Prescribing for Presbyopia
Decreasing Dry Eye Symptoms in Presbyopic Lens Wearers
By Craig W. Norman, FCLSA
Throughout this issue of Contact Lens Spectrum, you'll find a wealth of information regarding the management of dry eyes and contact lens wear. It cannot be overstated how big of a clinical issue this is—it remains, at least in my opinion, our biggest challenge to successfully prolonging patients' ability to comfortably wear contact lenses.
Ask any presbyope whether his eyes feel dry during lens wear, and he'll respond affirmatively. Following are four tips that I routinely suggest to help patients reduce these dry eye symptoms and achieve the comfort that they desire with their presbyopic lenses.
Try the New Lens Care Products
With the recent introduction of Biotrue (Bausch + Lomb), RevitaLens OcuTec (Abbott Medical Optics), and Opti-Free PureMoist (Alcon), we have new options for our lens-wearing presbyopes. All of these care products have been designed to, among other attributes, improve comfort during lens wear by keeping lenses wetter throughout the day. Combined with the focus of these manufacturers to also decrease associated corneal staining, dry eye symptoms with these solutions should be on the wane.
Routinely Replace Your Lenses
In a perfect world, all bifocal soft lenses would be replaced daily. Unfortunately, today there aren't enough contact lens options for us to offer this to all presbyopes, but more designs are becoming available every year.
Until daily disposable bifocal contact lenses become commonplace, our only choice is to reinforce routine lens replacement—before patients think they need to. I simply ask patients whether, when they replace their soft lenses, the new ones are more comfortable compared to the ones that they replaced. Most patients will enthusiastically say yes, upon which I immediately advise them that this means they waited too long to replace their lenses. Increase the frequency of contact lens replacement, and many dry eye symptoms will decrease.
GP-wearing presbyopes may also describe dry eye symptoms. Our strategy here is to consider a new lens if indicated or to simply change to a different material that may have better wetting characteristics. Ideally, multifocal GP wearers should be on a three- to six-month replacement cycle. Custom lathing of GPs doesn't make this schedule feasible yet, but this year we expect to see the introduction of Menicon's molded GP lenses that may make this a reality soon. In the meantime, we now tell GP lens wearers that annual replacement is what we advise for them.
Remember to Blink During Prolonged Near Work
Smart phones and computers have increased the amount of near tasks for almost all of our presbyopic contact lens patients. When asked, most presbyopes will agree that they often experience ocular dryness when using these devices. We simply remind them to blink more often or to look away from their device every few minutes to maintain comfort.
Keep Your Lenses Clean
This seems to be a matter of simple common sense, but it's amazing how many presbyopes don't clean their soft or GP multifocal lenses. We discuss cleaning methods during every patient encounter, emphasizing that clean lenses stay wet on the eye longer and help decrease lens awareness and dryness. Soft lens wearers using multipurpose solutions need to be reminded to rub and rinse, while GP lens wearers need to consider two-bottle regimens if they experience dryness symptoms. CLS
Craig Norman is director of the Contact Lens Section at the South Bend Clinic in South Bend, Indiana. He is a fellow of the Contact Lens Society of America and is an advisor to the GP Lens Institute. He is also a consultant to B+L. You can reach him at email@example.com.