Contact Lens Practice Pearls

Maximizing Lens Comfort

Contact Lens Practice Pearls

Maximizing Lens Comfort

By Jason R. Miller, OD, MBA, FAAO

Contact lens dropouts affect our bottom line and the growth of the contact lens industry. There are many factors that affect dropouts and that are often intertwined. Discomfort has been identified in multiple studies (Young et al, 2002; Pritchard et al, 1999) as the No. 1 reason for dropout rates, which may be as high as 16 percent to 30 percent (Rumpakis, 2010). The Dry Eye Workshop Study (DEWS, 2007) further concluded that the primary reasons for lens intolerance were discomfort and dryness.

In addition, many patients perceive their wearing schedule as a loose recommendation that is completely unnecessary, and they rationalize noncompliance (Phillips et al, 2012). What the Phillips et al article does not mention is that compliant patients reported fewer lens-related problems than did noncompliant patients (Dumbleton et al, 2011).

Figure 1. Subtle lissamine green staining on the cornea and conjunctiva of a lens-wearing patient who has dry eyes. The patient stated that his lenses were comfortable 50 percent of the time.

Many practitioners say that lens wearers are important to their business model, but how many of us actually focus on maximizing comfort and take the time to discuss new technological advances with patients?

Lens Comfort Strategies

Individualize the lens fit. This starts with treating any underlying condition. An underlying ocular health issue may be the root cause of the discomfort. According to the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire, approximately 34 percent of contact lens wearers discontinue use at least once, most frequently as a result of dry eye symptoms (Pritchard et al, 1999; Moss et al, 2000). This has the ability to slowly erode a contact lens practice. Subtle changes in the way patients are questioned about lens wear will give you valuable insights into comfort concerns that the patient may have while wearing contact lenses. Instead of simply asking patients, “How are your contact lenses doing?” consider asking, “What percent of your lens-wearing hours are comfortable wearing hours?” This question may reveal a surprising answer and a potential dropout that needs to be addressed.

Focus on the lens-wearing experience. This includes lens care, material, and modality. It is important to look for ways to modify the care system regimen to optimize comfort. This entails getting a true account of the care routine and understanding whether patients have strayed from prescribed wear and care patterns. After this, take the time to review proper care techniques.

Finding the Right Modality

From single-use daily disposable lenses to two-week, one-month, and the less-common quarterly/yearly replacement schedules—we have many options to consider when choosing a lens modality for today's wearers that improves the wearing experience.

For example, this may be a perfect time to introduce daily disposable options to your dry eye patients. One-day lenses are useful for part-time lens wearers and are often ideal for our dry eye population. This option offers the potential to add a significant number of lens wearers to your practice.

The Bottom Line

In the end, the best lens to use is the one that maximizes patients' comfort and keeps them coming back. CLS

For references, please visit and click on document #200.

Dr. Miller is in a partnership private practice in Powell, Ohio, and is an adjunct faculty member for The Ohio State University College of Optometry. He has received honoraria for writing, speaking, acting in an advisory capacity, or research from Alcon, Allergan, CooperVision, and Visioneering Technologies. You can reach him at