Patient compliance in orthokeratology
Compliance with wear and care instructions in contact lens patients is very important. Experience with patients tells us that it is pretty dismal. Patients usually overwear their lenses, don’t clean them properly, do not replace disinfecting solutions, sleep in lenses when they’re not supposed to, don’t replace their cases often enough or at all. I could go on.
In my ortho-k patients, I felt they were doing a pretty good job. I educate them on how important cleaning and taking good care of the lenses are. They need to. They sleep in these hard lenses every night. Well, according to Assessment of Patient Compliance in Orthokeratology and Analysis of Influencing Factors: A Cross-Sectional Study in the November 2021 issue of BMC Ophthalmology, I’m living in a fantasy world.
The subjects’ self-assessment compliance for wear and care behaviors was 96.6%, but the actual compliance for wear and care behaviors was 19.7%.
That means that, chances are, only one in five of my patients is actually doing what I asked them to do.
…poorest compliance was with “lens case replacement according to ECPs’ recommendation” (55.8%) in addition to “removal of lens deposition interval according to ECPs’ recommendation” (67.3%) and “avoiding exposure of lenses to non-sterile solutions” (71.8%)…
This was found in all age groups. The only pattern they saw was that compliance was better in the first year of wear. After that, it didn’t matter.
…while some non-compliance was unintentional, some patients were intentionally non-compliant. Therefore, it is important to re-examine ortho-k lenses patients’ wear and care practices to identify the wear and care behaviors that wearers are not following…
This highlights the dramatic need in not skipping over patients’ lens care regimens. I know we get busy and don’t worry about it if the cornea looks good. We must remain vigilant, though. Get the patient to describe to you how they take care of their lenses. Don’t just ask them yes/no questions about it. The risks of an ortho-k patient wearing a dirty lens while they sleep is too high.