Meeting the critical need for contact lens comfort
Eye care professionals identified the importance of comfort to patient satisfaction and improving levels of dropout in a roundtable hosted by Alcon and OT
While it can be hard to comprehensively define ‘comfort’ and ‘discomfort’ in contact lens wear, addressing any issues a patient may face is crucial for ensuring that they do not discontinue wear – a message that was reiterated during a roundtable of eye care professionals held by OT and contact lens manufacturer, Alcon.
Defining and addressing comfortA 2013 report by the Tear Film & Ocular Surface Society (TFOS) indicated that contact lens discomfort is a “regular and ongoing” problem for practices, with estimates suggesting that 31% – 79% of contact lens wearers experience discomfort.
With comfort being a subjective and non-clinical test, eye care professionals (ECPs) recognised that this can be hard to measure.
Considering how to define comfort, Kieran Minshull, director and contact lens optician at LK Leon in London, pointed out that what a patient deems to be an acceptable level of comfort may depend on how determined they are to continue wearing their contact lenses.
“What might be acceptable for a patient who enjoys wearing their contact lenses, someone else could find that level of comfort unacceptable,” Mr Minshull said.
To truly gain an understanding of a patient’s comfort, the ECPs suggested that a deeper level of questioning is needed.
“I very rarely talk to a patient about contact lens comfort because it is quite ambiguous,” explained Michelle Beach, optometrist and founder of Park Vision in Nottingham. She suggested, instead, asking a variety of questions to ascertain comfort, such as: “When are you taking them out and why? Can you feel them? Do they feel gritty? Do you think your vision suffers?”
Sacchin Sharma, optometrist and director at Scott Waters Opticians in Newbury, suggested that the wear-time a patient can achieve with their contact lenses is also a “tell-tale sign” of how comfortable their lenses feel.
When fitting a new contact lens patient, ECPs agreed that communication, and building a rapport, was key. As clinical questions do not always create space for relationship-building, it is also important to ask more personal questions to get to know the patient.
Mr Sharma commented: “Asking about their hobbies and getting to know the patient more is very important for us to break the ice, and understand what they are trying to achieve from their contact lenses.”
Mr Minshull suggested that patients who are struggling with discomfort in their contact lens wear can struggle to define exactly how their lenses feel.
“I think we need to open the conversation a little more to find out exactly what they are feeling. If they are able to be more specific with the symptoms, that may help us to move things forward to find a better solution,” he said.
However, all ECPs pointed to time constraints as the biggest limiting factor when exploring comfort with patients, reducing the questions that practitioners can ask in a consultation.
Declan Hovenden, optometrist and head of optometry at the Technical University, Dublin, asserted that more research is needed into the issues that prevent practitioners being as proactive as they could. He told the group: “If we could understand the barriers better amongst our peers, then we would be in a better position to move forward, advise them on how to change that and how we deal with contact lens practice as a profession. That would address the level of contact lens discontinuation.”
Responding to patients needs
Research quoted by Professor Philip Morgan, head of optometry and director of Eurolens Research at the University of Manchester, in a recent report, noted that 73% of patients who are considering discontinuing lens wear did not intend to discuss it with their practitioner, raising it instead with friends or consulting the internet. Commenting on these findings, Mr Hovenden emphasised that developing rapport is important for building trust and the patient’s sense that they can return to the practice if they have any problems.
Ms Beach also said that she found the report “powerful,” particularly noting research cited that found that contact lens wearers who discontinue in the first year tend to do so within the first two months.
As a result of the report, Ms Beach explained that she had appointed a ‘contact lens buddy’ in the practice to keep in regular contact with new patients after their fittings, establishing open communication.
Being pro-active is key for catching contact lens patients with the potential to dropout, particularly in the initial few months of a contact lens trial, the group agreed. A report by TFOS highlighted the importance of early intervention to prevent and manage contact lens discomfort, “even before the onset of symptoms,” to improve long-term prognosis for successful wear.
Commenting on the importance of contacting the patient proactively to ask how they are getting on, Mr Minshull shared: “It’s critical that there is a series of contact points with the patient, certainly in the first few months, to examine exactly what is problem, and make them feel comfortable to come in if there are any issues.”
The patient-practitioner relationship is key
“The emphasis around communication is very important. We can talk about the clinical things we can do, the solutions we can come up with, but at the core of it all is communication and making sure the channels of communication are open between the practitioner and patient.”
Michelle Beach, optometrist and practice owner, Park Vision, Nottingham
“As an ECP you have to remember, if you get a patient who is happy in their contact lenses, they are really, really loyal.”
Kieran Minshull, contact lens optician and director, LK Leon, London
“We need to go through the pre-screening of a patient a little more so we have an indication of where potential complications are going to arise. We need to have systems in place where we can check with patients on regular occasions to see how they are doing, to guide them through those crucial first weeks.”
Sacchin Sharma, optometrist and director, Scott Waters Opticians, Newbury
“Creating a relationship with a patient where they can talk to you openly is very important. Time can limit how many questions you can ask in a session, so having your own checklist in your mind is a good starting point.”
As well as addressing any issues with new contact lens wearers, ECPs also recognised the need to offer new and updated material technologies to existing patients. Even where they have not expressed any issues with comfort, new products could offer an enhanced experience, it was agreed by the group.
“We have a duty as a practitioner to inform patients that there are better products on the market for them to try,” Mr Minshull said.
Using the right language when discussing new contact lens products with patients was also important.
“I find a lot of patients want the ‘latest’,” explained Mr Hovenden. “Most people want to be up-to-date and want to have what they perceive as the best. Usually in most people’s minds; the latest equals the best.”
Trust, communication and getting to the root of dropout
- Communication and the relationship between practitioner and patient builds trust, which then allows them to come to the ECP with challenges.
- Think beyond the typical clinical questions used in a fitting that tend to give us simply yes or no answers. When you’re getting into the lifestyle of the patient and finding out more about their needs, it reaches a point where comfort or discomfort of the patient can be uncovered.
- Contact lenses are vital to the business. In rejigging some of the things we would normally do in practice, ECPs can identify the potential for dropout and increase comfort for patients.
Considering the bigger picture
Research by Professor Morgan noted that contact lens discontinuation also has a global impact on the contact lens sector, particularly the size of the market.
Calling this a “huge missed opportunity,” Ms Beach pointed out that many of those patients who drop-out would otherwise be visiting the practice regularly, potentially buying new glasses of sunglasses and driving additional revenues.
Reflecting on the level of patients potentially discontinuing contact lens wear, Ms Beach continued: “I would consider that a bit of a failure – and we’re not doing enough about that.”
Building on this conclusion, Mr Hovenden noted that it is not simply issues of discomfort, such as dryness, that are the cause of dropouts. “It is our failure to manage the dryness that is causing the dropout of lens wear,” he said.
As many people now turn to social media to share their experiences or seek out views from others, Mr Minshull observed that if a contact lens does not suit a patient, they could share their negative experience on social media – potentially dissuading new customers.
Meanwhile, a positive experience of contact lens wear – whether a first-time wearer, or a patient who receives a product that enhances their comfort – can also be spread through the patient’s social groups, Mr Sharma noted, emphasising the importance of sharing positive testimonials.
“This spreads amongst family and friends. If you give someone a good solution, they are going to mention it,” he added.
Watch the roundtable, hosted by OT and Alcon, below, or to watch the discussion in full, click here.
Top tips: delivering a good contact lens service
“Supply the best possible lens for that patient. Give them the opportunity to experience it and decide whether it is an affordable option for them. You want to simplify the process so you don’t have to take steps to refit later.
“It is doesn’t work, such as for finance reasons, then it has to be explained that going down one lens option may reduce the comfort.”
“If problems with discomfort are not addressed and they are allowed to discontinue the lenses, they equate that one experience of lenses with all contact lenses that are out there.
“Communicating the message that there are things we can do and that there is always an alternative or solutions to problems that arise is important, so patients don’t equate their one and only experience of contact lenses with the whole world of contact lenses.
“It’s really worth doing the pre-fitting homework. Find out as much as you can about the patient and exactly what they want in terms of contact lens wear.
“Have a look at what their eye looks like before you even start. Try and pre-empt comfort problems and complications. Then if they start to feel they are getting problems, they might remember that: ‘She mentioned I might have this issue, so I can go and talk to her about it.’”
“Quite often, I’ll compare contact lenses to a nice pair of trainers. The recommended trainer might vary depending on what sport or daily activities you need them for. It doesn’t mean everyone can wear or complete the same tasks with those trainers on. Not everyone will be able to wear the contact lenses all day, for example.
“But our aim as ECPs is to get you something that is going to provide the best comfort possible, for the most amount of time possible.”