We are all guilty of changing our patients’ contact lenses for comfort reasons. Contact lens representatives are helpful in educating us about the benefits of new technology and innovations, but might they be guilty of aiding in our ignorance of dry eye patients? Let’s face it, the contact lenses that we have today in our practices are leaps and bounds ahead of what we had in days past. Yet, our patients still keep experiencing dryness and discomfort.

A Real-World Example

Here is a classic example: Jenny, a 43-year-old mother of four, came into the office two years ago with some irritation in her eyes when wearing her contact lenses. She was new to our office, and we switched her to our preferred daily disposable contact lens.

Jenny called our office one week later and reported that her eyes were feeling great at the end of the day and that she had told three of her friends what a great office we have.

Currently, she has been “home-schooling” her kids for the past year, and she also puts in 45 to 55 hours per week working for a startup. She has been wearing the daily disposable contact lens that we prescribed and has been compliant with her replacement schedule.

Recently, Jenny walked into my office and said: “The lenses don’t seem to be working anymore. I think we need to find something else that will work.”

Jenny is a pretty traditional patient in most of our offices. As a contact lens resident, I was taught, and still believe, that we always blame the care solution first. Fortunately, I am not having to do this nearly as often as I used to. Most (93%) of my soft contact lens patients are in a daily disposable contact lens. Initially, I thought that this would solve all of my patients’ contact lens discomfort issues. However, while it has dramatically improved things, patients like Jenny still come in to my office.

Our Solution

If you haven’t figured it out yet, Jenny’s contact lenses are not changing, Jenny is. While contact lens technology has dramatically improved, and the contact lenses available today are more moist, patients can still progress down the road of dryness while wearing contact lenses (and when not wearing contact lenses too).

It is imperative for us to treat our patients as dry eye patients, not contact lens dry eye patients. While we could remove the contact lenses from the equation and patients may feel better, it is likely that their eyes still have an abnormality of some sort that has progressed and that is causing their ocular surface to no longer support the contact lenses the way that it did in the past. This progression will likely continue even if they stop wearing contact lenses.

In Conclusion

Discomfort with contact lenses should signal far more than a contact lens change. Rather, a patient’s discomfort should signal a non-supportive, non-robust tear film. As I see it, if practitioners do not remedy the ocular issues, their patients will continue to progress—first to contact lens discomfort, then to contact lens dropout, and then to dry eye disease. CLS