Why Are Soft Contact Lens Wear Discontinuation Rates Still Too High?

TOO MANY soft contact lens (SCL) patients who are initially able to establish routine comfortable wear are subsequently compelled to discontinue, with symptoms of dryness being the most commonly reported reason.¹ A 2020 review found that the pooled mean of SCL discontinuations in developed countries was 21.7%² despite improvements such as an increased use of daily disposable lenses that eliminate problems with cleaning and storage solutions. Daily disposable SCLs also greatly reduce difficulties associated with accumulated front-surface soiling and degradation that occurs with multiuse SCL.

A prevailing emphasis on introducing new patients to the many benefits of SCL wear is very appropriate, but is there enough attention being given to helping patients avoid discontinuation? Do too many patients self-manage by discontinuing SCL wear or limiting their use to special occasions without their practitioner becoming aware of this outcome?

Tighter fittings are more comfortable,³ but lack of lens movements appears likely to be associated with increased stagnancy of post-lens tear pools and the risk of the cornea being exposed to high concentrations of cellular debris and bacterial toxins.¹ Such effects would be exacerbated by tear film depletion due to evaporative dehydration and associated post-lens tear hyperosmolarity.⁴ Any subsequent corneal neuropathy that could develop over time in these unhealthy conditions might increase corneal sensitivity and explain symptoms of dryness.¹

Mental health disorders such as depression and anxiety are increasingly common (especially due to the influences of COVID)⁵ with the associated risk that somatization of physical symptoms will exacerbate difficulties with awareness of SCLs.¹

These mechanisms do not appear to have been examined previously, but there must be many others that need to be identified and assessed for their significance in relation to discontinuations. Reducing the SCL discontinuation rate to 10% could have the compounding effect of approximately doubling SCL manufacturing and use within about seven years!

–Charles W. McMonnies, Honorary Professor, Faculty of Medicine and Health, School of Optometry and Vision Science, University of New South Wales

References

1. McMonnies CW. Why are contact lens wear discontinuations rates still too high? Expert Rev Ophthalmol. 2023;18. DOI: 10.1080/17469899.2022.216032. (Copies available on request at c.mcmonnies@unsw.edu.au).
2. Pucker AD, Tichenor AA. A review of contact lens dropout. Clin Optom (Auckl). 2020 Jun 25;12:85-94.
3. Stapleton F, Tan J. Impact of contact lens material, design, and fitting on discomfort. Eye Contact Lens. 2017 Jan;43:32-39.
4. Fornasiero F, Prausnitz JM, Radke CJ. Post-lens tear film depletion due to evaporative dehydration of a soft contact lens. J Memb Sci. 2006 Apr 20;275:229-243.
5. Hossain MM, Tasnim S, Sultana A, et al. Epidemiology of mental health problems in COVID-19: a review. F1000Res. 2020 Jun 23;9:636.