Next month optician begins a CET series looking at the influences on compliance among contact lens wearers. In advance of this, Bill Harvey encourages practitioners to take a proactive approach to educating patients on contact lens wear
The patient may have no clear idea about contact lenses in general and so a good deal of information may need to be given in a clear and concise form before any actual examination takes place. In many cases a patient may have some confused or exaggerated belief about lenses which may need clarification. Very often the patient requires simple reassurance.
During the examination and fitting, a practitioner needs to assess the suitability of the patient and must consider indications and contra-indications for lens wear or for a particular choice of lens design or material. Furthermore, during the aftercare consultations, the practitioner should ascertain how the patient is coping with their lenses. Contact lenses require a degree of compliance on the part of the patient for successful wear. Compliance with, and understanding of, advice is a very important area of study in many clinical disciplines.
It is obviously true that a large proportion of ametropes are not corrected by contact lenses. It is unlikely that these patients are all familiar with the pros and cons of contact lens wear or are unsuitable for a particular clinical reason. A large number of these people might actually consider contact lens wear if offered the option with all the relevant and necessary information. The optometrist or contact lens practitioner is surely the best person to make such a recommendation.
Such behaviour on the part of the practitioner might be termed 'proactive'. Reactive behaviour might describe the action of discussing and fitting contact lenses only when asked to by the patient. This is dependent to a large extent on a filtering of awareness and knowledge of contact lenses through society as a whole and is, therefore, open to the influence of myth, hearsay and many various health beliefs.
Several studies have attempted to assess the effect of proactive behaviour in consultations. Jones et al1 reported a six-fold increase in the number of patients fitted successfully with contact lenses when a proactive behaviour was adopted.
Morgan et al2 compared the successful uptake of contact lenses in a selected sample of 300 patients who were divided into groups exposed to either reactive behaviour or proactive behaviour by the participating practitioners. It was found that a proactive approach almost doubled the contact lens prescribing rate.
A proactive approach might include mention of various advantages of contact lens wear as indicated in the table. It is hoped that a full eye examination would allow the practitioner to develop a good knowledge of the patient's overall requirements and thus allow for a proactive approach based on the considerations listed.
References
1 Jones et al. Reactive or proactive contact lens fitting-does it make a difference? Journal of the BCLA, 1996; 19, 2:41-43.
2 Morgan et al. The benefits of a proactive approach to contact lens fitting. Journal of the BCLA, 1996; 19,3:97-101.
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