Patient compliance with contemporary contact lenses: Impact on successful contact lens wear
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Purpose: Contact lens (CL) materials, modalities of wear and replacement, and care systems have changed considerably since the early studies of CL compliance were first conducted. Silicone hydrogel (SiHy) and daily disposable (DD) lenses are now the most popular lenses worn worldwide and the care systems that are currently available for them have been designed to be straightforward to use. The purpose of this research was to investigate patient knowledge of and compliance with the use of these contemporary CLs and care products, to determine whether non-compliant CL wearers experience ocular complications relating to lens wear more frequently and are more likely to discontinue lens wear, and to try to determine the factors that may constrain or enable patients to follow recommendations for appropriate lens wear and care. Methods: There are many ways in which compliance can be assessed in health care. Several different methodologies were employed during this research: A questionnaire was administered to just over 100 current lens wearers to determine whether photographic aids would help them to recognize which products they were using. More than 500 contact lens (CL) wearers were recruited by their eye care practitioners (ECPs) and mailed a questionnaire designed to evaluate their compliance with contact lens wear and care and to determine whether they had experienced any contact lens related complications which may have occurred as a result of non-compliance. Close to 5000 Current and lapsed CL wearers in Canada were recruited using Facebook to take part in an on line survey investigating CL wearing experiences during 2008 – 2010 and to establish the percentage of participants who temporarily and permanently discontinued CL wear during the period surveyed, the reasons for discontinuation and whether compliance with lens wear and care may have played a role. ECPs and patients independently completed more than 2000 linked questionnaires evaluating their contact lens wear and care. In addition the frequency with which patients attended their ECP’s office for eye examinations was assessed to determine whether there was a relationship between this and their patients’ compliance. More than 800 daily disposable contact lens (DDCL) wearers in four countries completed an online questionnaire designed to investigate how frequently they reused their lenses, the reasons for reuse and how the lenses were stored between uses. Quantitative (online questionnaire) and qualitative (focus groups) research methods were used to explore in detail the lens wear and care habits of adapted contact lens wearers in an attempt to seek a better understanding of what enables and constrains patient compliance with appropriate lens wear and lens care. Results: The rates of non-compliance with the wear of contemporary CLs were found to be similar to those previously reported. Non-compliance with recommendations for CL replacement was shown to be associated with a higher rate of CL related problems. CL wearers continue to “drop-out” for reasons of discomfort and dryness with their lenses but the drop out rates were not found to be different between compliant and non-compliant CL wearers. Patients who were non-compliant with lens replacement were found to attend their ECP’s offices less frequently. Wearers of DDCLs were the most compliant with lens replacement; however, some did report reusing these lenses and sleeping overnight in them. Focus group participants were able to provide a greater insight into why non-compliant behaviour occurs in CL wearers with the most frequently occurring themes identified as the “consequences” that may occur if patients are non-compliant with one or more aspects of their contact lens wear and the importance of receiving “instructions” regarding the most appropriate way to wear and care for their lenses. Most of the themes that emerged from this qualitative research study were both constraints to, and enablers of, compliance. Conclusions: Compliance with contemporary CLs and care products remains poor. Non-compliant behaviour can result in serious complications and patients may not always be aware of this. Careful counseling and education on the risks associated with CL wear is required to provide patients with a better lens wearing experience and continued successful contact lens wear. ECPs and the contact lens industry can hopefully apply this greater understanding of why patients fail to wear and care for their lenses as they should and to help them develop strategies and tools to aid compliance and success in contact lens wear.