Starting soft contact lens (CL) wear for the first time is often exciting. At the same time, it is sometimes frightening for our patients, because learning how to wear CLs can be a challenge. While prescribing CLs to new wearers may seem mundane, learning how to wear CLs and adapting to them is actually a complex process. This article will summarize much of the key literature related to learning how to wear CLs for the first time and the effect that CLs have on the ocular surface. This article will also touch on the psychological benefits of wearing CLs.

Initial Wear Schedule

Practitioners have historically educated their neophyte CL patients to follow a specific schedule—either to start wearing their CLs full-time during the initial adaptation period or to ramp up their wear times during their first week or so of CL wear. Unfortunately, there has not been justification for either of these practices until recently.

Wolffsohn et al (2020) specifically randomized adult neophyte CL patients (n = 65) to either a hydrogel or a silicone hydrogel daily disposable CL for two weeks. Patients were also randomized to either a full-time wear schedule, during which patients wore the CLs for 10 or more hours per day starting on day one, or a gradual wear schedule, during which patients started wearing their CLs on the first day for four hours per day and increased their wear times by two hours per day until they reached 10 or more hours per day. The researchers failed to find any clinically meaningful differences between the two CL materials or the two wear schedules with respect to ocular comfort or clinical signs.

Pucker et al (2020) has since published a study that randomized adult patients (n = 25) to wear a two-week silicone hydrogel CL for either eight or more hours per day starting on the first day or starting with two hours of wear and increasing their wear times by two hours per day until patients were wearing their CLs for eight or more hours per day. Pucker et al, much like in the aforementioned Wolffsohn et al study, failed to find any meaningful differences between the two wear schedule groups.

These studies together suggest that the best neophyte CL wear schedule may be the one that best suits an individual patient. These data likewise suggest that materials and wear schedules do not cause significant differential impact on a neophyte CL wearer’s ocular health.

Adults Adapting to CLs

The literature contains a number of reports describing the ocular changes associated with adults adapting to soft CL wear. One of the first reports came from Stapleton et al (1995), who evaluated ocular bacterial changes associated with extended-wear hydrogel CL use in experienced (n = 18) and neophyte (n = 26) wearers during a 12-month study. The authors found that there were no ocular bacterial colonization differences between the neophyte and established CL wearers with regard to the conjunctiva or eyelids.

Maldonado et al (2004) next compared ocular sign differences in neophyte silicone hydrogel and hydrogel CL wearers to non-CL wearers during a four-week study (n = 61). The investigators determined that while limbal and conjunctival redness were better in the silicone hydrogel CL group compared to the hydrogel CL group, the hydrogel CL group had less conjunctival staining compared to the silicone hydrogel CL group. Nevertheless, none of these factors rose to worrisome levels.

Santodomingo-Rubido et al (2007) later evaluated ocular surface signs and symptoms in neophyte daily wear and continuous-wear silicone hydrogel CL wearers (n = 45) during an 18-month study. The authors found that conjunctival redness, limbal redness, and corneal staining all increased during the study, though these changes did not equate to clinically meaningful values. Santodomingo-Rubido et al furthermore noted that patients indicated good comfort over the course of the study, that patients indicated improved CL handling by the end of the study, and that there were no differences in tear meniscus height or tear breakup times over the course of the study. There were also no meaningful differences found between wear schedules.

Morgan et al (2013) came to a similar conclusion with regard to slit lamp findings when comparing daily disposable CL wearers to non-CL wearers (n = 74). Lastly, Best et al (2013) determined during a six-month study that neophyte silicone hydrogel CL wearers who dropped out of CLs (n = 60) had significantly worse ocular surface symptoms and tear breakup times at the baseline visit compared to the successful CL wearers.

Children Adapting to CLs

One primary concern of parents is that CLs may cause negative side effects in children or that children may not be mature enough to wear CLs. Nevertheless, studies conducted by Walline, Jones, et al (2007) and by Li et al (2009) have mostly discounted these fears. Walline, Jones, et al specifically recruited children under the age of 18 years who had no prior CL wearing experience (n = 169), and they evaluated ocular health during the three-month study period. The authors also compared children who were between the ages of 8 and 12 years old to teens who were between 13 and 17 years old to determine whether there were differences between the two groups, as teens are commonly fit in CLs while younger children are generally not fit in CLs. Walline, Jones, et al failed to find any ocular sign differences between children or teens.

They also found that slit lamp findings were minimal during this study (e.g., corneal staining, limbal redness); however, they did find that conjunctival staining was significantly worse at all post-CL fitting visits. These data suggest that there is likely an ocular surface adaptation period in children and teens who are first starting to wear CLs, though these slit lamp findings are still overall minimal.

Walline, Jones, et al furthermore found that while children take slightly longer than teens do to learn how to apply their CLs, many children can easily learn how to wear CLs. In addition, like teens, children can wear their CLs for the entire day.

Walline, Gaume, et al (2007) later reported in a companion paper that both children and teens indicated that wearing CLs significantly improved their satisfaction with their vision correction, their appearance, and their ability to perform activities.

Li et al (2009) has since repeated Walline, Jones, et al’s study by recruiting a group of 8- to 11-year-old children from Singapore (n = 59) and following them for three months. Li and colleagues, much like Walline, Jones, et al, noted that the children in their study had minimal slit lamp findings and were able to see well with their CLs during the course of their study.

Li et al also determined that while patients were able to comfortably wear and were able to apply their CLs at the start of the study, they had improved CL comfort and were able to more quickly apply their CLs by the end of the study. These studies together suggest that both children and teens can safely and effectively wear CLs.

In Conclusion

While these data suggest that neophyte CLs wearers can easily adapt to and safely wear soft CLs, they likewise suggest that there are key aspects of initial CL wear about which we need to educate our patients. First, tell patients that they should start wearing their CLs on a wear schedule that works best for their eye comfort and lifestyle. Second, it is normal to have some minor ocular changes such as redness when first starting to wear CLs, though they are mostly inconsequential. And, despite those ocular changes, patients should continue to wear their CLs unless the CLs become bothersome. CLS

For references, please visit www.clspectrum.com/references and click on document #304.