When patients present with “something is wrong with my contact lenses,” practitioners often focus on the lenses. But, if they don’t identify the true culprit, it could be a long road of multiple trials and over-refractions. When patients who have an established history of successful lens wear present with acute lens performance issues, it may be a change in them, not a defect in the lenses. Let’s review some culprits that can affect the stability and optical performance of soft toric lenses.

‘Tis the Season

Ocular allergies play a huge part in affecting how a soft toric lens fits. Conjunctival chemosis can affect the way a lens settles and spins on the eye, limiting rotational recovery if the lens does happen to rotate out of place. Papillae on the palpebral conjunctiva, especially giant papillary conjunctivitis (GPC) of the upper lid, produce a mucus-like lipoprotein layer that sticks to the surface of the contact lens. This layer pulls the lens to a high position as the eye opens after a blink, often exposing the inferior limbus and causing lens awareness and significant vision fluctuation. Be sure to flip eyelids and to ask patients about any new discharge from their eyes, even if it is just a small amount.

Changes to the Old Routine

As complex as the tear film and eyelid environment is, it’s amazing that we have the contact lens technology to create a fairly stable tear layer on most contact lens materials. However, that tear layer equilibrium can be easily disrupted by medications, cosmetics, and other environmental factors, leaving the lens prone to dryness.

If practitioners observe deposits or tear breakup on a lens surface that does not normally occur, they should begin to think about tear layer instability that leads to a dry and exposed lens surface. A dry lens surface is like a magnet for deposits, which can affect the performance and comfort of their contact lens.

Ask about anything new in the patients’ daily routine (e.g., medications that can contribute to dehydration or work environments that lead to different air flow or quality). Cosmetics are also a likely offender, so ask about new eyeliners, mascaras, lash enhancers, and face creams.

Lens Care

With the high-quality contact lens materials that are available, some patients will try to push the limits by either over-wearing their lenses past the recommended replacement time or using solutions improperly. Reinforce the importance of regular replacement of lenses and storage cases. As lenses get older, they are more likely to build up protein deposits, which can attract preservatives from solutions and artificial tears (Gromacki, 2006). Prolonged exposure to these preservatives can lead to a toxic response by the corneal epithelium, resulting in blurry vision, light sensitivity, or lens discomfort. Storage cases that are not cleaned or replaced regularly are a breeding ground for biofilms and bacteria, which can lead to infections and inflammatory reactions.

In addition, reviewing the prescribed care system or switching to a hydrogen peroxide solution may be the problem solver for patients who have acute problems. While many patients can tolerate a wide range of solution brands, disinfecting agents, and preservatives, some need very specific recommendations. Explaining the differences in available solutions and why a specific recommendation is being made should help improve compliance. CLS

For references, please visit www.clspectrum.com/references and click on document #273.