Dry Eye and GP Lens Wear, Part 2
BY EDWARD S. BENNETT, OD, MSED
My October column "Dry Eye and GP Lens Wear" focused on the non-contact lens management of an interesting dry eye case originating from Dr. Jeff Sonsino. This patient was experiencing poor surface wettability from her GP lenses (OD > OS) with plugged meibomian glands, trace frothing of the tears, 2 + conjunctival staining, and 3+ superficial punctate staining (SPK) OD and OS. This month we will focus on optimizing the GP wearing environment once the meibomian gland dysfunction (MGD) has been adequately managed. As before, this article includes recommendations from members of the GPLI advisory panel with whom I shared this case.
Five Steps to Follow
1. Optimize the Lens Material A low- to mid-Dk fluorosilicone acrylate (FSA) lens material is often successful in such cases. Specific materials recommended include Hydro2 (Innovation), Optimum Classic (Contamac), Paragon HDS (Paragon Vision Sciences), and Boston ES (Bausch & Lomb). However, any of the FSA materials from these companies as well as any from Menicon, Lagado, and The Lifestyle Company can be successful in these cases. Be cautious of the wetting angle information of these materials, which is often used for promotional purposes.
The introduction of new high-refractive index materials, specifically Paragon HI 1.54 (Paragon) and the Optimum HR (Contamac) materials, provides lenses that can be cut thinner, making them lighter. They are also low-specific gravity materials, which also makes them lighter. This increases the likelihood of good centration, resulting in less disruption with the blink and less drying out of the peripheral cornea. In addition, ordering the lenses plasma-treated will optimize initial wettability and may also assist with initial comfort.
2. Lubricants/Rewetting Drops Blink Contacts (Abbott Medical Optics) and Aquify Long-Lasting Comfort Drops (CIBA Vision) are beneficial for patients such as the one in this case. Likewise, off-label use of Systane Ultra (Alcon) and Soothe XP (Bausch & Lomb), the latter placed into the bowl of the lens during application, have been recommended.
3. Care System Extra strength cleaners, in particular Miraflow Extra Strength Daily Cleaner (CIBA) and Optimum Extra Strength Cleaner (Lobob Laboratories), can help maintain surface cleanliness and wettability.
4. Hygiene/Makeup Most hand soaps and cold creams now have aloe, lanolin, conditioners, softeners, and emollients that can adhere to the lens surface and impact wettability. Optisoap (Optikern) is still available for sale to patients. It is also important to ask patients what they use to remove eye makeup, if worn. Patients have a tendency to use baby oil or cold cream to remove eye makeup. When some substituted diluted baby shampoo to remove water-soluble mascara, the oily tears have improved.
5. Optimize the Environment Advise patients to redirect vents away from their eyes as well as to minimize the use of ceiling fans to reduce the drying out of the tear film, both on the lens surface and on the peripheral cornea.
Success for More Patients
Borderline dry eye patients are the biggest challenge we face. However, the medical management of MGD and blepharitis continues to improve, and this — in combination with improved GP lens materials and care systems — will result in success for some patients who would have previously failed. CLS
Dr. Bennett acknowledges Drs. Ray Brill, Mile Brujic, Art Epstein, Steve Harney, Pat Keech, Clarke Newman, and Renee Reeder.
Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis and is executive director of the GP Lens Institute.