Patient compliance with contact lens wear and care is important to avoid complications. Non-compliance can be unintentional due to misunderstanding instructions, or deliberate by ignoring advice. Three key factors are proper hand washing, cleaning lens cases regularly, and using care solutions as prescribed. Practitioners should provide clear written and verbal instructions, check understanding, and encourage compliance through regular follow ups.

2. PRESENTATION OUTLINE:
1. Definition of Compliance.
2. Methods to improve Patient Compliance.
3. Types of Non-Compliance.
4. Hand Washing, Solutions and Lens Case Care.
5. Summary.
6. Checklist.
7. Conclusion.
8. The Future.

3. Definition of Compliance
the adherence of the contact lens
wearer to a series of steps of lens care
and usage recommended by their eye
care practitioner and the manufacturers
of their contact lenses and prescribed
regimen .(P.Morgan et.al.)
In the contact lens field, patient compliance can be defined as:

4. • Contact lenses are worn by approximately 125 million
people worldwide.
• Non-compliance is wide spread in contact lens wear.
• Non –compliant wearers are ignorant of or confused
about their non compliant behaviour.
• Compliance is largely a matter of faith and trust.
• Symptoms of dryness, especially at the end of the day,
are the most common reasons for contact lens drop -outs

5. • If there are “ Fifty ways to leave your lover”, according to
Paul Simon, then there are at least fifty ways in which
patients can be non-compliant with their contact lens wear
and care.
• I tell my patients that I know all the short cuts and all the
wrong ways to take care of their contact lenses, so they
cannot surprise me.
• I tell them that they will hear from their friends all kinds of
tricks, but they must listen to me and do what I teach them
to do, about handling their contact lenses. It is for their
benefit.
• They must go through “ The long and winding road” with
me, so that at the end of the day their compliance will be
good and we will cross “The bridge over troubled waters”
and reach tranquility.

6. Contact lens wearers who exhibit poor compliance
habits are highly prone to the development of corneal
ulceration, as seen in this patient

7. In order to minimize lens contamination and
thus reduce adverse effects we rely on:
-The efficacy of the disinfection solution.
-Patient compliance.
-Patient hygiene.

8. Methods which appear likely to contribute to
improved compliance include:
1.Keeping records of the progress made.
2.Commencing education at the prescribed visit.
3.Postponing non-urgent issues to aftercare visits.
4.Compensating for patient shortcomings in the areas
of understanding verbal instructions and reading
supporting literature.
5.Increase frequency of patient visits.

9. 6. “Prescribe” , do not recommend.
7.Dispense a complimentary care kit.
8. Provide a detailed written handout with the
solution name.(Give “prescription”)
9.Reviewthe advantage of the prescribed product.
10. Communication is the key!

10. REMEMBER:
• Within minutes of a consultation patients forget as much as
50% of the advice provided.
• Average learning retention rates of different kinds: 20% for a
demonstration, 30% for a discussion group, 75% for practice
by doing and 90% for teaching others.
• Compliance can be improved by helping patients to
understand the reasons for good hygiene in addition to being
shown how it best can be achieved.
• Compliance can be increased by increasing the frequency of
contact with and from the practitioner.

11. High levels of unintentional non compliance suggest
that one session to learn how to perform several
complex tasks is not enough.
If skills of lens insertion and removal are not developed
satisfactorily then dispensing of lenses should be
postponed.

12. Risk Taking:
Risk taking is a better predictor of compliance than
practitioner perception.
A tool to measure risk-taking personality may help
practitioners to better identify non-compliant wearers, in
order to develop more targeted management strategies.
Compliance levels are reduced when patients have a
higher risk taking tendency.
This is the only independent significant factor predicting
non-compliance.
Non- compliance can appear to be of no consequence.

13. Types of Non-Compliance:
Deliberate non-compliance:
Doing contrary to what you were told by your
practitioner or persisting with a procedure despite
recurring wearing problems.
Unintentional non-compliance:
High levels of unintentional non- compliance suggest
that one session to learn how to perform several
complex tasks is not enough.

14. Initial Instruction:
Too many issues are being covered
in this instruction meeting:
a) Insertion and removal.
b) lens cleaning and disinfection.
c)wearing schedule.
d) “do’s” and “do not's”

15. Now to the practical side of compliance:
• We must instruct the patient both verbally and also in writing.
• It is not advisable to give out all the instructions at one visit.
• The patient cannot absorb everything at once.
• Hand hygiene prior to contact lens handling is problematic.
Better patient education to improve hand washing techniques
as well as patient attitudes toward hand hygiene are needed to
reduce high non-compliance levels.
• Patients must be instructed how to wash hands properly. For
example , for optimum hand hygiene enough soap should be
used and the duration of the washing should be 30 seconds.

16. This graph shows patient compliance with hand
washing prior to lens handling.
(Mile Brujic, O.D., and Jason Miller, O.D., M.B.A.)

18. SOLUTION COMPLIANCE:
• 40% of contact lens wearers do not remember the
name of their solution.
• Ask the patient which solution he is using. Do not ask
if he is using the solution you prescribed.
• Keep a variety of solutions on hand and when patient
removes his lenses ask him to use the solution he has
at home.
• If there is hesitation, or he is not sure, you may need
to further educate the patient.

19. MPSs are the most common solutions used.
They consist of:
Antimicrobial agent.
A surfactant.
A chelator.
Wetting agents.
Buffering agent.
These agents must be effective in killing microbes but
because they come into contact with the cornea ,on a
daily basis they must also be biocompatible with the
cornea.
Another form of disinfection is by using Hydrogen
Peroxide plus a neutralizing agent

20. I would like to spend a few more moments
talking about the lens case
• Professor Wilcox in his latest paper, suggests that poor
hygiene of contact lens cases is associated with increased risk
of developing microbial keratitis.
• Even in controlled clinical trials,, the frequency of
contamination of cases reached 92% of cases.
• Many contact lens care solution products were found to be
ineffective in preventing contact lens case contamination.

21. Survey results of how often patients
clean lens cases.
• Only 26% of respondents reported cleaning the case daily. The
average was 2-3 times a week. 1 in 3 clean the case
monthly.(Sheila B. Hickson –Curran, B.Sc.(Hons) MCOptom,)

22. Professor Wilcox recommends a new case-cleaning
protocol:
• 1. Rubbing the case with a finger.
• 2. Rinsing the lens case with the disinfecting
solution and then discarding the solution.
• 3. Wiping the interior side of the case well in a
circular motion with a clean facial tissue.
• 4. Air-drying the lens case for six hours before reusing
the case.

23. The important issues are as follows:
1. Hands washing both before removal and insertion of
lenses.
2. Topping up of solution in the case is not an option !
3. The lens case must be rinsed with hot water and
disinfecting solution and then left to dry upside down.
4. Solution toxicity. One must emphasis to the patient how
important it is not to change solutions without consulting
you.
5. Not to contaminate the solution bottle nozzle with
fingers. , or by leaving the cap off.
6. The replacement of the lens case is vitally important.

24. 8.Do not store contact lens case, with or without lenses, and
solutions in the bathroom.
In an effort to decrease lens storage case-related
contamination, silver impregnated lens cases have been
produced and shown to reduce bacterial contamination of
cases. These are now widely available.
(O.and V.S.,vol89, no.3,March 2012).
7. The F.D.A. recommends case replacement every3 to 6 months.
Today with every bottle of solution there is a new case in the
package.
Lack of case replacement can cause Microbial Keratitis.

25. • 9.Lenses must be replaced according to recommended
schedule.
• 10.The patient must have regular check-ups to assess ocular
health.
• 11. Wearing lenses when swimming or in a shower or spa can
cause adverse results.
• 12. Sleeping in lenses is not a good idea.
• 13.At every visit one must raise the subject on lens cleaning
and handling so as to keep the patient aware of its
importance.

26. 14.Ask your patients to bring their contact lens
case, solution and any other products they use to
care for their lenses. This will give you greater
insights into patients’ actual contact lens habits.
15. When taking a thorough history, use pointed
questions to determine if patients are washing
their hands, rubbing their lenses, replacing their
solution daily and cleaning their case regularly.
Remember!!
Communication is the Key

27. A commitment type form should be given to the
patient.
When the patient ticks the box and adds his initials after
each step, he indirectly is adding a degree of commitment
to the compliance programme and thus increasing the
chances of success.

29. There are a number of mottos that you can quote:
• Failure to comply is to comply with failure.
• Keep It Simple Stupid-------KISS
• No rub---No good.
• Clean (Rub), Rinse and Disinfect or as I call it :
• The 3 “L”s---LENAKOT (Leshafshef), LISHTOF, LECHATEH.
• The 3 “R”s of compliance: R- Routine; R-Review; R_Repeat at every visit.
• I - Inform, Instruct, Inspire.

30. Conclusion:
• The behaviour of contact lens wearers has not changed
over the years.
• The rate of non-compliance with contact lens wear and
care, as well as infection rates, seem to not have changed
significantly over the past 25 years.
• Dumbleton et al. suggest that there is a relationship
between poor compliance with contact lens wear and
care regimens and contact lens related complications.
• Non – compliance can result in serious complications and
patients may not always be aware of this. It is important
for us, the eye care practitioners to strive to improve
patient compliance.
• New strategies and approaches to effectively modify
patient non-compliance are urgently required.

31. The Future:
• Improving end of day comfort will continue to be the
number-one interest for the contact lens market.
• Contact lenses possessing antimicrobial properties
are in the early stages of investigation.
• Other strategies that have been investigated include
silver-coated and silver impregnated contact lenses.
• Cationic coating of lenses with the peptide melamine
has shown to reduce bacterial adhesion in the animal
model.
• Developing lens care solutions with enhanced anti
microbial efficacy.
• Development of lens materials and cases that
prevent bacterial adhesion.

32. • With the introduction into the market of Hybrid Lenses , and
their increasing popularity the issue of the care of these
lenses must be addressed.
• Hybrid lenses, by definition , contain a GP center and a soft
(hydrophilic) skirt.
• The manufacturers of the ClearKone( SynergEyes, Inc.)
recommend the following multipurpose solutions for lens
disinfection:
• Clear Care (Ciba)
• Complete (AMO)
• Renu Fresh (Bausch & Lomb)
• Opti-Free Express (Alcon)
• Opti-Free Replenish (Alcon)

33. • Daily rubbing and rinsing steps are required for all
SynergEyes lenses. This can be done with the
above mentioned solutions or with a daily
cleaner approved for use with soft contact lenses.
• Of course the Hydrogen Peroxide method of
disinfection is also recommended.

34. ‫רבה‬ ‫תודה‬.
THANK YOU.

35. References:
• Boost Maureen, Shi Guang-Sen and Cho Pauline, Adherence of Acanthamoeba to Lens Cases and Effects of Drying on Survival, O.and V.S.,
Vol.88, No. 6, June 2011
• Dumbleton Kathy MSC, MC Optom., Jones Lyndon PHD,FC Optom;DipCLP,Dip Orth, Non-compliance: so what?; Editorial 26/ 9/2011.
• Dumbleton Kathryn A., Woods Craig A., Jones Lyndon W., Fonn Desmond, The relationship between compliance with lens replacement
and contact lens-related problems in silicone hydrogel wearers. C.L.&.A.E. 34(2011)216-222.
• Dumbleton Kathryn A., Woods Mike, Woods Craig A., Jones Lyndon W., Fonn Desmond, Ability of patients to recall habitual contact lens
products andenhancement of recall using photographic aids. C.L.&.A.E. 345 (2011) 236-240.
• Hickson-Curran; Chalmers Robin L.; Riley Colleen, Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses
and storage cases.C.L.& A.E. 34(2011)207-215)
• McMonnies Charles W. , Improving patient education and attitudes toward compliance with instructions for contact lens use, C.L.& A.E.
34 (2011) 241-248.
• Morgan Philip B., Efron Nathan, Toshida Hiroshi, Nichols Jason J., An International analysis of contact lens compliance , C.L.& A.E. 34
(2011) 223-228/
• Omali Negar, Proschogo Nicholas, Zhu Hau, Zhoa Zhenjun,Diec Jennie, Borazjani Roya and Willcox Mark, Effect of Phospholipid Deposits on
Adhesion of Bacteria to Contact Lenses, O and V.S., vol.89,No.1, January 2012.
• Pappas Eric, The future of contact lenses, Contact Lens Spectrum, June 7, 2011.
• Wu Yvonne T.,Yuu Juan Teng, Nicholas Mary, Harmis Najat, Zhu Hau, Willcox Mark, and Stapleton Fiona., Impact of Lens Case Hygiene
Guidelines on Contact Lens Case Contamination, O. and V.S., Vol. 88, No. 10, October 2011.