Ten Steps to Managing Dry Eye in GP Lens Wearers, Part 1
BY EDWARD S. BENNETT, OD, MSED; MILE BRUJIC, OD; MICHAEL LIPSON, OD; MARSHA MALOOLEY, OD; MURIEL SCHORNACK, OD; & RONALD K. WATANABE, OD
The most challenging GP patients are those who have dryness-related symptoms and/or clinical signs. I called upon experts from the GP Lens Advisory Committee to assist in developing a 10-step approach for managing this common problem. This column presents the first five steps.
STEP 1: Comprehensive History
It is very important to ask these patients about their wear, care, and hygiene habits. Have they initiated a new medication recently? Do they use a hand cream or facial cream before lens application? If so, advise them to use an optical or non-lanolin-based hand soap to remove creams prior to lens application.
Also ask patients whether they clean their lenses upon removal at night in the palm of the hand before soaking them overnight.
STEP 2: Diagnose and Treat Any Ocular Surface Disease
It is beneficial to improve tear quality for GP contact lens wearers who are experiencing dryness. Perform tear breakup time and carefully evaluate the eyelids, assessing the integrity and function of the meibomian glands. Treat blepharitis if it is present. Instruct patients to perform digital massage of the meibomian glands after a warm shower to help improve gland expression. AzaSite (Merck), doxycycline, Restasis (Allergan), or punctal plugs may also help.
STEP 3: Lubricants/Rewetting Drops
Most patients don’t think about using supplemental rewetting until after they experience symptoms. Dr. Schornack likes to tell patients that using lubricants after their eyes become uncomfortable is similar to applying sunscreen after they’ve gotten a sunburn. A dry GP lens surface will deposit much more rapidly compared to a moist surface. The concentration of protein/lipid/debris in an aqueous-deficient eye is higher than in a well-lubricated eye. Rewetting drops or lubricants such as Blink Tears (Abbott Medical Optics) or Refresh Optive (Allergan)—both available in preservative-free versions as well—can help.
STEP 4: Lens Material
Which material is best for GP wearers who are heavy depositors? Some of the more popular materials in these cases include Optimum Comfort (Contamac), Hydro2 (InnoVision), and Onsi-56 (Lagado/Menicon). Plasma treatment of any GP lens can also help minimize this problem.
STEP 5: Lens Design
A good lens-to-cornea fitting relationship reduces lid-lens edge contact, optimizes the blink, and lessens tear film drying, both on the lens surface and on the exposed peripheral cornea. Ultra-thin designs, available from any GP lab, are more likely to result in this form of fitting relationship.
Maintaining an optimum edge clearance—defined as slightly greater than central clearance—is important as well. Peripheral seal-off can aggravate dry eye issues. Conversely, excessive edge clearance can result in more lid-edge interaction, which impacts blink quality. A larger diameter (i.e., 10.0mm to 10.5mm) often improves comfort and reduces dryness. Newer mini-scleral designs for healthy eyes are also a viable alternative. CLS
Dr. Bennett is assistant dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. Dr. Brujic is a partner of Premier Vision Group in northwest Ohio. He has received honoraria in the past two years for speaking, writing, participating in an advisory capacity, or research from Alcon, Allergan, B+L, Odyssey Medical, Optovue, Nicox, Paragon, TelScreen, Transitions, Valeant Pharmaceuticals, Vistakon, Valley Contax, and VMax Vision. Dr. Lipson is an assistant professor at University of Michigan’s Kellogg Eye Center, Department of Ophthalmology and Visual Science, at the Livonia location. He has received travel funding from Paragon Vision Sciences and authorship or lecture honoraria from Diversified Ophthalmics. Dr. Malooley is part of an MD/OD practice and is an adjunct assistant professor at the Illinois College of Optometry. Dr. Schornack is a consultant in the department of ophthalmology at the Mayo Clinic in Rochester, MN. She holds the rank of assistant professor in the Mayo Medical School. She is a founding member of the Scleral Lens Education Society and serves on the organization’s Board of Directors. Dr. Watanabe is an associate professor of optometry at the New England College of Optometry.