Dry eyes and contact lenses are not usually a happy couple. Often, dry eye patients who try wearing contact lenses report increased dry eye symptoms during lens wear. Contact Lens Spectrum Editor-in-Chief Jason Nichols wrote in his January annual report: “When there is an existing dry eye condition, lens-related dryness cannot be resolved by simply changing to a different lens or a different care solution,“ (Nichols, 2018).

One strategy to help our dry eye patients feel more comfortable while wearing their contact lenses is to treat and resolve their dry eye condition first. But, another option to consider is to prescribe orthokeratology (ortho-k).

Backed by Research

Clinically, patients using ortho-k lenses often report that their eyes feel much more comfortable during the day compared to when they were wearing soft contact lenses. Results of two different studies confirm this.

In the first study, a group of investigators compared ocular surface symptoms, as measured by the Dry Eye Questionnaire (DEQ), in a group of silicone hydrogel soft contact lens wearers compared to a group using ortho-k (García-Porta et al, 2016). The ortho-k wearers reported significantly fewer symptoms of dryness and discomfort at the end of the day. In addition, bulbar redness, limbal redness, and conjunctival staining were less in the ortho-k wearers compared to in the silicone hydrogel soft contact lens wearers.

A second study looked at objective measures of dry eye (Carracedo et al, 2016). The researchers looked at goblet cell density (GCD), tear breakup time (TBUT), and tear volume, in addition to symptoms, before ortho-k compared to one month after starting ortho-k. Although they did not find a change in tear volume or TBUT, subjects showed an increase in GCD and a better Ocular Surface Disease Index (OSDI) score after one month of ortho-k.

Benefits for Your Patients and Your Practice

Ortho-k lenses are manufactured in high-oxygen-permeable GP materials that are very wettable and worn only while sleeping. Most patients who have dry eye symptoms during the day report good comfort with ortho-k lenses and that the lenses are easy to wear, apply, and remove. Patients who have more severe dry eye may require the use of lubricating drops prior to lens application, during lens wear, or prior to removal.

In general, dry eyes may be a reason to prescribe ortho-k rather than a contraindication. In other words, prescribing ortho-k offers your dry eye patients (and many others) an alternative to glasses and to daytime contact lens wear. In addition, it adds to the services that your office provides to help expand your practice and profits.

Conclusion

In summary, ortho-k can provide your patients with excellent vision, better daytime comfort compared to with daytime contact lens wear, and freedom from vision correction during the day. In making every effort to provide our patients with comfortable contact lens correction during the day, the best option may be to not wear a lens during the day at all. CLS

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