The last several months have certainly been unprecedented, and the majority of the population was affected in one way or another. Some people are spending more time at their computer working remotely, while others are donning new protective gear such as masks, gloves, and face shields. The daily use of a face mask is posing a vision problem for many who use spectacle lenses for vision correction.

Spectacle lens fogging is not only a productivity hazard, it is also a health hazard during a pandemic. Those who struggle with this fogging are more likely to touch their face while adjusting their glasses and masks throughout the day. The use of contact lenses is a great way to solve this problem. However, many presbyopes who wear glasses may have previously dropped out of contact lenses or, in general, they may feel that they are not good candidates because of dry eye symptoms. Practitioners need to help this group overcome those assumptions so that they can work safely and more efficiently.

It is well established that one of the primary reasons why presbyopes drop out of their lenses is discomfort related to ocular surface dryness (Rueff et al, 2016). Many of these patients think that they can no longer wear contact lenses when in fact, it’s not the contact lens at all. For example, delayed hypersensitivity to the preservatives in many lens care solutions makes it difficult to continue lens use because of eye redness, watering, and papillary conjunctivitis.

Try, Try Again

If your patients claim long-term success with lens wear followed by a decrease in comfort and eventual drop out, consider re-introducing contact lenses. The primary choice would be converting them to single-use multifocal lenses; this not only eliminates exposure to solution preservatives, it also eliminates the possibility of a reaction to the lens surface from biofilms or deposits. If single use is not an option, another choice is to switch care systems from preserved, chemical care systems to a hydrogen peroxide solution.

For those patients who have significant dryness, it’s likely that they have failed in several soft lens options, and it’s time to introduce a completely new option to spark interest. Introduce mini-scleral lenses as a way to not only optimally correct vision but also to provide relief from many symptoms related to dryness. The best candidates for mini-sclerals are those who desire to be able to wear contact lenses but have failed in soft lens designs because of dryness or vision complaints.

Mini-scleral lenses are large enough to protect a moderate amount of the ocular surface yet small enough to be handled successfully by both experienced and non-experienced lens wearers. The post-lens tear layer will correct even the smallest amounts of corneal astigmatism, which sets up a great multifocal optics platform for those patients who struggle with vision quality from other multifocal options due to uncorrected astigmatism in their soft lenses.

Lastly, it’s important to not forget that dry eye is a chronic and potentially progressive condition. If symptoms are improved with a solution or modality switch, these patients still need continued monitoring and management of the ocular surface. Staining with vital dyes, tear breakup time, and meibomian gland evaluation should be included during the assessment. Other treatments such as meibomian gland expression, immunomodulators, or punctal plugs can be the final piece to creating a safe and successful setting to wear contact lenses for our patients looking to see through the “spectacle lens fog.” CLS

For references, please visit www.clspectrum.com/references and click on document #296.