GP Lenses for Dry Eye
BY EDWARD S. BENNETT, OD, MSED, FAAO
Two common questions today are, “What contact lens material—if any—should you use to fit a dry eye patient? Are GP lenses a viable option for these patients?” To assist in answering these questions, I surveyed the 60 members of the GP Lens Institute Advisory Committee as they constitute a group who are noted for their expertise in GP lens fitting. Their responses contributed to the content of this column.
From consumer inquiries on contactlenses.org, it is evident that many consumers are told that they are not good candidates for contact lenses based on any of the following three reasons: they have astigmatism, they have presbyopia, or they have dry eyes. It is quite evident today that astigmatic and presbyopic patients—with few exceptions—are very good candidates for contact lenses, but it is interesting to note that the experts indicated that almost all dry eye patients can also be successful in either soft or GP lenses.
Soft Lens Options
Daily disposable soft lenses and hydrogel lenses marketed for dry eyes such as Proclear (CooperVision) and Extreme H2O and Clarity H2O (Hydrogel Vision) are highly recommended for dry eye patients, as are some of the newer-generation silicone hydrogel lenses such as Acuvue Oasys (Vistakon) and Biofinity (CooperVision). Hydrogen peroxide is the care system of choice for these patients, supplemented by preservative-free rewetting drops. However, patients who have critical vision needs or who have experienced soft lens-induced complications (i.e., recurrent infections, clinically significant papillary hypertrophy) are often good candidates for GP lenses.
GP Lens Options
Any of the available fluorosilicone/acrylate (FSA) materials would be suitable for fitting dry eye patients, although many respondents had a preference for the low- to mid-Dk (i.e., 25 to 70) materials. The materials most recommended by the advisory committee included the Optimum materials from Contamac (notably Optimum Comfort and Optimum Extra) as well as the Boston series of materials (ES, XO, and XO2) from Bausch + Lomb, Menicon Z (Menicon), Fluoroperm 30 (Paragon Vision Sciences), and Onsi-56 (Lagado Corporation).
It is also evident that for dry eye patients to be successful in wearing a GP lens material, they must not be partial blinkers—either naturally or induced by a poor lens-to-cornea fitting relationship.
The Committee often recommended larger diameters (i.e., ≥10mm) including the Naturalens from Advanced Vision Technologies. This assists in promoting a lid-attachment fitting relationship to minimize lid-to-edge interaction. Likewise, centration can be promoted with an ultrathin design in all but highly astigmatic corneas (i.e., >1.50D of cylinder). The use of a moderate-heavy blend will also promote initial comfort while minimizing stagnation of tears behind the lens.
During fluorescein evaluation, there should only be slightly greater tear pooling peripherally compared to centrally; excessive edge clearance will funnel tears from the peripheral cornea, increasing the likelihood of peripheral corneal desiccation while also possibly compromising the quality of the blink.
Dry Eye Patients Can Succeed
GP lenses are not for every dry eye patient, but even moderate dry eye patients can succeed with them or with the aforementioned soft lenses when supplemental treatment modalities such as omega-3, Restasis (Allergan) (before and after lens wear), preservative-free lubricants such as Optive Sensitive Preservative-Free Lubricant (Allergan), and punctal plugs are used. In fact, the ocular protection and comfort achieved with scleral and semi-scleral lenses in dry eye patients make this option a good one today and likely a great option in the future. CLS
Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis and is executive director of the GP Lens Institute. You can reach him at firstname.lastname@example.org.