It’s probably not an exaggeration to call the state of contact lens patient compliance a disgrace. Most practitioners sense this anecdotally, as they’re continually frustrated by patients who simply won’t bother to care for lenses properly. Now, a report from the Centers for Disease Control all but confirms it.

A recent survey of 1,000 contact lens wearers by the CDC found that 99% reported at least one contact lens hygiene behavior associated with an increased risk for eye infection or inflammation.

Risky behaviors reported by patients included swimming (61%) or showering (85%) while wearing lenses, rinsing (36%) or storing (17%) them in tap water, sleeping (50%) or napping (87%) in daily wear lenses, extending the replacement interval for lenses (50%) or cases (82%), topping off solution in lens cases (55%) and failing to wash hands before inserting (4%) or removing (17%) lenses.

Truth be told, the survey design makes it almost impossible not to give patients a failing grade. If a respondent reported anything other than “never” for each of the above behaviors, they were counted as having “ever” engaged in risky behavior. In other words, there was no consideration for the frequency of compliance failure. There also was no weighting of the relative risks of behaviors; all were equally bad.

Still, there’s no denying that these actions have consequences. “Nearly one third of contact lens wearers reported having experienced a previous contact lens-related red or painful eye requiring a doctor’s visit,” the report said.

Curiously, what’s perceived as the safest modality of lens wear—daily disposables—didn’t improve most of the scores on the risky behaviors. These patients were nearly as likely as other subgroups, or the contact lens population as a whole, to engage in most of the bad behaviors. And, in fact, they were actually more likely to rinse or store lenses in tap water and to top off solution when they do use them—which stands to reason, since part of the selling point of daily disposables is the ability to avoid solution costs. Maybe these patients take the convenience of daily disposables too far and could stand to be reminded that disposability doesn’t absolve them of responsibility.

Extending the lens replacement interval beyond what’s intended (and prescribed) seems especially hard for patients to give up. Even with 365 pairs of lenses at their disposal (no pun intended), these patients only shaved off 11% from the number likely to abuse the recommended replacement cycle, from 50% for all CL wearers to 39% for patients wearing daily disposable lenses.

Expect the Expected
Little of the above is surprising at this point. So, when educating your contact lens patients about lens care, expect the expected: They’ll cheat. Better to recognize this than try to hold them to an unrealistic ideal. Remind them that convenient doesn’t mean carefree, and give them a good understanding of the consequences of their actions—and ‘inactions.’