Wash, rinse, repeat: Reminding contact lens wearers about risky hygiene
It could be a rough respiratory season between flu, COVID-19 and now monkeypox. As long as the public is being reminded about good hygiene this fall, doctors of optometry might want to refresh patients’ knowledge on handwashing and wearing contact lenses.
Flu may be around year-round, but flu season typically starts in October and peaks between December and February, the Centers for Disease Control and Prevention (CDC) say. Curiously, the CDC reported that the number of flu cases was down markedly during the height of COVID-19. The reason? All the precautions taken due to COVID-19—the mask wearing, the social distancing and the handwashing.
Monkeypox, recently declared a public health emergency, is spread virally, too.
With all of that, this may be a good time to reiterate to patients the benefits of good hygiene, including handwashing, especially with 45 million contact lens wearers in the U.S.
“There is certainly room for increased concern, but like most flu seasons, there is a lot we don't know,” says Paul Velting, O.D., chair of the AOA Contact Lens & Cornea Section (CLCS) who practices in Illinois. “People are definitely becoming more relaxed in their precautions, whether through a change in perception or general fatigue with masks and distancing. Hopefully, many of the reminders for routine hygiene habits and awareness of how viral pathogens spread over this pandemic will influence behavior enough to temper the increased potential for this coming season.”
Doctors of optometry play an important role in educating patients on safe contact lens use, says the CDC in its Morbidity and Mortality Weekly Report in August 2019, which recommends that patient communications be “easy to understand, specific, use repetition, minimize jargon” and are checked for patients’ understanding of the information.
And in a recent study, researchers concluded that contact lens wearers (CLWs) need information that is accurate and that they can understand in order to ultimately prevent complications from risky hygiene.
“Most CL-related complications occur due to noncompliance with recommendations and CL care, including improper cleaning and disinfection, using the CL for more than the recommended period, incorrect use of the solution, and inadequate handwashing,” say the authors of “Determining the information needs of contact lens wearers for better education and more support: a qualitative study” published online the Sept. 7. 2021 in BMC Ophthalmology.
“To do proper CL care and maintenance, CLWs need adequate knowledge and awareness to minimize or prevent complications,” they continue. “Acquiring relevant information is an important aspect of care and support for CLWs that enable them to have greater control over their self-care. Therefore, CLWs should be trained—both at the beginning of CL use and periodic throughout CL wearing—to increase their knowledge, modify their behavior and enhance their motivation about CL care and hygiene.”
‘A few simple rules’ for patients
Members of the CLCS agree.
“Patients just need to be reminded that wearing contact lenses is a safe form of vision correction and give them a few simple rules,” says Ashley Tucker, O.D., who practices in Texas. “That includes proper handwashing before handling lenses, disposing of contact lenses at the appropriate time, using a good quality MPS or cleaning system to care for their lenses, and no overnight wear unless approved by their doctor. I have also found that patients are much more open to daily disposable contact lenses now—all of a sudden, the concept now makes perfect sense to them.”
Says Mile Brujic, O.D., the section’s chair-elect who practices in Ohio: “The most important thing that patients need to be aware of is that contact lenses are a safe and effective form of vision correction when worn appropriately. It is critical for them to continue what I refer to as ‘common sense’ hygiene habits. Make sure to advise patients about washing hands before touching contact lenses—either prior to placing lenses on eyes or removing lenses. We have had an increasing percentage of patients wanting to pursue daily disposable lenses, if they are candidates for the lenses, because of a lack of any cleaning regimen to care and wear the lenses.”
Karen DeLoss, O.D., who practices in Michigan, observes that the COVID-19 pandemic underscored the necessity to be vigilant about handwashing.
“It reinforced the need to adhere to replacement guidelines and nightly disinfection,” Dr. DeLoss says. “For me, it reminded me to be more proactive in discussing contact lens care and compliance with each of my patients and to check in with their nightly routine.”
Others pertinent patient education includes “not reusing contact lens solutions and replacing contact lenses as recommended,” says Melissa Barnett, O.D., CLCS immediate past chair, who practices in Ohio.
Staying in contact with patients between visits isn’t easy, Dr. Velting says, but it’s important.
“Social media is still a great way to do this,” he says, “and a quick reminder on CL hygiene can land home for someone even as they're scrolling to get to their friend's baby photos.”
Hip to hand hygiene
The public is more sophisticated than it used to be about hygiene due to COVID-19, says Amber Dunn, O.D., who practices in Oregon.
Yet an opportunity remains. Communication is key.
“Contact lens hygiene has always been an educational opportunity for patients in our practice—and we provide it in great detail,” Dr. Dunn says. “We educate our patients to use hypochlorous solution on their hands prior to insertion and removal. We also try to get patients into a single-use lens as often as possible. Educate them on making sure to cut their nails short and keep the area where they are putting lenses in clean. All of those things help.”
The AOA offers several resources that doctors of optometry can use to start these conversations, including:
- "Contact Lens Wear & Care"
- Contact lens care resources including a downloadable Halloween infographic.
- CDC resources for eye care providers for patient education
Try the 'teach-back' method
To help bridge the communication gap, the 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.
For additional information on the teach-back method, including a provider toolkit and interactive learning module, visit the Agency for Healthcare Research and Quality.
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Doctors of optometry can play a role in detecting monkeypox—the virus recently declared a public health emergency. Be aware of the ophthalmic manifestations.