How to Manage Dryness Symptoms in GP Lens Wearers
BY EDWARD S. BENNETT, OD, MSED, FAAO; MATT KAUFFMAN, OD, FAAO, FSLS; BRIAN SILVERMAN, OD; & MELANIE FROGOZO, OD, FAAO
When GP lens wearers report dryness symptoms, management depends on a number of factors. With the help of some rising stars in the contact lens profession, this article will present some common and successful approaches.
The “Go To” Diagnostic Tests
Evaluating the lens-to-cornea fitting relationship is particularly important. An inferiorly positioning GP lens can result in more lid-lens edge interaction, which can impact the quality of the blink. Decreasing lens mass (i.e., ultrathin design and lenticulation in high-minus and all plus powers) and a lower-edge-clearance design, if appropriate, can be beneficial. Also evaluate the peripheral cornea, notably for desiccation staining.
Tear breakup time (TBUT) without the lenses can reveal whether patients have issues with wetting through the blink cycle. Lissamine green staining can be especially helpful to see areas of greatest irritation. Lid wiper involvement should be addressed with in-office debridement.
Evaluating for meibomian gland dysfunction (MGD) is essential. Placido-based topography will show blurry mire quality if a patient has a quick TBUT. Some topographers have an infrared imager that shows whether there is meibomian gland dropout.
Artificial Tears and Lubricants
Any of the commercially available preservative-free artificial tears are helpful in these cases. Patients who have MGD can use a more viscous and oily drop when not wearing their lenses, supplemented with warm compresses and lid scrubs. Gel formulations at night can provide an additional therapeutic effect. If this approach is not successful, cyclosporine ophthalmic drops may help maintain the ocular surface; they are best instilled 10 minutes prior to lens application and after lens removal.
Lens Care Systems and Adjunct Cleaners
When dryness is accompanied by surface deposition, we have found that it’s best to use a hydrogen peroxide-based cleaning system, supplemented by rubbing with a multipurpose solution after lens removal. If filming persists, an extra-strength cleaner can be added to the care regimen.
What Else Can Help?
Ordering the lenses plasma treated is always a good idea, although patients must care for the lenses properly (i.e., no abrasive cleaners) to optimize the effect of this treatment on the front surface. Recommend that patients avoid tap water exposure because its impurities can affect the lens surface. A unit-dose, nonpreserved saline is ideal for rinsing cleaners from GP lenses. Sometimes changing to a lower-Dk lens material will lessen the risk of deposit-related problems.
Patient compliance with lens care is also important. They should be able to repeat the instructions for every step of lens care prior to leaving the office. In addition, emphasize that the use of hand creams and lanolin-containing hand soaps must be avoided prior to application.
The availability of increasingly wettable GP lens materials in ultrathin designs has made symptomatic GP wearers a less common problem. Hopefully, the pearls presented here will help even more in optimizing patient comfort and satisfaction with GP lenses. 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. You can reach him at email@example.com. Dr. Kauffman graduated from the University of Houston College of Optometry and completed a residency in cornea and contact lenses at the University of Missouri–St. Louis. He is an associate at Family Vision Solutions and Specialty Contact Lens Center and an adjunct clinical professor at the University of Houston College of Optometry. Dr. Silverman is in specialty group practice in Seattle and Bellevue, WA. He trains residents from SCCO on specialty contact lens fitting. You can contact him at firstname.lastname@example.org. Dr. Frogozo specializes in adult and pediatric specialty contact lenses. She is the director of the Contact Lens Institute of San Antonio and the owner of Alamo Eye Care in San Antonio, Texas. She also is a consultant to CooperVision. You can contact her at email@example.com.