Contact Lens Practice Pearls
Relieve the Silent Sufferers
BY JASON R. MILLER, OD, MBA, FAAO
True contact lens-related dryness may be difficult to differentiate from many other conditions. There may not be any obvious complaints or clinical signs, but they all add up to a silent sufferer. These patients rarely complain because their symptoms creep up gradually. They often just think that their symptoms are normal for contact lens wear.
First, Ask the Right Questions
Start with this statement: “I want to provide you with the optimal contact lenses for your eyes. Before I can do that, I need to ask a few questions concerning your wearing experience.”
Eyecare professionals can often identify these silent sufferers through a detailed history and examination. Ask the following:
1. How often do your eyes get red when you wear your contact lenses?
2. Do you ever experience intermittent blurred vision throughout the day? If so, how often does this occur?
3. Do you use any eye drops throughout the day?
4. How many hours a day do you work on a computer?
Troubleshoot the Source of the Irritation
Take for example this hypothetical patient encounter. A 30-year-old contact lens wearer presents with vague comfort complaints including burning, scratchy, or irritated eyes. He’s wearing his lenses for fewer days with reduced hours of wear during the day.
In a case like this, start by determining the underlying etiology. Is it the contact lenses? Is it the care solution? Is the patient wearing his contact lenses overnight or incorrectly? Has something changed with his work environment or medications that he is taking? Does he have clinical dry eyes or ocular surface disease? True ocular surface disease will typically occur both with and without contact lens wear (Townsend, 2008).
After examining your patient, you determine that he is experiencing dryness and irritation after about four to six hours of contact lens wear. He uses a computer or digital device often throughout the day, and his vision seems to decrease as the day progresses. There is very little movement of the contact lenses, and visible lens surface dryness is evident with slit lamp examination. There may even be corneal staining with fluorescein and, potentially, limbal irritation evident with lissamine green (Figure 1).
Figure 1. Subtle lissamine green staining and mild redness at the limbus may indicate an issue with the contact lens fit and subsequent irritation.
This is a typical clinical scenario with contact lens-related dryness, and it needs to be addressed. This may initially include a prescription to stabilize the ocular surface, such as a “soft steroid.” Then, consider changing the lens material, care system, and/or modality to resolve this issue.
We currently have many new, innovative contact lens technologies out there to address these patients’ concerns. Unfortunately, they often go undetected and untreated. Understanding how to identify potential threats to contact lens wear and how those threats can compromise successful lens wear are keys to a thriving contact lens practice.
This can be achieved by utilizing a patient-centered, proactive approach. Innovation continues regularly with new materials and designs that can enhance your patients’ lives. Don’t let your contact lens wearers continue to suffer in silence. CLS
For references, please visit www.clspectrum.com/references and click on document #249.
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, B+L, Revolution EHR, and Johnson & Johnson Vision Care, Inc. You can reach him at firstname.lastname@example.org.