Comfort is king

The scenario

As a locum optometrist working across a wide range of practices, the most common feedback I hear from contact lens wearers is that they would like to be comfortable in their contact lenses for longer. Can you advise on how to have an effective upgrade conversation whilst managing expectations?

Prinal, locum optometrist

The advice

Nadia Siddiqi, optometrist, professional affairs consultant and faculty member of the Vision team at Johnson & Johnson

Once the patient is seated, I like to begin with an open discussion about their wearing patterns since the last visit. The aim is to detect any shifts in wearing behaviour that the patient may or may not have consciously recognised. For example, a patient might report no changes to their contact lens wear, yet have an uncollected three-month supply, indicating a reduction in actual wear. This information can provide valuable initial insights into compliance, lifestyle adjustments or even potential barriers to lens use.

Changes in the vision or comfort a patient is getting when wearing their lenses can be subtle and it is important that we as eye care professionals try to spot these changes in the early stages. Earlier intervention is not only more successful but often less complex, as patients at this stage are often more receptive to advice or adjustments. If a patient gets to the point where they have stopped lens wear, regaining their willingness to try again requires significantly more effort and may involve overcoming negative perceptions which can prove to be challenging.

This does mean that a large number of patients think they could be happier in their contact lenses and that’s worrying as that could cause dropout of wear

Key questions

Research has shown that three out of four patients would like more from their contact lenses. That’s not to say they are unhappy, it’s just to say that there is something missing or something a little bit extra they would like when wearing their lenses.

However, this does mean that a large number of patients think they could be happier in their contact lenses and that’s worrying as that could cause dropout of wear.

I have a pool of questions that I can draw upon when speaking to contact lens patients about their lenses. These questions are designed to be open and conversational.

First of all, I may ask if there is anything they would like to change about their lenses. This question provides me with an idea of their happiness in their lenses. I will follow up by asking if there is something they would like out of their lenses that they are not receiving now.

I will try to read between the lines and pick up on cues that enable me to delve deeper. For example, if the patient is only wearing lenses for specific tasks or at particular times of the day, I might ask why they wear them for that task. This helps me to figure out what other solutions could work for them and why. The patient may say they only wear their lenses to the gym, but what may be overlooked is that they may be wearing the lenses on the drive to the gym as well, which is important to note.

I also like to ask patients to grade their level of comfort in their contact lenses out of ten at key points in the day or during certain tasks – for example morning, during the day and at the end of the day. A patient may start as a ten out of ten but end up as a five out of ten. The average they give may be a seven, which without the extra detail may be misconstrued as adequate. It is important to be aware at what point in their journey comfort is at it’s lowest – this allows us to better identify periods or tasks where comfort could be improved.

Comfort is a broad topic. It can be categorised into visual comfort and physical comfort and determining which is affecting the patient is important. For example, visually if the patient is finding tasks trickier, it could it be that there is instability of the lens, or there may be a refractive/contact lens design amendment you could make that could improve things. Physical comfort would be classified by the feeling of the lens on the eye or indeed lack of feeling of the lens.

The patient will not necessarily know the difference between these types of comfort. They might just say that their eyes feel tired or heavy at the end of the day. It is therefore down to us as clinicians to figure it out and resolve these issues for them, ultimately increasing their overall comfort throughout the day’s wear.

Contact lenses all look similar and patients won’t necessarily know the difference, so they rely on us as clinicians to identify their needs and recommend a lens that meets them

Patient expectations and understanding

It is important to make sure that patients understand that contact lenses are not a one-size-fits-all. A lot of patients may have only experienced one contact lens design or material and that’s their only point of reference. Offering a trial upgrade, (even for happy patients), can be useful to ensure that they have a point of comparison, supporting them in gauging if their vision could be improved or they could be more comfortable in a different lens design or material. I find contact lens patients sometimes tolerate something unnecessarily as they don’t know what alternatives are available.

Analogies also work well with patients. I sometimes equate selecting contact lenses to buying a new computer. If you are not tech savvy and have three different computers in front of you, you may not know which would best meet your needs. You would likely seek reviews online or speak to an expert about your needs and from that choose the one that best meets your requirements.

Similarly, contact lenses all look similar and patients won’t necessarily know the difference, so they rely on us as clinicians to identify their needs and recommend a lens that suits. When recommending a new lens, I will aways directly relate it’s properties to the benefits it will bring to them and I find this a successful method to open patients up to try something new.

This approach allows a patient to understand the features of a lens without getting too technical. You don’t want to bombard them with fancy names and terms, they just need to know how the features can benefit them specifically.

By letting them know that not all contact lenses are equal, that their vision can change, and there is scope for improvement may mean they present to practice if an issue occurs rather than dropout of lens wear

The upgrade conversation

When talking to patients about their contact lens wear behaviours and comfort we should be mindful that if a patient has been in a particular contact lens for a long time it may no longer be suitable. It may well have been the right choice when they were first fitted, but their eyes and the environments they find themselves in may have changed. What worked for someone in their mid-twenties may no longer work as they approach their forties. Another analogy can be useful here – the moisturiser that we used as a teenager is unlikely to be the most suitable for our skin further down the line.

Refocusing on comfort and grading, if a patient grades their lens comfort as seven out of ten at the end of the day and they are happy, you could ask the patient if they would like you to try to make it a nine. This type of question opens the patient up to thinking that there is potential to improve things rather than having to accept the status quo.

When you pose it in that way, a patient becomes more open to discussing an upgrade. It is not perceived as a sell as you have made it specifically relevant. For example, I might say; ‘So if we want to increase the comfort level from your seven to potentially a nine, we could consider lens ‘x’ because I think it will help your eyes with this task and be much more comfortable while you’re working in air conditioning.’

For the patient with no complaints, I would still offer a trial of an upgraded lens. I offer this as a no obligation opportunity to try the latest technology and seek to hear the patient’s valuable feedback. Even if the patient doesn’t take the trial there and then, they know that there is potential for that in the future.

By letting my patients know that not all contact lenses are equal, that their vision or comfort can change and that there is scope for improvement, may mean they present to practice in future if an issue occurs, rather than dropout of lens wear without the opportunity for me to intervene.