Optimizing GP Performance in Dry Eye Patients
BY EDWARD S. BENNETT, OD, MSED, FAAO; STEPHANIE WOO, OD; & ROBERT M. GROHE, OD, FAAO
Advances in GP materials, technology, and design can all contribute to optimizing GP performance in patients who have dry eye or borderline dry eye. GP lens material surface properties continue to enhance wettability, and plasma treatment is particularly beneficial in helping to improve initial comfort because it removes all surface impurities (Bennett, 2014). Ultrathin designs and more uniform peripheral and edge designs also reduce the likelihood of an inferiorly decentered lens, which results in a higher incidence of corneal desiccation (Henry et al, 1987).
Beyond these advancements, GP wearers keep the same lenses for one to three years on average, so taking care of their lenses is of utmost importance. Protein, lipid, and mucous deposits can frustrate patients and practitioners alike. Patients suffering from dry eye or borderline dry eye may have even more problems with deposits and discomfort. Along with current treatments for dry eye (lid hygiene, artificial tears, warm compress/massage, cyclosporine, punctal plugs, etc.), taking proper care of the GP lenses themselves is critical to patient success.
GP Care System Considerations
Selecting an appropriate care system is essential for long-term GP wear to avoid recurring dry eye symptoms. While one-bottle systems are convenient in the short term, the reduced cleaning component may permit gradual accumulation of protein and difficult-to-remove peripheral calcium buildup.
Care systems that consist of separate bottles for wetting/conditioning, cleaning, and enzyme treatment are a more thorough and long-term approach. For patients who may need additional enzyme treatment added to their current system, we use Opti-Free SupraClens (Alcon) enzyme. While most enzymes are used weekly, SupraClens may be used every day for tough cases of protein buildup, which causes filmy, hazy vision complaints.
Menicon’s Progent is extremely effective at removing stubborn protein deposits. Patients immediately notice a difference in vision and comfort. Practitioners can treat the lenses in the office, or, when more frequent treatments are needed, patients can order the Progent kit online and treat their lenses at home.
Hydrogen peroxide systems help to prevent protein buildup on GP lenses (Ward, 2012). If patients continue to have dry eye symptoms with a hydrogen peroxide system, consider adding a conditioning solution such as Boston Simplus or Boston Conditioning Solution (both Bausch + Lomb) to help moisturize the lens and improve wettability.
GP Care and Patient Education
Always instruct patients to clean their lenses upon removal at night. Not only does this optimize disinfection, perhaps more importantly, the wetting agents within the solution help condition the lens prior to application the next morning. In addition, lenses should be applied directly from the solution if it is also a wetting/conditioning solution, or they should be rewetted prior to application. The U.S. Food and Drug Administration advises against exposing contact lenses to any form of water to minimize risk of eye infection (www.fda.gov); impurities from tap water can impact surface wettability as well. CLS
For references, please visit www.clspectrum.com/references and click on document #226.
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. You can reach him at firstname.lastname@example.org. Dr. Woo currently practices at Havasu Eye Center in Lake Havasu, AZ. She is also the public education chair for the Scleral Lens Education Society and is an Advisory Board member for the GPLI. She is a consultant to Blanchard, X-Cel, and SpecialEyes. 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.