Contact Lens Care & Compliance
Care and Compliance’s Relationship with Lens Comfort
BY ANDREW D. PUCKER, OD, MS, FAAO
The Tear Film & Ocular Surface Society (TFOS) has highlighted the importance of, and the issues surrounding, contact lens discomfort (CLD) (Nichols et al, 2013). CLD is a major issue. It is experienced by millions of wearers, and it has been cited as the number one reason why patients discontinue contact lens wear (Nichols et al, 2013; Fonn, 2007). While contact lens wearers can experience discomfort at any point, CLD is most frequently noticed toward the end of the wearing day (Chalmers and Begley, 2006; Papas et al, 2013).
Lens discomfort/dryness has a different presentation compared to dry eye disease, which suggests that the two conditions have different mechanisms (Chalmers and Begley, 2006). Furthermore, the underlying causes(s) of CLD is unknown, which has made it difficult to treat (Papas et al, 2014).
TFOS’s report details a systematic approach for combating CLD (Papas et al, 2013). It begins with taking a comprehensive case history, which is followed by first treating any underlying systemic disease (Papas et al, 2013). It then addresses several other factors, many of which focus on proper contact lens care and compliance (Papas et al, 2013).
How Contact Lens Care and Compliance Fit in
To see whether contact lens care and compliance are related to CLD, start by investigating the state of the contact lenses (Papas et al, 2013). Specifically, make sure that the contact lenses are in good condition (e.g., no rips/tears or excess deposits) and that they fit well (Papas et al, 2013).
Address wear schedule next because contact lens wearers who discard their lenses on schedule tend to report better end-of-day comfort (Dumbleton et al, 2010). If patients are over-wearing daily wear contact lenses, you may want to consider switching them to daily disposable contact lenses because this may improve compliance; it may also improve comfort because daily disposable lenses have been associated with better end-of-day comfort compared to daily wear contact lenses (Papas et al, 2013).
Contact lens care solutions can also have an impact on lens comfort (Papas et al, 2013). This is highlighted by how many contact lens care solutions contain comfort-promoting agents (Fonn, 2007). Likewise, lens discomfort is associated with improper use of lens care products and contact lens cases (Papas et al, 2013). Optimizing contact lens-care solution combinations could also improve contact lens comfort (Papas et al, 2013).
Furthermore, it may be prudent to advise your patients to regularly use artificial tears to treat their discomfort. Artificial tears can be the most effective treatment for lens discomfort outside of discontinuing contact lens use, which is a much less desirable treatment (Chalmers and Begley, 2006). Contact lenses divide the tear film into two layers, which may promote tear evaporation; artificial tears can help replace this lost fluid (Fonn, 2007).
Look to the Experts
Contact lens care and compliance play an integral role in the diagnosis and treatment plan outlined by TFOS for managing CLD. Implementing TFOS’s recommendation in a systematic fashion and promoting proper contact lens care and compliance will likely help mitigate the current epidemic of CLD, and it could also help curtail the high rate of contact lens dropouts (Chalmers and Begley, 2006; Nichols et al, 2013). CLS
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Dr. Pucker earned his OD and MS degrees from The Ohio State University. He is currently a senior research associate at The Ohio State University. He has also received research funding from Johnson & Johnson Vision Care. You can reach him at email@example.com.