A 58-year-old female came into the office for a comprehensive exam. The patient was currently wearing a two-week silicone hydrogel lens. In asking how she was doing with her contact lenses, she said everything was great and she loved them. The examination revealed moderate nonobvious meibomian gland dysfunction (MGD), mild inferior corneal staining, and a tear film breakup time of two seconds in each eye, as well as mild collarettes at the base of the lashes. When asked to rank the comfort of the contact lenses on a scale from zero (least comfortable) to 10 (most comfortable) at the beginning of the day, she responded with a resounding 10. When asked to use the same scale to rank the comfort of her lenses five to 10 minutes before removing her lenses, she responded “two.” When asked why she had told me that everything was great with her contact lenses when there was such a precipitous drop in comfort by the end of the day, she told me that with the magnitude of her prescription, she just loves the fact that she can wear contact lenses.

Understand the Patient’s Perspectives

Many patients come into offices thinking that nothing that can be done to improve contact lens comfort. Often, they feel that whatever they’re currently wearing is what’s in their best interest or has the latest advances in technology for contact lenses. Many are even unaware that newer modalities or options exist. Additionally, the ocular surface changes over time. This may be the reason that contact lenses are comfortable at one point in their lives, but those same patients become less comfortable in their lenses over time. Appropriate analysis and clinical examination will often reveal the reasons that patients will start feeling less comfortable in their contact lenses. Identification is the key for each of these situations. Patients may downplay their contact lens discomfort in fear that the solution that the practitioner will offer will be to simply discontinue contact lens wear. Asking questions that allow patients to freely discuss their symptoms will allow us to serve them more appropriately.

Back to the Patient

The patient was told that her ocular surface health would benefit from improved lid hygiene and that there are newer contact lenses currently available that may enhance her wearing experience. She was fitted with a daily disposable silicone hydrogel lens and dispensed a 10-day supply of the lenses. Additionally, the patient was started on a hypochlorous spray regimen to clean the lid margin twice a day to help promote lid margin wellness.

The patient came back in five days and was surprised at how much of a difference the new lenses and the cleaning regimen made to her wearing experience. She now reported end-of-day comfort of “nine.” Previously, when she got home, she would need to remove her lenses. Now, she must remind herself to remove them in the evening because the comfort lasts throughout the day.

The Verdict

Key questions about the patient’s wearing experience and thinking about how to ask these questions will uncover some of these key issues, which is critical to optimizing the patient’s wearing experience. If not asking questions is the new normal, then we don’t want to be normal. CLS