discovering dry eye
Study of Lubricating Eye Drops Offers Interesting Conclusions
BY KELLY K. NICHOLS, OD, MPH, PHD
At the recent American Optometric Association (AOA) meeting, researchers made a presentation about a concept I'll call "pre-lubrication of the ocular surface." The poster was titled "Prospective Case History Study Using Systane Lubricant Eye Drops to Help Reduce Symptoms of Dry Eye Associated with Contact Lens Wear."
In this study, 75 patients experiencing dryness or discomfort with contact lens wear used Systane Lubricant Eye Drops (Alcon) before and after lens wear. The study aimed at evaluating whether using Systane pre- and post-lens wear improved contact lens wearing comfort.
Contact Lens Dropouts
While many patients start wearing lenses each year, many also discontinue wear. Stopping is often a slow process often undetected by practitioners. Patients may report discomfort, reduced wearing time or they may skip days of wear, resulting in decreased lens purchasing.
Many solutions or quick-fixes (including changes in contact lens materials, solutions, replacement schedules and modality) may relieve discomfort. Some options lead to increased comfort and longer wearing time; however, they haven't shown documented decreases in annual frequency of contact lens dropouts.
Wettability and Comfort
In the past, research focused on using drops while wearing contact lenses. In 1991, Efron and coworkers reported that using lubricant eye drops (available at the time) with contact lens wear didn't significantly improve relief from lens dryness and dehydration when compared to saline. But what if pre-and post-lubrication of the ocular surface provides more aid in reducing contact lens discomfort than actually using rewetting drops while wearing lenses?
Anecdotally, practitioners have reported improved patient comfort when using Systane pre- and post-lens wear. (No lubricating eye drop has been FDA approved for use with contact lenses.) These reports led to the research discussed at the AOA (and here).
At day 14 of Systane use pre-and post contact lens insertion/removal, 89.3 percent of patients reported that they agreed or strongly agreed that the drops made insertion more comfortable, 69.3 percent agreed or strongly agreed that end-of-day comfort was improved, 80 percent agreed or strongly agreed that their contact lenses were less dry all day, and 80 percent agreed or strongly agreed that their contact lenses were more comfortable all day. Comfortable wear time increased significantly from baseline
(p < 0.0001) by two hours at day 7 and 3.1 hours at day 14.
Based on this Alcon-supported study, it's unclear whether other types of lubricating eye drops would have the same effect pre-and post-lens use, or if the effect would exist in patients who didn't have symptoms.
Regardless, the study may have an important conclusion in that pre-lubrication of the ocular surface acts like a pre-treatment or perhaps protection from insult caused by contact lens wear. In some patients, the tear film and ocular surface may be "fragile," and contact lens wear could disrupt it to the point of irritation and possible lens discontinuation. While we don't know the exact mechanism of action, artificial tear use pre- and post-lens use may benefit patients who complain of reduced wear time and discomfort.
Have your patients add this step to their routine and monitor the result. You just may get a happier patient who is less likely to drop out of lens wear.
Dr. Nichols is an associate professor of clinical optometry at The Ohio State University College of Optometry in the area of dry eye research.