There are many choices when it comes to prescribing contact lenses—varying modalities, varying materials, and varying care solutions. We know that our patients are going to wear their contact lenses for long hours, and we know they are more prone to dryness in today’s digital world. With all of that information, I don’t want to be the one to prescribe an uncomfortable contact lens.
Are There Ways to Prevent That?
1. Address any underlying conditions. This means proactively treating any ocular surface disease (OSD) and ocular allergies. You can’t wait for patients to tell you that they are having discomfort; expect it. If you don’t actively evaluate and treat that discomfort, they will likely drop out of contact lens wear...and this often happens silently.
An ocular surface examination with sodium fluorescein, a Wratten filter, and lissamine green can reveal a myriad of issues (Figure 1). Within a few minutes behind the slit lamp, you’ll be able to see multiple scenarios, from OSD to meibomian gland dysfunction to seasonal allergic conjunctivitis to giant papillary conjunctivitis.
Ocular allergies can be a big problem for contact lens wearers. It has been demonstrated that allergy sufferers experience improved contact lens comfort with daily disposable lenses (Wolffsohn and Emberlin, 2011). There may be times when reusable lenses work better, such as for extended wear, but daily disposable lenses offer many advantages.
For allergy suffers, this may be due to less allergen buildup on the lens surface and less surface friction with the eyelid. For that reason, recommend daily disposable lenses to improve their contact lens-wearing experience.
2. Understand the lens material characteristics. There are materials that increase wettability and decrease lid interaction with the lens. We typically blink 10 times per minute; our blink rate is usually even less during visually demanding tasks (e.g., using digital devices). The higher the wettability, the less eyelid friction is produced and the higher the comfort score achieved (Keir and Jones, 2013). There are many factors that lead to improved wettability during lens wear; some relate to the specific patient, and the rest are due to the lens’ technology.
During a contact lens evaluation, it is important to let patients know that you are focused on improving their full-day comfort. While this can be difficult to predict, discussing why you have chosen a specific lens will engage your patients in this process. If you believe in an innovative product, get them excited to try it.
Many manufacturers are hard at work in the lab developing new materials that have higher wettability characteristics, less eyelid interaction, and that result in higher patient satisfaction. Embrace that. Offer these new advancements to all of your patients and not just to the patients who are complaining.
I don’t want to be the one to prescribe an uncomfortable product. For that reason, I choose to focus on innovative products and make that offer. CLS
For references, please visit www.clspectrum.com/references and click on document #255.