We are taught as human beings to always look for the best in people. Our mothers always told us that people are good, and we need to look for and celebrate the good. For years, we have celebrated the victory of contact lens wear for our patients. Our dialog with patients in the exam room has historically centered on what is working with their lenses, what we have improved over their prior lenses, and what we can do to make their lens wear great again. Doing the same thing over and over and expecting change to happen has remained the law of insanity since day one.

In spite of this, lens dropout rates have shown little change, patients continue to come in feeling different from the year before, and the contact lens market has not exploded like it should with the increased need for vision correction. Perhaps we need to stop looking at the good and instead focus on how bad things are or will be—at least with regard to our patients’ ocular surfaces.

Seeing the Worst

The ocular surface is delicate. We are learning more and more about the complexity of the outer lid, lashes, line of Marx, lid wiper, inner eyelid, and meibomian gland interfaces. Realizations about seen and unseen effects of biofilm and Demodex have crept into our daily clinical decision-making.

Evaporative stress is becoming a common term in our understanding of the effects of decreased oil on the outer lens or ocular surface. With digital device use as it is, patients’ blink rate and quality can impact the functionality of the normal tear film and tear production. And over time, meibomian gland production may change, leading to blockage and atrophy.

These are some of the worst in patients’s ocular surfaces that we see. These are the things that we now expect to see. And these are the things that, if left unchecked, can impact the good that we see everyday in our patients.

The Verdict

Our normal has changed over the last three years. Now, instead of waiting for patients’ good ocular surfaces to turn bad, we treat the bad before we even see it.

From our clinical perspective, patients who have poor blinks tend to develop meibomian gland problems. Thus, we advocate for warm compresses on all contact lens patients. We also advocate for lid hygiene that is practitioner recommended/prescribed and hypoallergenic. Having a routine to ensure a reduced bioburden of the lid margin is key to maintaining a healthy ocular surface.

The more severe that the patients’ worst is, the more frequently we recommend that they adopt this routine. Compliance is always a challenge, especially when patients feel good. The dental world moved us to brush our healthy teeth everyday because we came to realize the effects of plaque (bacterial build up) and how this leads to cavities. Good contact lens patients are dropping out everyday. It’s time to see a new normal in all of them; it’s time to look for the worst. CLS