Contact Lens Care & Compliance

Contact Lens Discomfort and Contact Lens Care

BY SUSAN J. GROMACKI, OD, MS, FAAO

A recent 18-month-long workshop conducted by the Tear Film & Ocular Surface Society (TFOS), published in Investigative Ophthalmology and Visual Science in October 2013, discussed contact lens discomfort (CLD), which impacts millions of lens wearers worldwide (Nichols et al, 2013). CLD is related to, but not synonymous with, “contact lens-related dry eye,” which is defined by the authors as a “pre-existing dry eye condition which may or may not be exaggerated with contact lens wear.” It can ultimately result in patients dropping out of contact lens wear altogether.

The authors define contact lens discomfort as, “a condition characterized by episodic or persistent adverse ocular sensations related to lens wear, either with or without visual disturbance, resulting from reduced compatibility between the contact lens and the ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear.”

Causes

Contact lens discomfort can arise from the lens and/or the environment. Categories of the former include contact lens material (e.g., lubricity or water content), design (e.g., edge or base curve), fit and wear (e.g., lens interaction or modality), and lens care (e.g., solution chemistry or care regimen). Environmental categories include inherent patient factors (e.g., age, gender, and ocular/systemic disease), modifiable patient factors (e.g., medication compliance), ocular environment (e.g., lipid/tear stability and blink), and external environment (e.g., humidity and air quality).

Management

According to the authors, managing CLD begins with a good case history. Next, it is important to diagnose coexisting pathologies that may be causing patients’ symptoms—such as ocular medicamentosa, systemic disease, eyelid disease, tear film abnormalities, and corneal or conjunctival disease—and treat them before addressing the contact lens as the primary source of discomfort. After that, focus on the lens and lens care system.

During the workshop, a subcommittee explored the impact of contact lens material, design, and care on contact lens discomfort. An entire paper was published on their findings (Jones et al, 2013). Contact lens issues such as edge chips or tears, deposits, edge design, material properties, and on-eye fit should be addressed. The authors also state that, “Care solutions and their components or improper care regimens also may at times contribute to CLD” (Nichols et al, 2013). They write that even the solution in the lens’ blister pack can be associated with CLD. And lastly, changing a patient’s lens care system, “may have some effect on deposit formation.” (Nichols et al, 2013).

They go on to state that contact lens care schedules and practices are “of interest” in understanding CLD. And although the peer-reviewed literature needs to study this topic in greater detail, “most practitioners agree” that regular contact lens care including rubbing, rinsing, and adequate soaking (disinfection and cleaning) is important in the long-term success of lens wear. CLS

For references, please visit www.clspectrum.com/references and click on document #224.

Dr. Gromacki is a diplomate in the American Academy of Optometry’s Section on Cornea, Contact Lenses and Refractive Technologies and practices in Chevy Chase, Md.