therapeutic topics
The Effect of Medications on Contact Lens Wear
BY JULIE A. SCHORNACK, OD, MED

When patients present with specific problems in contact lens practice, you want to solve their problems to the best of your ability. However, many difficulties with contact lenses may be attributed to side effects associated with medications. Your job is to provide the patient with the best contact lens under the circumstances, but ultimately your best ally may be solid patient education outlining the compromises that particular medications may cause.

When dealing with contact lens patients who return to your office for annual exams, it is easy to gloss over the specifics of the patients' medications due to your familiarity with patients. The tendency to review previous medication lists that the patient has pro vided and briefly ask if there have been any changes is easy to do. Asking the patient to carefully review previous medication information and specifically asking about changes in dosages can sometimes reveal the culprit of contact lens problems. Even if specific drugs have not been changed, a subtle change in dosage over time can cause an asymptomatic patient to manifest previously unnoticed side effects.

As the over-the-counter market for self medication options continues to increase, the impact of these non-prescription drugs is an additional area to investigate for potential contact lens interactions. The acute or chronic administration of over-the-counter medications has as much potential to sacrifice contact lens success as prescribed counterparts. A case in point are the well-known dry eye side effects noted with many prescribed and over-the-counter antihistamines.

Don't Forget Herbals

In a somewhat related category, the wide use of nutraceuticals by patients for a diverse list of health benefits is an easily overlooked area of self medication that may be impacting on contact lens success. Although many practitioners may consider nutraceuticals an innocuous form of self medication, don't underestimate their potential to cause ocular side effects. In addition, the ascribed dosage that any patient can take for a particular nutraceutical can vary widely among patients. A solid resource on nutraceuticals that outlines potential side effects is a must in eyecare offices.

Some patients can be exceptionally poor historians when it comes to recalling names and specifics regarding their medication history. If you suspect that prescribed medications may be at the root of contact lens problems, ask the patient to bring along all his medications.

Examine the date of initiation of particular drug therapies. The start of a drug regime and the emergence of a subsequent contact lens-related side effect in short succession may be easily connected. Side effects with some medications will not manifest for a longer period of time and may show more cumulative patterns. Attention to these details may be helpful in pinpointing contact lens-related problems.

We all want our contact lens patients to be successful. However, the side effects associated with a variety of prescribed and self-prescribed medications can compromise your best efforts. Atten tion to the patient's medication history and patient education concerning related side effects can be instrumental in addressing patient contact lens complaints and moving toward patient satisfaction. Current contact lens practices must have a variety of resources available to describe the potential side effects of prescribed, over-the-counter and nutraceutical agents. Use the Inter net to expand your knowledge base and guide patient understanding about medication side effects.

Dr. Schornack is the Assistant Dean of Clinical Education and serves in the Cornea and Contact Lens Service at the Southern California College of Optometry.