This exercise proved interesting, not least to see if there had been any change in practitioner views regarding aftercare frequency from the last time we published such an exercise over two years ago. As was noted then, typical responses to the question of how to decide on aftercare frequency included ‘if there are no problems the next aftercare is in six months’ and ‘my colleagues and I will on the whole see patients at six-monthly intervals’. In fact, over 50 per cent of respondents had a six-month frequency as the default period. Reasons for this were not always stated, though many suggested it was to do with the design of the appointment-keeping systems. Adoption of a flexible approach, whereby no set time period exists and each case is decided on assessment (whether one week to two years), was the approach of just 10% of respondents to this exercise.
So have things changed in 2016, bearing in mind a noted increase in presbyopic lens wearers and paediatric lens use for various reasons?
Annual frequency
The overall pattern of aftercare frequency indeed does seem to have changed, based on your responses, with a move towards annual aftercare frequency when no problems are reported or predicted. Less than 20% have an automatic default to six-monthly aftercares, and the majority (more than 70%) now look to 12-month frequency.
Here is a typical response from your discussions. ‘It was agreed that the first appointment would take place approximately two to four weeks after the collection appointment. This is to review how the patient is getting on with the lenses and the information given at the collection appointment is understood and complied with. The aftercare is recommended to be three to six months later. At this appointment, compliance is reviewed on average wear time, cleaning regime (if applicable) and replacing the lenses as specified in the collection appointment [considered]. Also the lenses performance on the eye is assessed and their effect on ocular health. Any issues are tackled and resolved. The next schedule appointment is 12 months later and at 12-monthly intervals thereafter providing there are no visual/ocular health issues.’
The majority of you wisely add the proviso that 12 months may not always suit. For example, ‘The aftercare frequency is dictated by lens type (monthlies/dailies), average wearing time, lens replacement frequency and age. An example of this is a patient wearing continuous wear lenses. These patients need to be seen on a more regular basis as they are at more risk of microbial keratitis. The recommended aftercare schedule after the collection appointment is the morning after the first overnight wear, one week later, one month later, and six-monthly thereafter.’
Another commented that 12 months ‘would not suit all wearers, if there were any signs of problems due to, say, tear quality or failure to stick to agreed wearing times we would both want to see the patient more frequently than this. Also, where the lens type was more complex the schedule would be different. An example we discussed was an extended wear patient, where we would want to see them the day after their first sleep with them in, then again after a week, then at three months. We would then go on to see them probably every three to six months depending on what we had seen at the previous aftercare visits.’
Of those still advocating a six-month default, this answer was typical. ‘[For] New wearers I would recommend one month, three months and then six-monthly check ups and this would be the same for neophyte wearers. In the early days it is extra important to check handling, hygiene, etc, and to rectify any early bad habits.’ A small number of you implied that recommending a six-monthly frequency was most appropriate to your confidence and experience level, or as in the following response, to maintain a good relationship with the patient. ‘We both agree that for the new wearer where there are no complications, we would see them every six months. However, if after a few years they are still free of complications, my colleague may well see them once a year. I would rather stick with six-monthly check ups because I think it’s better for the patient/practitioner relationship.’
Two yearly appointments
Around 10 per cent of you also suggested that, in some circumstances, 24-month review might be appropriate – something that was little mentioned in the last CET exercise. ‘We both agreed that, for daily wear lenses, whether daily or monthly disposable, we would want to see the patient again about two weeks after collection to check eye health, lens fit, patient compliance and handling. Assuming no problems at that stage, I then would probably see them at six months and then two yearly, whereas my colleague would prefer to see them annually.’
Another suggested that annual appointments ‘may not be necessary for all neophyte wearers, for example one who wears lenses very infrequently, perhaps once a week to participate in sport. It would not be unreasonable, after the first annual check-up, to see such an individual every two years. In all cases patients should be advised to return sooner if any problems arise.’
Finally, another new trend was the increased use of remote checks. ‘It was discussed that in some cases we may be able to forego the appointment after four weeks and replace it with a telephone consultation to discuss their new lenses, care regime and any concerns and then their next aftercare would be in three months.’