contact lens care
Maximizing Contact Lens Comfort in the Spring
BY MICHAEL A. WARD, MMSC, FAAO
Springtime brings us blue skies, flowering trees, singing birds and fresh air (cough, cough for seasonal allergy sufferers). It's time once again to review how to keep our contact lens wearers comfortable through the spring pollen season.
Pollen and Lens Wear
Pollen may affect contact lens wearers in multiple ways. It's both a physical and an immunologic irritant. It's estimated that pollen allergy (hay fever or allergic rhinitis) affects 10 percent to 20 percent of Americans, not including those who have asthma.
Pollen counts are highest in atmospheres of higher heat, higher humidity and higher carbon dioxide concentrations. As carbon dioxide concentrations increase with global warming, so do the number of pollens and other allergens in our environment. Regrettably, experts predict atmospheric carbon dioxide levels to double over the next 50 years.
Trees contribute the majority of the pollens in spring, with flowers, grasses and molds following into the fall. Our greatest physical irritant is pine pollen, a bi-lobed vesiculate pollen grain with a rough-surfaced body measuring 50μm to 75μm (roughly equal to the corneal epithelium's thickness). Pollen particles cover our clothes and bodies. They land in the tear film and may create significant foreign body sensation, scratchiness and tearing. To add insult to injury (literally), an allergic reaction occurs in susceptible individuals, releasing inflammatory mediators that cause tearing, itching and chemosis.
• Physical Barriers Wear goggles or close-fitting sunglasses when outside. Keep home and automobile windows closed if possible. Washing face and hands often with cold water can relieve symptoms. (Cold compresses help to relieve ocular itching.)
• Air Cleaners High efficiency air filters and electrostatic air cleaners can remove pollen and dust to improve air quality in central air conditioning systems. Filters should be replaced regularly.
• OTC Eye Drops Frequent use of low-viscosity, preservativefree artificial tears such as Refresh Plus (Allergan) or Systane (Alcon) help to dilute and rinse out irritants. In-eye lens cleaners such as Blink-N-Clean (AMO) or Clerz Plus (Alcon) may also help. OTC medications such as Zaditor (Novartis), Alaway (Bausch & Lomb) or Similasan Allergy Eye Relief may help relieve symptoms (not to be used over lenses).
• Lens Care Products Ignore the "no rub" product labeling on multipurpose solution products. Instruct patients to rub and rinse their lenses upon removal to decrease the accumulation of debris and contaminants on lens surfaces. If you suspect a solution-related hypersensitivity, change to peroxide disinfection to eliminate possible preservative sensitivities.
• Replace Lenses Often Shorten the replacement interval for soft lenses. Consider single-use lenses, which allow wearers to throw away the lenses — along with the allergens — daily.
• Prescription Medications Systemic antihistamines can help alleviate allergic symptoms, but may lead to ocular dryness. Patients should only use topical decongestants sparingly to avoid vascular rebound. Mast cell stabilizers are helpful if prescribed proactively before symptoms occur. Combination drops such as azelastine HCl ophthalmic solution 0.05% (Optivar, Meda Pharmaceuticals), olopatadine HCl ophthalmic solution 0.1%/0.2% (Patanol/Pataday, Alcon) and epinastine HCl ophthalmic solution 0.05% (Elestat, Inspire Pharmaceuticals/Allergan) offer allergy symptom relief by combining immediate antihistaminic relief with the prolonged effect of mast cell stabilizers. CLS
Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service.