PROLONGING COMFORTABLE contact lens wear time has long been the holy grail of contact lens wearers and practitioners. While contact lenses provide freedom from glasses, they seem to come with a cost that rises the longer a patient wears their lenses.

Just over 29% of all contact lens wearers are over the age of 45 years (Nichols, 2014). By the time a patient reaches this age, the majority of wearers have dropped out. Some may think that it’s because of presbyopia, but, in reality, the top two symptoms that contact lens wearers report are discomfort and dryness (Riley et al, 2006).

This is not a surprise, as contact lenses have been shown to have a negative side effect on the tear film (Craig et al, 2013; Faber et al, 1991). In a survey of 199 people who discontinued lens wear, 72% reported that discomfort was the cause (Schlanger, 1993).

This problem has yet to be solved. Despite all the advancements in materials, designs, and solutions, the dropout rate for contact lens wearers remains as high as 16% to 34% per year (Rah et al, 2014; Rumpakis, 2010). This begs the question: Should contact lens specialists become ocular surface specialists? Is this the new normal?

WHAT CAN WE DO?

Clinicians have seen the challenges that contact lens-wearing patients experience. Over the years many of us have tried prescribing different lens types, altering solutions, and switching patients to daily disposables. While the new treatments have enhanced their lens wear and likely improved their eye health, patients still report dryness/discomfort and end-of-the-day comfort issues. Several years ago, we decided to start digging deeper and treat patients who have contact lens discomfort as having ocular surface disease unless proven otherwise.

The studies on dry eye show that meibomian gland dysfunction (MGD) accounts for 86% of all the dry eye that patients experience (Lemp et al, 2012). A 2018 study looked at contact lens-wearing patients who had MGD and dry eye symptoms (Blackie et al, 2018). In this open label, randomized, multicenter clinical study, patients who wore soft contact lenses were randomized into a treatment group who received a single vectored thermal pulsation treatment and a control group with no treatment. At one month, the treatment group’s comfortable contact lens wear time increased by four hours. This was sustained at the three-month follow-up visit (Blackie et al, 2018).

Another study on retrospective data looked at contact lens discomfort and patients who were treated with topical cyclosporine (Kislan, 2015). The data in this study showed an increase in comfortable wear time of 3.5 hours per day (Kislan, 2015).

THE VERDICT

The nuances of dry eye disease are such that we cannot treat every patient with the same monotherapy. Instead, the management of dry eye disease is complex, and each patient must be carefully evaluated in order to find the appropriate treatment modality.

Thanks to the contact lens industry, we continue to get better products. These products help support our patients and make them more comfortable, but still, placing a lens on the ocular surface will change it in some way. This disruption in homeostasis alters the tears. As our patients continue to use their eyes in more intense ways on digital devices, this disruption can expand and lead to problems.

To safely improve comfort and visual acuity for our patients, we must do more than just offer different lenses. We must become experts in the care of the ocular surface and the treatment of dry eye disease. CLS

References

1. Nichols JJ. Contact Lenses 2014. Contact Lens Spectrum. 2015 Jan;30:22-27.
2. Riley C, Young G, Chalmers R. Prevalence of ocular surface symptoms, signs, and uncomfortable hours of wear in contact lens wearers: the effect of refitting with daily-wear silicone hydrogel lenses (senofilcon A). Eye Contact Lens. 2006 Dec;32:281-286.
3. Craig JP, Willcox MDP, Argüeso P, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the contact lens interactions with the tear film subcommittee. Invest Ophthalmol Vis Sci. 2013 Oct 18;54:TFOS123-TFOS156.
4. Faber E, Golding TR, Lowe R, Brennan NA. Effect of hydrogel lens wear on tear film stability. Optom Vis Sci. 1991 May;68:380-384.
5. Schlanger JL. A study of contact lens failures. J Am Optom Assoc. 1993 Mar;64:220-224.
6. Rah MJ, Merchea MM, Doktor MQ. Reducing dropout of contact lens wear with Biotrue multipurpose solution. Clin Ophthalmol. 2014 Jan 24;8:293-299.
7. Rumpakis J. New data on contact lens dropouts: an international perspective. Rev Optom. 2010 Jan 15. Available at reviewofoptometry.com/article/new-data-on-contact-lens-dropouts-an-international-perspective#:~:text=Dropout%20rates.,Europe%2FMiddle%20East%2FAfrica . Accessed May 30, 2023.
8. Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012 May;31:472-478.
9. Blackie CA, Coleman CA, Nichols KK, et al. A single vectored thermal pulsation treatment for meibomian gland dysfunction increases mean comfortable contact lens wearing time by approximately 4 hours per day. Clin Opthalmol. 2018 Jan 17;12:169-183.
10. Kislan T. A retrospective study of contact lens patients with/without cyclosporine. Presented at American Academy of Ophthalmology Annual Meeting; 2015 Nov; Las Vegas.