How many times have practitioners heard that statement? Too many times, that’s for sure. Dry eyes are not a contraindication for contact lens wear anymore. That said, regardless of whether it is aqueous deficient or evaporative dry eye disease, it can make the fitting more challenging.
However, dry eye disease does not need to prevent practitioners from fitting patients. If eyecare practitioners consider dry eye disease a barrier, then they may be missing many contact lens opportunities. Instead, physicians should focus on the improved contact lens technology that may impact these patients in a positive way. Here are three tips that can help when fitting patients who have dry eye disease.
1) Understand What You Are Dealing With
Whatever dry eye questionnaire you use, make sure to get a baseline reading. For example, the Ocular Surface Disease Index will provide a range of normal versus mild/moderate or severe dry eye disease. Practitioners know that symptomology does not always match clinical signs with this disease, and understanding the patients’ perspective of their condition is a key component.
After you have a baseline symptomology, evaluate the eyelids and ocular surface carefully. There are a multitude of diagnostic tests for evaluating and treating dry eye disease. Determine whether the level of meibomian gland disease and ocular surface punctate keratitis can support healthy contact lens wear. Depending on the level of dry eye disease, patients may need additional treatment options, but contact lens wear is a possibility. Additionally, for many patients, part-time wear is considered a success.
2) Offer the Best
We often use contact lenses as a bandage for corneal abrasions, but newer lens designs and technology may even improve the ocular surface over time if worn appropriately.
What lens do you use for bandage contact lenses? For dry eye patients, are you going to use a reusable contact lens that has an uncomfortable edge design and a low level of hydration or a daily disposable contact lens that has minimal eyelid interaction and stays hydrated throughout the wearing experience?
Patients are asking for relief from their dry eye disease, but many would still like to wear contact lenses as well. If you can provide them relief and do so with a contact lens, make the offer. Let them know, “I know that you have not been able to wear contact lenses in the past due to your dry eyes, but I think I have something for you now!” Focus on the features of that technology, and let patients wear the lenses in their normal life environments.
3) Follow Them Closely
Instead of waiting a year to see these patients, consider following up with them at least every six months. The objective is to stay up-to-date regarding their dry eye disease and success/failure with contact lens wear. At that follow-up appointment, repeat the symptomology questionnaire, and evaluate their eyelids and their ocular surface with sodium fluorescein and lissamine green. You may find a slow steady improvement over time with these patients.
Evaluate your protocol and how the staff and practitioners in your practice handle patients like this. This needs to be a focus because there are quite a few patients in this category. Successful treatments with these wanna-be contact lens wearers who have some sort of dry eye disease is critical to the success of your contact lens business. CLS