editor's perspective

Taking the Next Step

BY JASON J. NICHOLS, OD, MPH, PHD, FAAO

I've recently had discussions with many colleagues about the use of pharmaceuticals in contact lens wearers. No doubt we have all used therapeutics to manage contact lens complications, ranging from inflammatory events such as papillary conjunctivitis and infiltrates to infectious complications such as microbial conjunctivitis and keratitis. It is always unfortunate when such events occur in our patients.

However, my recent discussions have been more along the lines of using agents to promote such things as improved comfort during contact lens wear. We all know the statistics very well—up to half of lens wearers complain of dryness and discomfort. Correspondingly, when patients do discontinue contact lens wear, the number-one reason (regardless of age) without question is discomfort and dryness. We have come a long way with new materials and understanding the impact of care solutions, but we need to take another step further in solving this problem.

That's where other agents should come into play. Interestingly, in our Annual Dry Eye Report (printed in July 2009), only about 6 percent of practitioners reported using a pharmaceutical and less than 5 percent reported using a nutritional supplement (e.g., omega-3) as a first or second option in managing contact lens-related dry eye. Granted, we are currently limited in the number of pharmaceuticals available to treat dry eye diseases, but I believe that it is important for us to proactively embrace medical management in this area. Some argue that contact lens wear is elective, and thus it seems unreasonable to manage this form of dry eye with a therapeutic approach. I strongly believe that this view is short-sighted and that we need to change this culture.

There are several agents that might be considered to improve comfort during lens wear in addition to “traditional” management including pharmaceuticals for dry eye, allergy, and blepharitis in addition to nutritional supplements and lid hygiene. There are also a variety of additional medications in the R&D pipeline that may become available in the not-so-distant future. This therapeutic management approach will undoubtedly prompt further discussions about a much-needed change in the way we manage comfort in our lens wearers.