I am a contact lens enthusiast. I am an optometrist and an optimist; I sing along to Bing Crosby’s classic hit – ‘Accentuate the positive, eliminate the negative’ and yes, you guessed it (not least by my musical recall), I am a presbyope. Phew – disclaimers up front and out of the way.
I have never been comfortable with the term ‘dropout’ – sounds too negative, a failure, been there done that, unsuccessful, outcast. An optimist takes a more positive approach – focusing on how to retain wearers for longer, to meet an individual’s needs throughout their lifetime.
Eyes change, lives change – our needs change. So, as eye care practitioners, do we really know our patients, and understand their individual needs and preferences at different stages in their life? I believe we can do more to improve the experience of a contact lens wearer, not least by speaking positively and personally about the benefits of contact lenses to each and every individual.
My initial passion for contact lens work was not as a wearer (I am an emmetrope), but was ignited by patient reactions – the smile on their face when you mention there is an alternative to spectacles. I experienced early on in my career, the difference tiny, ‘invisible pieces of plastic’ could make to the confidence of children and adults alike.
Even now, 25 years on, I still get a buzz from reactions of groups of schoolchildren when I pass around sample lenses to ‘touch and feel’ their softness and moistness. Anxiety removed, and the barrier of ‘pokephobia’ significantly reduced by a simple demonstration.
The innovation of daily disposables in the mid-1990s, provided a boost for contact lens retention, removing the need for solutions, cases, and complicated care regimes. Consumer insights and clinical performance studies continue to support the significant benefits of this modality, and the convenience to the wearer should not be underestimated.
Fifteen years ago, Professor Graeme Young and I designed a study on contact lens dropouts which is still often cited.1 I recall two key learnings from involvement in this research study. Lapsed wearers are more common than you think and can easily be tempted back, requiring no more than a simple notice in the practice window (not all clinical studies are so easy to recruit for).2 Astigmats are over-represented among dropouts, but most could be successfully refitted with soft toric lenses.
Since this study, although there have been significant inroads to correcting more astigmats with contact lenses and further product advancements – many astigmats are still unaware they can be fully corrected with contact lenses. More work still to be done here to meet spectacle prescribing standards.
Sadly, some 15 years later we are still discussing the ‘leaky bucket’, but new, deeper insights are changing our thinking on who, why and when wearers dropout. For years we have heard discontinuation is primarily due to discomfort, which remains true for many established wearers, not forgetting vision too.
For new wearers, recent studies published by Sulley and Young2,3 show dropout can occur surprisingly early in their wearing experience, with various reasons cited for cessation. A multi-faceted approach is often required, with attention to comfort, vision, handling and convenience.
As an educator at the Johnson & Johnson Institute, I follow the mantra ‘Tell me and I will forget, show me and I will remember, involve me and I will understand.’ Understanding patients’ needs is put at the core of our courses – delegate workshops often result in the realisation that we might think we have communicated successfully with our patient, but from the patient’s perspective there is a disconnect. Effective communication is key. A simple progress call and a dose of personalised positivity may help more wearers to continue enjoying the benefits of lens wear.
Most dropouts are not talking to their eye care professional about problems
I recently became a new wearer myself – with increasing presbyopia my needs changed and now I enjoy the benefits of 1-Day Acuvue Moist Multifocal brand contact lenses, interchanging with reading specs on other days. My choice, to fit my lifestyle. Sadly, so few presbyopes are aware multifocal contact lenses are even an option for them.
In my opinion, it is hugely disappointing, to learn the number of new contact lens wearers is roughly equivalent to the number of wearers dropping out. This means that all the efforts the eye care professional does to attract new wearers, assess their ocular physiology, trial and fit the most appropriate contact lenses, teach young, old and in between, how to apply and remove, wear, care and more, results in little net gain in overall wearers, because as nearly as many wearers are dropping out each year.
Not in my practice, I hear you say. Wearers do not drop out in my practice. But do you really know?4
References
1 Young G, Veys J, Pritchard N et al. A multicentre study of lapsed contact lens wearers. Ophthal Physiol Opt 2002 22:516-527.
2 Sulley A , Young G and Hunt C. Factors in the success of new contact lens wearers. Cont Lens Anterior Eye 2016;40:1 15-24.
3 Sulley A, Young G and Hunt C et al. Retention rates in new contact lens wearers. Eye & CL 2017 (in press).
4 JJVC Data on file 2016. CL Drop Out Deep Dive. Independent Qualitative Interviews N= 36 patients; 12 ECPs and Quantitative Online Survey N=308 lapsed wearers UK and Germany.