Allergies and contact lens wear used to be a major issue. Many patients experienced discomfort and/or intermittent blurred vision due to their lenses moving around so much on their eyes. With new advances in materials and designs, this combination of allergies and contact lens wear is rarely an issue anymore. Over the last decade, contact lens practice has been a dynamically changing area with technological advances, and this trend does not seem to be slowing down.

Take for example a patient who presents with mild-to-moderate inferior conjunctival papillae (Figure 1). The traditional thought is that this patient needs to discontinue contact wear and be treated appropriately with pharmaceutical agents. If patients discontinue lens wear, there is a chance that they may drop out of lens wear altogether. Growing your contact lens business means adding new wearers and preventing dropouts at all costs. There are three important things to consider with lens wear in this particular patient.

1. Ocular and Eyelid Characteristics for Comfortable and Healthy Lens Wear If a patient’s eyelids are not in good health (e.g., inferior conjunctival papillae), then treatment may be appropriate. There are times when pre- or post-lens wear treatment can improve clinical signs and patient symptoms. I will typically start with a topical antihistamine (either an over-the-counter or a prescription product), then progress to a topical steroid, if necessary.
   I often try to maintain lens wear or refit into a different modality or material during this treatment phase, depending on the situation. For example, if a patient is wearing a reusable lens, I provide samples of daily disposable lenses during this phase as well as for the long run after treatment is complete.
2. Prevent Allergen Buildup This has everything to do with the modality and the compliance with that modality. From daily disposable lenses to the variety of reusable lenses, make sure to match your patients’ wishes and compliance, but encourage daily disposable lens wear.
   Obviously, a compliant daily disposable wearer will have the least amount of allergen buildup on the lenses compared to a noncompliant reusable lens wearer. Guide the selection of a proper modality to produce the best results for a patient’s ocular health and optimal vision.
3. Contact Lens Material Characteristics Just as important as improving the ocular surface and eyelids is choosing the right lens material that provides the most comfortable lens wear. Practitioners are in luck for their allergy patients, as some of the greatest innovation has come from the multitude of daily disposable lens options that have been brought to market over the last several years. These lens designs have improved the modulus, surface hydration, and edge design. This combination provides the least interaction between the surface of the lenses and the inside of the eyelids.

Put It All Together

The most important thing with allergy sufferers is to prevent lens and eyelid interaction. Any lens surface rubbing will amplify allergy-related signs and symptoms. Treat the underlying condition while offering the optimal lens material and modality. Putting all of this together will maximize success for allergy sufferers. Discontinuation of lens wear or dropouts due to allergies may be a thing of the past in the future. CLS