Article

DRY EYE DX AND TX

THERE IS NO MAGIC BULLET FOR CONTACT LENS DISCOMFORT

What is the best contact lens material for a patient who experiences discomfort or dryness during wear? If you survey 10 practitioners, you’ll probably get 10 different answers. In fact, the Tear Film & Ocular Surface Society (TFOS) International Workshop on Contact Lens Discomfort (2013) evaluated peer-reviewed literature on at least nine major properties of contact lens materials and concluded that “To date, almost none of these attributes, with the possible exception of friction based on early evidence, appears to be associated directly with Contact Lens Discomfort.” There is no magic bullet, and work still needs to be done to answer this question.

Determining What Is Wrong

Lens complaints may include reduced wear time, lens awareness, fluctuating vision, dryness, and redness. And, many patients assume that some degree of discomfort is normal and may not report any of these issues at all. Therefore, we need to be very pointed during our interview, sometimes just to uncover a complaint in the first place. For example, rather than asking how how many hours a day lenses are worn, specifically inquire as to how many hours lenses are on the eye before they become bothersome, or how often rewetting drops are needed throughout the day. These questions provide very real answers that can assist you in getting to the root of any problems.

It’s very important to rule out and address other symptom contributors (Table 1) before switching materials. If the problem stems from underlying ocular surface inflammation, these conditions will often progress until irreversible damage occurs. CLS

TABLE 1 ADDRESS THESE ISSUES BEFORE CHANGING LENSES
1 Solution Sensitivity Stinging or burning upon contact lens application may point to a solution sensitivity. Try a solution with a different preservative or switch to a hydrogen peroxide care system.
2 Deposits or Poor Habits Review cleaning and storage techniques with patients, or consider changing them to a contact lens with a more frequent replacement modality.
3 Allergy/Giant Papillary Conjunctivitis Evert upper lids at every contact lens visit. Papillary conjunctivitis can cause itching, redness, increased mucous production, and lens discomfort. Treat early by decreasing wear time, increasing replacement frequency, or starting topical mast cell stabilizers and/or a steroid.
4 Lid Disease/Lid Wiper Epitheliopathy Lid inflammation or infestation can lead to tear film disruption, ocular surface inflammation, and contact lens intolerance. Begin lid hygiene, manual debridement, and/or topical medication.
5 Meibomian Gland Dysfunction (MGD) Healthy meibum is vital for stabilizing the tear film over a contact lens surface. Meibum should be thin, clear, and easily expressed with minimal pressure. Begin warm compresses, omega-3 supplements, and/or other MGD therapies.
6 Aqueous Deficiency Most soft contact lenses are 30% to 70% water and absorb tears to remain hydrated. Aqueous-deficient individuals may have difficulty keeping a soft contact lens properly hydrated for comfortable wear. Begin topical therapy and/or switch to a GP material.

For references, please visit www.clspectrum.com/references and click on document #264.