Health literacy and contact lens patients: How doctors of optometry can help

Published Aug. 15 in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR), survey results indicated only a third of contact lens-wearing adults recalled hearing any lens wear and care recommendations from their eye care provider. This, despite the fact, that providers reported sharing all nine contact lens recommendations at initial visits, check-ups and complication-related visits.

Popular with roughly 45 million Americans, contact lenses are a safe, effective vision correction option when worn and care for properly. But, therein lies the rub: poor-fitting or improperly used contact lenses can result in serious eye and vision conditions, such as microbial keratitis. Despite efforts to educate patients about these risks, the CDC estimates 99% of contact lens wearers report at least one behavior that increases their risk for a contact lens-related eye infection.

"Previous studies have identified health behaviors that can reduce the risk for contact lens-associated eye infections," CDC authors note. "Although eye care providers report mentioning these behaviors to their patients frequently, patients report hearing the messages less frequently, suggesting that new communication strategies might be needed."

By the numbers

Clear, effective communication is vital across health care to improving patients' outcomes, yet the MMWR suggests many of patients' informational needs remain unmet or failed to register during their doctor's visit. In fact, the CDC's online public health survey of 4,088 participants found less than half of contact lens wearers reported hearing all nine recommendations on their last visit.

Specifically, the MMWR noted that patients recalled some guidance more frequently on their last visit, such as: 

• 47.9% recalled their provider advising against sleeping in lenses
• 46.9% recalled their provider advising hand hygiene when handling lenses
• 41.6% recalled their provider advising replacing lenses as recommended  

However, other recommendations weren't iterated on their last visit, such as:

• 8.3% recalled their provider advising against showering in lenses
• 12.4% recalled their provider advising against swimming in lenses
• 19.8% recalled their provider advising against "topping off" solution or rinsing lenses in tap water
• 21% recalled their provider advising against storing lenses in water
• 23.8% recalled their provider advising a case replacement schedule  

That said, patients overwhelmingly reported hearing all nine recommendations with an initial contact lens fitting.  

In contrast, the MMWR notes the results of AOA's own survey of practicing eye care providers where doctors reported sharing all nine recommendations regularly, but most frequently when patients present with a contact lens-related complication. The MMWR notes providers shared some recommendations more frequently than others during routine "check-ups," including:

• 85.1% advise replacing lenses as often as recommended
• 79% advise replace lenses as recommended, and against sleeping in lenses
• 70% advise against storing or rinsing lenses in water   

While addressing the communication gap is a priority, the MMWR notes that providers are on target with their priority messaging as sleeping in lenses increases risk of infection 6-to-8-fold and water exposure likewise ups chances of microbial contamination.  

Despite the observed deficit in provider-patient communication, it isn't an anomaly unique to eye care. As much as 80% of the medical information patients are told during office visits is forgotten immediately, while nearly half of the information they do retain is altogether incorrect, studies show.

The 'teach-back' method  

To help bridge the patient-provider communication gap, AOA developed a resource for doctors of optometry and their contact lens care teams that emphasizes the 'teach-back' method. Essentially a technique that asks patients and families to reiterate in their own words what the health care provider shared, the teach-back method ensures patients understand the core takeaways and can allow for immediate intervention should a misunderstanding occur.   The AOA recommends providers use teach-back to confirm patients understand key contact lens wear and care reminders, such as:  

• Avoid sleeping overnight or napping in lenses
• Wash and dry hands before inserting or removing lenses
• Replace lenses as often as recommended
• Replace lens cases at least once every three months
• Avoid storing or rinsing lenses in tap water
• Avoid 'topping off' disinfecting solution
• Avoid swimming or showering in lenses  

The Agency for Healthcare Research and Quality offers additional information on how to use teach-back effectively, including a provider toolkit and interactive learning module.  

AOA, CDC engage public  

Once again, AOA is partnering with the CDC in its Contact Lens Health Week observance, to increase public awareness and promote healthy contact lens wear and care. This year's campaign theme, "Contact Lens Health Starts with You," encourages patients and eye care providers alike to take an active role in caring for their eyes through improved provider-patient communication, education on the consequences of improper contact lens use and the importance of regular, comprehensive eye care.

Taking these messages directly to the public, AOA and CDC will partner on a Facebook Live chat with AOA President Barbara L. Horn, O.D., at 2 p.m. ET, Monday, Aug. 19, to open an annual dialogue regarding the importance of contact lens health and safety.

Obtain more information and resources regarding the CDC's Contact Lens Health Week, or access AOA's patient and public resources on healthy contact lens use.