Ten Steps to Managing Dry Eye in GP Lens Wearers, Part 2
BY EDWARD S. BENNETT, OD, MSED; J. BRUCE BALDWIN, OD, PHD; S. JILL BRYANT, OD; ROBERT M. GROHE, OD; ROXANNA T. POTTER, OD; & MURIEL SCHORNACK, OD
This column continues the discussion from the July GP Insights column on how to deal with the far too common—but often manageable—problem of borderline dry eye in GP wearers. As with July, this column features input from experts on the GP Lens Institute Advisory Committee.
STEP 6: Optimized Environment
Patients and eyecare practitioners (ECPs) can both benefit from a greater awareness of what Dr. Bob Grohe terms “techno-dryness.” This results from intermittently staring at computers and smartphones or other such devices throughout the day. Remind patients to blink, to use rewetting drops frequently, and to follow the guidelines in Step 7 below.
Also advise patients to limit their exposure to tobacco smoke. Smoke introduces particulate debris into the air that can irritate the eyes; it also causes generalized inflammation that can significantly decrease tear film quality.
Finally, increasing environmental humidity where possible may also help reduce symptoms.
STEP 7: Water Intake and Omega-3 Supplements
Advise patients to drink more fluids, especially during work hours. Omega-3 supplements can also help decrease dry eye. Patients can initially take 1g daily and can increase to up to 3g as tolerated.
STEP 8: Lens Care and Cleaning
Remind patients to clean their lenses in the palm of the hand upon removal. If they are using a one-step system, consider a two-step system such as the Boston Conditioning Solution/Boston Cleaner (Bausch + Lomb [B+L]) (although an abrasive cleaner is not recommended for plasma-treated lenses), Optimum by Lobob (Wetting/Rewetting and Extra Strength Cleaner), and MeniCare Rewetting Drops/MeniCare GP Cleaning, Disinfecting and Storage Solution (Menicon).
Supplemental use of the Boston One Step Liquid Enzymatic Cleaner (B+L) (weekly), Opti-Free SupraClens Daily Protein Remover (Alcon), and Progent GP Protein Remover (Menicon) (every two to four weeks) can help deposit-prone patients. Another alternative for optimizing surface cleanliness and wettability is a hydrogen peroxide system such as Clear Care (Alcon).
STEP 9: Planned Replacement
Although GP lenses can last up to several years, a planned replacement schedule will optimize success for patients experiencing lens-related dryness. Depending upon the severity of the symptoms and signs, a replacement schedule as often as every six months may be recommended, especially for patients over the age of 50. ECPs can customize the replacement schedule to accommodate allergy, medication use, computer use, and health problems such as diabetes.
STEP 10: Technology
Newer technologies can provide a more detail-oriented, individualized approach to evaluating and managing dry eye. Consider tear osmolarity testing, interferometry, and meibography. The LipiFlow Thermal Pulsation System (TearScience) is beneficial for patients who have evaporative dry eye. Once the cause of the dry eye is established, then treatment can be more targeted. CLS
Dr. Bennett is assistant dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. Dr. Baldwin is director of Contact Lens Services at the University of North Carolina Department of Ophthalmology. He is president of the Scleral Lens Education Society and has received lecture or authorship honoraria from Essilor and Alden Optical. Dr. Bryant is an assistant professor of Ophthalmology and the director of Contact Lens at Duke Eye Center. She is also a Fellow of the Academy of Optometry and the Scleral Lens Education Society. Dr. Grohe specializes in contact lenses and anterior segment in his suburban Chicago practices while also being associated with the Department of Ophthalmology at Northwestern University Medical School. Dr. Potter owns a private practice in Sylvania, Ohio. She enjoys fitting, writing about, and lecturing on specialty contact lenses. She can be reached at firstname.lastname@example.org. Dr. Schornack is a consultant in the department of ophthalmology at the Mayo Clinic in Rochester, MN. She holds the rank of assistant professor in the Mayo Medical School. She is a founding member of the Scleral Lens Education Society and serves on the organization’s Board of Directors.