discovering dry eye
Find the Underlying Cause for Contact Lens "Sins"
BY KELLY K. NICHOLS, OD, MPH, PHD
We've all been there. While at a salon, car wash or grocery store, you observe a contact lens "sin" or overhear a contact lens "confession." If someone has done something before, then he's likely to do it again and is unlikely to volunteer that information to the practitioner. However, when practitioners can discover these sins and their underlying causes, changing care routines, products, and/or lenses often solves the patient's problem.
My first experience occurred when I was sitting next to a bride at a brunch the day after her wedding. She took out her soft contact lens, dipped her spoon into her ice water, swished her lens and reinserted it so efficiently I couldn't get a word out during the process. While the wedding party watched my expression, I managed to retort, "I know you're the bride and everything, but don't ever do that again."
Her lack of hesitation in solving her discomfort problem likely indicates that she'd done something similar many times. I don't know the cause, but using lubricant eye drops/rewetting drops in place of ice water would have made me much more comfortable. Perhaps her eye doctor hadn't educated her about the no-no's of tap water or asked her about the "worst thing she had ever done to her contact lenses." In any regard, I doubt she'd ever mentioned this habit to her eye doctor.
The Wedding #2
A non-eyecare colleague returned to her hotel after a wedding and realized she'd forgotten her contact lens case. She put her soft lenses into a glass with solution (same power lenses OU). Her husband picked up the glass and used it to rinse their son's soapy head in the bathtub. Realizing the mistake, they searched for and found the lenses in the bath water. They used the remaining disinfection solution to clean the lenses so she wouldn't have to wear her glasses at her PhD graduation the next day.
This "sin" occurred before the commonplace frequent replacement lenses of today. Having an extra set of contact lenses, even daily disposable lenses, can help solve this problem even if the more frequent replacement lens is sold in a low quantity and isn't the patient's primary lens.
The Hair Salon
At the hair salon recently I overheard the person in the next chair telling her stylist that the chemical-filled air at the salon was bothering her contact lenses. She also complained her eyes got tired in the afternoon and explained that splashing water on her lenses to get them wet "helped." Together they joked about how that was better than putting them into the mouth (which is what the stylist used to do). At that point I had to get my hair washed, and when I returned, she was gone.
Where to start with this one? A practitioner can most likely identify the late afternoon contact lens discomfort, and a number of management steps can address the problem including lens material, replacement schedule, solutions, artificial tear/lubricant eye drop use, punctal occlusion and/or prescription medication use.
Don't Lecture, Discuss
All of these cases are just regular people (some highly educated regular people) who probably would benefit from proper lens hygiene reminders. I'm convinced that giving lectures on this topic is ineffective, and that couching the discussion into the question of "what's the funniest/worst thing you've done with your lenses" or "what do you do when this happens" may be more effective to communicate the important health aspects of lens wear with your patients.
Dr. Nichols is assistant professor of clinical optometry at The Ohio State University College of Optometry in the area of dry eye research.