Majority of people do not follow standard guidelines for lens wear and care

Dec 1 2011

Most people who wear contact lenses perceive themselves as following standard guidelines for lens wear and care—but only a tiny minority are actually compliant with all recommended care steps, according to a study in the November issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

A "significant proportion" of patients don't follow recommended care even though they're aware that their behavior places them at increased risk of complications, according to the new research by Danielle M. Robertson, OD, PhD, and H. Dwight Cavanagh, MD, PhD, of The University of Texas Southwestern Medical Center, Dallas.

More than 80 Percent of Patients Say They Follow Recommended Care…

The researchers analyzed contact lens care practices and knowledge of complications and risk factors in two groups of contact lens wearers: 281 patients visiting a random sample of eye care practitioners in the Dallas-Fort Worth area and 152 seen at a university eye clinic.

In both groups, most patients could name a complication related to contact lens wear: 58 percent in the general community and 91 percent at the university clinic. The most commonly named complications were those related to lens comfort/handling and infections.

Differences in knowledge and perceptions between groups likely reflected the higher rate of significant eye problems in the university group. There were only marginal differences in contact lens-related complications between groups.

Most patients could identify important risk factors for lens-related complications. These include "topping off" rather than replacing contact lens solution; exposing lenses to tap water, including wearing lenses while showering; and poor hygiene practice. "Overall, 85 percent of patients perceived themselves as compliant with their lens wear and care practices," Drs Robertson and Cavanagh write.

…But Only Two Percent Have Good Compliance

However, when the researchers used a standard model to determine the patients' actual level of compliance with recommended care steps, the results were very different. In this model, compliance was rated good for only two percent of patients. "The average contact lens wearer only performed 50 percent of the recommended behaviors," according to the authors.

Just one patient was "fully compliant" with all recommended contact lens wear and care practices: a rate of 0.4 percent. Drs Robertson and Cavanagh point out, "While most patients consider themselves to be complying with standard practitioner guidelines for lens wear and care practices, essentially all contact lens wearing patients exhibit behavioral non-compliance with resulting increased risk for significant complications."

Given that most patients knew the risk factors for complications yet very few followed recommended care steps, "[A]wareness of risk alone is not a driving factor establishing compliant behavior," the researchers write. Failure to follow recommended lens care a "persistent clinical problem" for eye care practitioners. Despite low compliance rates reported in this and previous studies, rates of severe complications associated with contact lens wear are relatively low.

Since patients are already aware that not following recommended lens care increases their risk of complications, further education doesn't seem likely to lead to long-term changes in behavior. "New strategies and approaches to effectively modify inherent patient non-compliance are urgently needed," Drs Robertson and Cavanagh conclude.