Dry Eye Dx and Tx

Ocular Surface Disease and Contact Lens Wear

BY JASON MILLER, OD, MBA, FAAO

In the changing face of healthcare, contact lenses are vitally important to most practitioners. Advanced materials, designs, and lens care solution systems have improved our ability to provide a comfortable contact lens-wearing experience, but a careful eyelid and corneal evaluation can identify potential complications along with specific treatment regimens for these patients. Remediation of any underlying conditions may be achieved by utilizing a patient-centered, proactive approach.

Don’t Assume All is Well

Many patients may be silently sufferering with their current lenses for many reasons (fear of being unable to wear lenses anymore, lower expectations, etc.). The more subtle conditions pose the biggest potential complication threats that lead to the discontinuation of lens wear. For example, meibomian gland dysfunction (MGD) can exist in a not-so-obvious form (Henriquez and Korb, 1981). This non-obvious form is easily missed without careful analysis and will pose a threat to successful lens wear.

Figure 1. This lid may not appear to be inflamed, but upon expression, gland secretions are thickened in this patient who has a non-obvious form of MGD.

To identify these patients, gland expression is critical. It may take 10 to 15 seconds of sustained pressure in a specific area, but when a thickened meibum (Figure 1) or lack of fluid appears, those glands are not functioning properly and need to be addressed (Korb and Blackie, 2008).

Ask the Right Questions

Eyecare practitioners can often identify these silent sufferers through a detailed history and examination. Subtle changes in the way patients are questioned and when they are questioned about their contact lens-wearing experience will provide valuable insights into any comfort concerns.

For example, ask your patient at what time of day his contact lenses start to feel uncomfortable and question him during your anterior segment evaluation. Patients may be more honest if they suspect that their eyecare practitioner has identified a concern.

Follow up on reasons why the patient’s ocular surface may be drying out earlier in the day and discuss ways to improve comfort and maximize his success. In addition, practitioners need to address subsequent ocular surface dryness to improve success.

Figure 2. Careful evaluation with fluorescein staining prior to and during lens fitting will help identify possible complications from dry eyes.

Understanding how to identify threats to lens wear and how dry eyes can compromise success are the first steps in preventing patients from dropping out of lens wear. Determining the underlying cause will dictate appropriate treatment of ocular surface disease. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #205.

Dr. Miller is in a partnership private practice in Powell, Ohio, and is an adjunct faculty member for The Ohio State University College of Optometry. He has received honoraria for writing, speaking, acting in an advisory capacity, or research from Alcon, Allergan, CooperVision, and Visioneering Technologies. You can reach him at drmiller@eyecarepowell.com.