Contact Lens Dry Eye: Research Funding Key Issue in Progress
By Jason J. Nichols, OD, MPH, PHD, FAAO
Contact lens comfort remains one of the largest, if not the largest, perceived obstacles to growth in the contact lens market. The numbers tell the story. Up to one-half of lens wearers continue to have dry eye and ocular surface-related symptoms. Estimates suggest that about 16 percent of all contact lens patients discontinue wear each year (Nichols, “Contact Lenses 2009,” January 2010 issue) and about 40 percent of those discontinuing do so because of dryness and discomfort (Gaume and Nichols, “2012 Annual Report on Dry Eye Diseases,” p. 26). What's the in-the-trench clinician to do?
The answer is obviously complex—but it starts with good clinical research, including going back to the basics. How is the tear film different compositionally and/or structurally in contact lens wearers compared to non-lens wearers? How does the contact lens polymer change the ocular surface environment? Are tear film secretory pathways altered? Are new, sub-clinical inflammatory pathways initiated? Are the neuro-biological and sensory pathways altered? And, how do these things initiate the symptoms that our lens wearers experience?
It takes financial funding to support this kind of research and, unfortunately, obtaining federal funding (e.g., National Institutes of Health—NIH) for this sort of critical and foundational contact lens research isn't easy. As discussed by Contributing Editor Dr. Loretta Szczotka-Flynn in our e-newsletter Contact Lenses Today (April 22, 2012 edition), obtaining “federal funding” for cornea/contact lens research is difficult. She notes that, “We commonly hear that the ocular surface conditions including contact lens complications we study do not have enough morbidity or public health impact to warrant federal funding, or that the contact lens industry should absorb these costs.” She has hit the nail on the head—the review panels associated with NIH are generally not interested in funding research related to contact lenses. It's often perceived by these more general scientists that contact lenses are “cosmetic devices” and that they are not important enough to warrant federal funding unless they are linked to a blinding eye disease.
Although estimates can vary, there are thought to be upwards of 35 million lens wearers in the United States alone, and while contact lens dry eye may not have the morbidity of infectious keratitis, a rare condition, contact lens dry eye certainly is more frequent in the general population. We need federal funding agencies, both in the United States and abroad, to step up and help us move the needle.