contact lens case reports

Tinted Lenses Provide Relief for Some Photophobic Patients

BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ

Occasionally we work with patients whose chief complaint is photophobia. Most of us experience varying degrees of photophobia when exposed to bright sunlight, and most of us can gain relief by wearing proper sunglasses.

However, a very small subset of patients have photophobia that may be considered pathologic. These individuals are often confined to indoor environments in which curtains must be continually drawn, and they wear sunglasses for most of their waking hours. For these patients, outdoor activities (especially on sunny days) are limited and almost any light exposure can be extremely painful.

This debilitating photophobia may be optical, anatomical, neurological or psychological in origin; however, in most cases the etiology of the condition remains unknown.

Relief for Some

Our patient underwent bilateral corneal transplants for keratoconus, in the right eye in 1975 and in the left eye in 1978. Postoperatively, the patient experienced bilateral high regular and irregular corneal astigmatism that, throughout the subsequent years, had been adequately corrected with a piggyback lens system. However, the patient continued to complain of pathologic photophobia that significantly compromised her lifestyle. As with so many others afflicted by this condition, the etiology of the photophobia was unknown.

Figure 1. Dark gray tinted GP lenses.

Figure 2. Piggyback system on the patient's right eye.

We discussed a number of options with the patient that including the use of tinted HEMA soft contact lenses piggybacked with traditional GP lenses. Another option was to use silicone hydrogel soft lenses piggybacked with tinted GP lenses. Ultimately, we jointly decided that the patient might be best served with clear hydrogel lenses piggybacked with dark gray tinted GP lenses. The GP parameters were right eye 51.00D base curve, –7.00D, 10.0mm diameter, 9.0mm OZ 20/25, left eye 57.00D, –12.00D, 10.0mm, 9.0mm OZ 20/20, dark gray tint OU (Figure 1). Parameters for the underlying soft contact lenses were 8.5mm, –0.50D, 14.2mm, 1-Day Acuvue (Vistakon) (Figure 2).

On the return visit the patient reported great improvement in her photophobia symptoms with the tinted GP lenses. She indicated that for the first time in years she's been able to comfortably leave her home in daylight hours and to actually drive her car.

Throughout the years we have used the tinted lens modality for a number of patients who have extreme photophobia. Unfortunately, only 50 percent of our patients report some degree of improvement. At this time we have no way of predicting which individuals will succeed with the tinted lenses; therefore, we discuss the options with patients, review the success rate and ultimately suggest a diagnostic fitting. These patients are often interested in trying anything that carries any potential for success. CLS

Patrick Caroline is an associate professor of optometry at Pacific University. He is also a consultant to Paragon Vision Sciences and SynergEyes, Inc. Mark André is an associate professor of optometry at Pacific University. He is also a consultant for CooperVision and SynergEyes, Inc.