The Business of Contact Lenses

It’s Time to Change the Patient

BY CLARKE D. NEWMAN, OD, FAAO

Recently, I answered a question posed to the GP Lens Institute from a practitioner who had tried several different materials to combat heavy deposits that had suddenly started plaguing a patient. He also tried different contact lens care systems. None of these changes helped.

The “change solutions, then change the lens, then change the patient” adage needs to be rethought. Some of the latest evidence suggests that we have more problems with the patients than we do with the lens wear. The term contact lens discomfort has become, or should become, a big part of contact lens practitioners’ lexicon.

Since I was in optometry school in the early 1980s, the number of people who drop out of contact lens wear has stayed monotonously the same—about 16% (Rumpakis, 2010). The primary reason why people drop out of lenses has been contact lens discomfort.

The Role of the Practitioner

While many things have been done to try to reduce contact lens discomfort, materials and solutions can only do so much. Whether we like it or not, we have to do the rest. We hope that the lens and solution manufacturers can solve the problems with contact lens wear. That way, we could prescribe the magic bullet and look like heroes.

Unfortunately, the real world is simply not a wish-granting factory, so we actually have to practice good medicine. In fact, many of the problems that we face in contact lens wear have to do with the fact that we are placing relatively large foreign bodies in the ocular/adnexal interface, and then we expect the tissue to like it.

When we deal with the main causes of contact lens dropout—end-of-day discomfort and redness—we can improve the quality of our patients’ lives, which can reduce our headaches as well.

Common Issues

Korb et al (2002) found that 85% of patients who had contact lens discomfort had lid wiper epitheliopathy (LWE). Think about that for a second. If you look for, and treat, this one condition, you can greatly decrease the incidence of contact lens dropout. It therefore makes sense for each of us who prescribe contact lenses to become experts in diagnosing and treating LWE.

In my experience, the main dropout curve begins at age 35. It just so happens that this is roughly the same age that dry eye symptoms really ramp up.

While correlation does not mean causation, the 2013 TFOS International Workshop on Contact Lens Discomfort is significantly focused on the abnormalities of the tear film. Whether deal­ing with the physical chemistry of the tear film and the lens surface, with medicamentosa, with systemic dryness caused by medications, or with corneal and conjunctival disease, a level of dryness may develop that prevents successful lens wear.

One of the things that I say to patients is that I can give them a Ferrari, which has the best engine in the world. However, if I drain the oil out of it, they can’t drive it. Likewise, I can give them a Ferrari of a contact lens system, but without a quality tear film, they can’t wear it.

We have to make sure that, when we are addressing contact lens discomfort and dryness, we deal with the patient first, then change the lenses and solutions. Your patients will thank you. CLS

For references, please visit www.clspectrum.com/references and click on document #241.

Dr. Newman has been in private practice in Dallas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine, and refractive surgery. He is a Diplomate in the AAO and a consultant to B+L, AMO, and Alden Optical. Contact him at cdnewman@earthlink.net.