Contact lens discomfort (CLD) is a concern because it limits contact lens (CL) wear time and because it is the top reason why patients permanently discontinue wearing CLs (Pritchard et al, 1999). Even with the introduction of silicone hydrogel materials and daily disposable CLs, reports of CLD and discontinuation continue to be relatively steady (Dumbleton, Woods et al, 2013; García-Porta et al, 2013; Chalmers and Begley, 2006). Those who discontinued CL wear tend to be of older age and to have worn CLs for a shorter amount of time compared to current wearers (Dumbleton, Woods et al, 2013; Richdale et al, 2007).

Thus, understanding CLD and knowing the factors that lead to CLD, which include age, tear film quality, and poor CL compliance, are key to preventing CLD, keeping patients in CLs, and running a successful practice (Dumbleton, Caffery et al, 2013).

A Possible Solution

By definition, CLD exists only while wearing CLs (Nichols et al, 2013). In fact, CL removal is a primary way that patients who have CLD treat their condition (Begley et al, 2001). Therefore, if a patient were to avoid wearing CLs during the day—for example, by wearing overnight orthokeratology CLs, which are rigid CLs that reshape the cornea during sleep so that patients can see clearly during the day without CLs—patients may be able to alleviate their CLD and promote additional years of comfortable CL use (Caroline, 2001; Dave and Ruston, 1998).

While orthokeratology has yet to be fully explored for the treatment of CLD, there is evidence emerging to support this. To date, at least three studies have shown that orthokeratology resulted in better ocular comfort compared to daily wear CLs (García-Porta et al, 2016; Lipson et al, 2005; Carracedo et al, 2016).

In a randomized crossover study by Lipson et al (2005), 65 subjects were assigned to eight weeks of orthokeratology and eight weeks of soft CL wear. Of the included subjects, 67.7% preferred orthokeratology to soft CLs, reporting less discomfort with orthokeratology than with soft CLs.

Carracedo et al (2016) reported significantly less discomfort in established soft CL wearers who were refit into orthokeratology after one month compared to those subjects’ habitual soft CLs. In addition, the authors found an increase in conjunctival goblet cells, suggesting that orthokeratology promotes better surface integrity and decreased dryness compared to soft CLs (Carracedo et al, 2016).

Finally, in a prospective non-randomized study in which one group was fitted in soft CLs and the other in orthokeratology for three months, García-Porta et al (2016) reported less dry eye and discomfort symptoms in the orthokeratology group than in the soft CL group.

Although these studies did not investigate the use of orthokeratology specifically to treat CLD, they suggest that patients who have CLD may benefit from being refit into orthokeratology.

Looking Forward

Overall, evidence suggests that orthokeratology is relatively safe and it might circumvent CLD associated with soft CLs (García-Porta et al, 2016; Bullimore et al, 2013). Nevertheless, more work is needed to fully vet the use of orthokeratology for treating CLD.

With that said, orthokeratology is a promising alternative to daily wear soft CLs for patients who are experiencing significant CLD. Furthermore, orthokeratology is particularly appealing for patients whose CLD may be exacerbated by living/working in a harsh and/or dirty environment (Dumbleton, Caffery et al, 2013). Likewise, orthokeratology can be of great interest to practitioners because it has the potential to fix problems, generate additional income, and allow practitioners to provide an intellectually stimulating service to their patients. CLS

For references, please visit www.clspectrum.com/references and click on document #272.