contact lens case reports
Dry Eyes and Overnight Corneal Reshaping
BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ, FAAO
Hardly a day goes by without patients reporting symptoms of dryness when wearing their soft contact lenses. Nichols et al (2005) reported that 52 percent of lens wearers described having dry eyes at some time throughout their wearing schedule. This number was 12 times higher than that of emmetropes requiring no correction. Therefore, it's not surprising that the most reported reason for lens dissatisfaction and discontinuation is dry eye-related.
So, how do we manage our patients who are unable to obtain adequate comfort and/or wearing time secondary to dryness? Step one is to rule out preserved lens care products as the source of symptoms. You can often accomplish this by switching patients to daily disposable lenses or initiating a preservative-free system.
Figure 1. Patient's corneal topography and fluorescein photos post-CRT fitting.
If the symptoms continue we can begin our regimen of dry eye treatments that may include artificial tear therapy, omega-3 supplements, lid hygiene, ocular anti-inflammatories and punctal occlusion. Even with maximum therapies some still experience symptoms. Many of these patients seek resolution in refractive surgery. However, we need to caution patients that laser correction can adversely affect tear production. Dry eye patients have a higher risk of post-operative dry eye complications.
A Problem Solved Overnight
Our patient was a 28-year-old female with a refractive error of –3.50 sphere in the right eye and –3.75 sphere in the left. She had a four-year history of dry eyes with contact lenses despite attempts with daily disposable lenses and dry eye therapies. The patient was free of any corneal or conjunctival pathology and reported that her dry eye symptoms were significantly reduced when she wore spectacle correction. However, she insisted that glasses weren't an option.
At that time, we suggested contact lens corneal reshaping. Clinical experience has taught us that some dry eye patients do exceptionally well with overnight reshaping therapy. The closed eye environment may prevent excessive tear evaporation, a contributing cause of dry eye symptoms in some lens wearers. With the overnight reshaping modality, many report improved comfort because no corrective device is on their eyes throughout the day to stress the tear film.
We successfully fit the patient with Paragon CRT (Paragon Vision Sciences) lenses and in seven days her uncorrected visual acuity was a stable 20/20 throughout her waking hours. She reported no overnight ocular discomfort with the lenses or dry eye symptoms throughout the day.
A Reshaping Solution
We believe that a number of contact lens-induced dry eye patients may be excellent candidates for corneal reshaping. This is especially true for those individuals considering surgical intervention as a refractive treatment. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #154.
Patrick Caroline is an associate professor of optometry at Pacific University. He is also a consultant to Paragon Vision Sciences. Mark André is an associate professor of optometry at Pacific University. He is also a consultant for CooperVision.