The tear film and its stability are both critical for successful contact lens wear at any age, but especially for the presbyopic population. Among some of the important properties and functions of the tear film are optical qualities, nutrients, and antibacterial protection. An unstable tear film will result in blurred vision, reduced tear film breakup times, and contact lens intolerance. A contact lens will inherently disrupt the tear film to some degree, as it is placed on the corneal surface.

I often use a “like the windshield of your car” analogy when talking to patients about the relationship between their cornea and their tear film. The windshield wipers (or eyelids) are helping to create and spread a healthy tear film with every blink. When something interrupts that—such as poor windshield wipers or cracks in the glass—then discomfort and decreased ocular surface health may occur during contact lens wear. This is a quick and easy way to set up the practitioner-patient discussion prior to leading into your specific contact lens recommendations.

Improving the Tear Film

Here are two important ways to encourage a healthy tear film for patients who wear contact lenses:

1) Identify and treat any underlying eyelid or ocular surface issues. If your patient has any clinical signs or symptoms of ocular surface disease, get those under control before you perform a contact lens evaluation. For example, if a patient has significant ocular allergies, treat as necessary and have your patient return to begin contact lens wear when the ocular allergies are under control. Inferior or superior conjunctival papillae may interfere greatly with any contact lens fit, but especially when fitting a toric contact lens.

Additionally, more and more contact lens-wearing patients seem to have significant meibomian gland disease, or maybe eyecare practitioners are just looking more closely at patients’ eyelids. Resolving this may be as simple as just prescribing a warming mask, but make sure to address this and treat as necessary.

2) Offer the newest technologies in the proper modality. Many of the contact lens manufacturers have spent years working on contact lens surface wetting strategies. All eyecare practitioners understand that a wet lens surface will cause less friction with the eyelids and will enhance the tear film, thus improving visual acuity.

In a perfect world, your patients would wear contact lenses the way that you prescribed them. Whether patients are wearing a daily disposable lens or a weekly, two-weekly, or monthly replacement lens—when patients are noncompliant, they are more likely to experience contact lens complications. Have that discussion with your patients to find out how they prefer to wear their lenses, but offer your recommendation. For example, “I’m recommending daily disposable contact lenses because of their convenience and health benefits, but I’d like to know how you would like to wear your lenses, because there are excellent choices in each category.”

Focus on Individual Needs

It is critically important to keep contact lens wearers—especially presbyopes—happy and healthy. If they are having discomfort or vision issues, a few patients will tell you that something is wrong, but many will just silently drop out of lens wear. Proactively identify and prescribe your patients the best treatment plan to keep your contact lens wearers and business growing in the right direction. CLS