editor’s perspective

Lens Discomfort—A Road Too Long Traveled

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

Contact lens discomfort plagues many of our patients. They complain of problems with dryness as well as reduced wearing times on both a daily and a weekly basis. We often try a new lens material or replacement schedule, or add a rewetting drop or change the care solution. Unfortunately, in many instances none of this works, and patients ultimately end up quitting contact lens wear altogether.

What are the impediments that keep us from solving these problems more satisfactorily? Perhaps we need to ask whether we have the right contact lens-related tools to solve the problem, by focusing on the right variables in our patients’ eyes and implementing the right protocols to proactively prevent complications.

What tools should we use to fix contact lens discomfort? More oxygen transmissibility? Unlikely, when we consider that we have not seen any sort of reduction in the rates of discomfort over the last 10 years, the same time frame when the market transitioned predominantly to silicone hydrogel use. Maybe we need to be thinking about other material attributes such as modulus or coefficient of friction rather than continually returning to the predictable approaches offered by conventional wisdom.

What else can we consider in trying to remedy lens discomfort? Corneal staining? I doubt it. Population-based studies have shown for years that there is not a clear relationship between corneal staining and symptoms. I suggest that we really look at the lids, margins, and orifices—I suspect that these areas are the real source of many problems that we see in our offices.

Lastly, why do we routinely do so little to avoid problems in the first place, instead acting only after some issue has raised its head? Dentistry has very successfully implemented a prophylactic model. We floss and brush our teeth to prevent tooth decay and cavity formation. Why don’t we proactively express the meibomian glands of asymptomatic patients? Furthermore, why don’t we ask our patients to use a drop to prevent contact lens discomfort, rather than “treat” the problem once it already exists? I don’t just suspect—indeed I believe—that a big part of the answer lies here.