Contact Lens Design & Materials
When a Material Is Not Enough
BY DAVID L. KADING, OD, FAAO
Every day, we encounter patients who love their contact lenses. But, just as often, it seems that we encounter patients who are struggling with their lens comfort or vision. In fact, a study by Nichols et al (2005) mentioned that as many as 52% of patients encounter dry eye symptoms with their lens wear. Surprisingly, it seems that these statistics have remained unchanged since I graduated from optometry school. That being said, I still think that the quest for the holy grail of contact lens materials continues, even though we are light years ahead of where we were 10 years ago.
The Definition of Insanity
Although I have a referral-based dry eye practice, I am becoming more and more aware of how complacent I have been to contact lens wearers’ ocular surface concerns. I recently asked myself why a particular patient is “dry” in this material now, but he was not a year ago? Back then, he raved about his lens comfort.
Historically, my approach was to switch my patients to the latest and greatest lens material. That action was followed with a three-week follow-up rant-and-rave about how great the new lens was (cycle repeat).
Maybe I’m realizing my own insanity. Albert Einstein once defined it as follows: “Insanity: doing the same thing over and over again but expecting different results.” Yup, that’s me.
In reality, the fantastic lens material didn’t change. So what happened? Enter the ocular surface.
Don’t Overlook Ocular Surface Issues
Independent of contact lens materials and care solutions, the ocular surface is in a constant state of change. From decreased blink rate and quality with computer use, to the change of the seasons, to hormonal shifts, our patients’ eyes change with time, and so should our dry eye treatments and contact lens approach.
Consider dry eye treatments beyond artificial tear palliative care. Instead, you should use treatments such as cyclosporine, punctal plugs, and meibomian gland expression techniques. Then, ensure that each patient is in the right lens. Follow up later to confirm that you were right.
The Right Lens
My mom always told me that the best decision is the next right decision. I am constantly telling my patients that the perfect contact lens has not been invented yet, but the lens that we are placing them in today is the best lens for them now. Ensure that you can say that with confidence to your patients daily.
In my mind, for dry eye patients, that usually means a single-use lens material (if available in patient parameters), although orthokeratology holds a strong place too. Single-use lenses offer some of the most innovative materials and surface designs. In addition, compliance and toxicity issues related to lens care are eliminated.
I also favor orthokeratology because, from my standpoint, it reduces eyelid friction and eliminates daytime blinking issues.
On the Road to Comfort
Fixing comfort isn’t easy. It starts with you identifying a patient’s real problem. Next, you need to fix the inherent issue. And, finally, you must find the most ideal lens material. CLS
For references, please visit www.clspectrum.com/references and click on document #230.
Dr. Kading owns the Specialty Dry Eye and Contact Lens Center in Seattle. He is the co-owner of Optometric Insights with Dr. Brujic. He has received honoraria for consulting, performing research, speaking, and/or writing from Alcon Laboratories, Allergan, Bausch + Lomb, Biotissue, Contamac, Essilor, Nicox, Oculus, RPS Detectors, TearScience, Valley Contax, and ZeaVision. Follow him on Twitter @davekading.