Many presbyopic patients are working from home more often and spending increased hours on digital devices—and dryness, intermittent blurriness, end-of-the-day lens awareness, and contact lens intolerance are increasing at a rapid rate (Gann and Nichols, 2020).

Dry eye with contact lens wear is typically more prominent with age, but I have noticed this in the clinic more and more with younger patients as well. Develop a protocol to identify and treat these patients. And, utilize the Subjective, Objective, Assessment, and Plan (SOAP) strategy learned while in school, which is outlined here.

Subjective: It is important to identify those patients who are at risk. Start by making sure to ask probing questions during the examination. Many presbyopic patients are already struggling with focus, and ocular surface dryness will only complicate and frustrate anyone trying to see clearly. These two questions may provide some clarity:

1. “When do you typically take your contact lenses out at night?” If that is earlier than expected, follow up with “Why?”
2. “Have you noticed any blurriness intermittently throughout the day while wearing your contact lenses?”

Objective: Develop a protocol that provides the necessary information to identify and treat contact lens-related dryness. Besides a slit lamp microscope, utilize all the tools to analyze the anterior ocular surface with and without contact lenses on the eyes. Consider using advanced imagery if it is available. There are many different instruments that can provide an image of the anterior ocular surface, but try to obtain as much information as possible before developing the treatment plan. Figure 1 illustrates one example of using imagery to determine dry eye.

Assess: Develop an assessment and plan specific to that patient. This will be customized depending on the presentation. From a high level, consider these two options:

1. Refit using contact lenses with a different material and/or modality. This is often my primary strategy. I am currently wearing daily disposable multifocal lenses and have worn contact lenses for more than 35 years, so I treat my patients with the same mentality. Most often, though, there is a newer, innovative technology that this patient has never experienced. Offer something new. Many of these contact lenses have improved designs or lubricating properties have been added to the material and/or the packaging to help maintain comfort and good vision throughout the day.
2. Treat the underlying condition. There are many presbyopic patients who don’t just have contact lens-related dry eyes; many have true underlying ocular surface disease. Treat that condition accordingly. There may be instances in which the eyecare professional should consider removing the patient from contact lens wear for a period of time and treat the patient aggressively with prescriptive products or treatments. There are many new and innovative treatments for meibomian gland disease, along with new prescriptive therapies that may make a life-changing improvement for your patient.

Plan: There are many options to consider, but develop a strategy to attack the issues based on the presentation of the patient. Needless to say, act quickly and offer the best options to prevent contact lens intolerance and possibly the loss of a contact lens patient. This is a key moment to go big or risk a contact lens dropout. Utilize all tools necessary to identify and treat this situation. CLS

Full references are available with the online version of this article.