Strategies to Better Engage, Educate, and Empower Patient Compliance and Safe Lens Wear: Compliance: What We Know, What We Do Not Know, and What We Need to Know

University of Connecticut Health Center, Farmington, CT, USA.
Eye & Contact Lens Science & Clinical Practice (Impact Factor: 1.47). 12/2007; 33(6 Pt 2):430-3; discussion 434. DOI: 10.1097/ICL.0b013e318157f62a
Source: PubMed


To assess the extent of noncompliant behavior of contact lens wearers and to develop strategies of engaging and educating patients to increase compliance with safe contact lens practices.
The literature regarding noncompliance with medical regimens, contact lens wear, and cleaning was reviewed. One hundred eleven contact lens wearers from a college campus, a dental clinic, and ophthalmology clinics were surveyed in a pilot study regarding their contact lens knowledge, attitudes, and practices. Statistical analysis of the results was performed with SPSS software.
A review of the literature found overall rates of noncompliance with medical regimens varies from 24.8% to 44%, and the rates reported for contact lens wearers varies from 50% to 99%. Noncompliant behavior affecting the safety of contact lenses is more common than behavior affecting lens comfort. This study found that many lens wearers thought they were compliant, but actually reported a wide variety of noncompliant behaviors.
Although there have been remarkable advances in contact lens science, noncompliance with lens-wearing schedules, replacement schedules, and lens care regimens remains a significant problem of contact lens complications and lens failure. Noncompliant behavior is a complex phenomenon that involves knowledge, attitudes and beliefs, and available resources. Data regarding strategies for increasing compliance are scant. Noncompliance must be considered in the development of future lens care products and must be addressed by eye care professionals when patients are fitted with contact lenses and at each follow-up appointment.

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    • "In the light of these findings, it is essential that CL care products, especially CL care solutions, should be designed to sufficiently decrease the amount of potential pathogens in order to minimise the risk of CL-related infections. CL care products should ideally have a certain level of ‘excess efficacy’, or safety margin [36,37]. Unfortunately, different CL care solutions do not even provide a minimum of safety for the wearer and had to be taken off the market as they were associated with CL-related microbial keratitis [11,38-44]. "
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    ABSTRACT: Background Contact lens-related infections are often associated with inadequate contact lens hygiene, and therefore, contact lens care products should be able to sufficiently minimise the amount of pathogens that are responsible for these infections. In 2001, the EN ISO 14729 was introduced to ensure adequate disinfection efficacy of contact lens care solutions, but this norm has recently been criticised. Methods In this study, six frequently used contact lens care solutions were retested according to the Stand Alone Test of the EN ISO 14729 (2001). The Stand Alone Test is a quantitative suspension test. In addition, the products were tested in a modified setting adding an organic load. The load was a mixture of human blood serum, lysozyme, and mucine, which resembles tear fluid. Results The criteria of the Stand Alone Test recommended in EN ISO 14729 were only met by Aosept Plus. This 3% hydrogen-peroxide-based contact lens care solution attained a reduction factor of > 5 log units for bacteria and > 4 for fungi in all cases. Two further contact lens care solutions, Blue Vision and Optifree Replenish, met the criteria of a reduction factor of > 3 log units for bacteria and > 1 log unit for fungi, but only in the presence of artificial tear fluid. The three remaining products did not exhibit adequate disinfecting efficacy, at least against one of the tested microorganisms. Conclusions Through the observation that the artificial tear fluid used in this study influences the disinfecting efficacy of contact lens care solutions, especially that of multi-purpose solutions, in a different way than does albumin, mucine, or even the organic load suggested in EN ISO 14729, it becomes obvious that the test conditions in the EN ISO 14729 should be revised in order to create more realistic conditions, e.g., by using a more realistic artificial tear fluid. Furthermore, we suggest adapting the EN ISO 14729 to the European test hierarchy for chemical disinfectants and antiseptics, which consists of three test phases and also requests meeting stricter criteria in order to pass the test. Unless the test conditions guarantee a sufficient reduction of potential pathogens, the risk of contact lens-related microbial keratitis and other infections will remain for the users.
    BMC Infectious Diseases 10/2012; 12(1):241. DOI:10.1186/1471-2334-12-241 · 2.61 Impact Factor
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    • "However, other complications do still occur periodically, including cases of corneal inflammation, infection and mechanical disruption [8] [9] [10] [11] [12]. While many studies have investigated the impact of lens replacement frequency (RF) on contact lens complications in conventional hydrogel lens wearers [13] [14] [15] [16] [17] [18], this has not been extensively evaluated in silicone hydrogel lens wearers. "
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    ABSTRACT: To evaluate the relationship between compliance with replacement frequency (RF) and contact lens (CL)-related problems in silicone hydrogel (SiHy) wearers. 501 SiHy wearers from seven optometry offices completed surveys regarding their lens wear and any CL related problems which they may have experienced in the preceding 12 months. File review was subsequently conducted at their optometry offices to confirm the information provided. 49% of respondents were wearing 2-week replacement (2WR) and 51% 1-month replacement (1MR) SiHy lenses. 67% wore their lenses for longer than the manufacturers' recommended RF (MRRF) and 60% for longer than their optometrist's recommended RF (ORRF). The mean RF was 2.6× the MRRF for 2WR and 1.5× for 1MR wearers (p<0.001) with median values of 31 and 37 days, respectively. Twenty-three percent reported signs or symptoms consistent with potential complications relating to CL wear. This rate was significantly higher for wearers who were non-compliant with the ORRF than compliant wearers (26% versus 18%, p=0.028). It was also higher for those multipurpose solution users who reported never/almost never rubbing and rinsing their lenses when compared with those who did this every night (29% versus 17%, p=0.007). Two thirds of the SiHy wearers did not comply with the MRRF and 2WR wearers stretched the replacement interval of their lenses to a greater degree than 1MR wearers. Failing to replace lenses when recommended and failing to rub and rinse lenses were associated with a higher rate of patient-reported CL problems.
    Contact lens & anterior eye: the journal of the British Contact Lens Association 04/2011; 34(5):216-22. DOI:10.1016/j.clae.2011.03.001 · 1.37 Impact Factor
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    ABSTRACT: as using solution, storing in a lens case and closing the case tightly, were correctly performed by more than 80% of wearers. However, other areas - too many days of wear, overnight use of lenses prescribed for daily wear, incorrect hand-washing and topping up solutions - had only moderate levels of compliance (40-80%). Napping with lenses, case replacement and case cleaning, and checking expiry dates were associated with high levels of non-compliance (less than 40% compliant).
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