bottle, the cost for “compliant use” is about 10 cents per day.
If we look at this from another angle, to be truly compliant, approximately ten 10-ounce bottles of multipurpose lens solutions are needed each year. This adds up to a total cost of approximately $90 per year for name-brand solutions vs. just $32.50 per year for generic solutions. Most patients are using only 33 ounces of solution (about 3.5 bottles) each year.
Of course, we know the source of this discrepancy; patients are topping off their lens case wells, or are completely skipping the rub and rinse step, which patients typically see as leading to additional cost savings. The average patient spends just $30 per year on current generation, name-brand solutions, and only $10 per year on generics.
While the cost of compliance may seem daunting to some patients in strict monetary value, the cost of non-compliance—e.g., discomfort, dryness, blurred vision, redness and infection—can be even higher. In some extreme scenarios, non-compliance can lead to vision loss.
If lens care compliance is simply too much for patients, the average cost of daily disposable lenses comes out to about a dollar a day. Compared to lens care solutions, daily disposables are only 32 cents a day more (16 cents per eye) than the use of lens replacement and solutions.
1. Donshik, Ehlers, Anderson, Suchecki. Compliance: What We Know, What We Do Not Know and What We Need to Know. Eye & Contact Lens. 2007;33(6):430-433.
2. Robertson D, Cavanagh D. Non-Compliance with Contact Lens Wear and Care Practices: a Comparative Analysis Optometry and Vision Science. 2011 Dec;88(12).
3. Rumpakis J. New Data on Contact Lens Dropouts: An International Perspective. Review of Optometry. 2010 Jan;147(1).
5. Eydelman MB, Tarver ME, Kiang T, Alexander KY, Hutter JC. The Food and Drug Administration’s Role in Establishing and Maintaining Safeguards for Contact Lenses and Lens Care Products. Eye and Contact Lens. 2012 Nov;38(6):346-349.