EACH MONTH, Contact Lens Spectrum broadcasts a livestream series called CLS Live! during which the host sits down with leaders in the world of contact lenses to discuss new and future products, the latest research, and worldwide trends in prescribing—and even brings viewers up to date live from the floor of CLS conferences such as the Global Specialty Lens Symposium.

This episode, which aired on Aug. 3, was hosted by Lyndon Jones, PhD, DSc, director of the Centre for Ocular Research and Education (CORE) at the University of Waterloo. He spoke with James Wolffsohn, PhD, professor of optometry and the former deputy executive dean for life sciences and associate pro vice chancellor at Aston University. He is the current head of the school of optometry and of the department of audiology at Aston.

Q: Lyndon Jones, PhD, DSc: What do we know about the impact of contact lens comfort on contact lens success?

A: James Wolffsohn, PhD: When we think about dropout, comfort is going to be a major part of that. When we’re fitting someone with lenses, we’re interested in making sure that they’ve got good physiology—immediate effect on the eye but also the prevention of future complications. [Comfort is] critical to contact lens wear. There are lots of other benefits of lens wear, but we’re not going to be able to wear them if our eyes aren’t comfortable.

In a series of wearer studies, we see that the main driver of dropout is discomfort. In those studies, about 17% to 50% of people drop out of lens wear, which is really why that market isn’t necessarily growing. But if we break that down, about 41% to 64% of people who have dropped out report that was due to discomfort or dryness. The next biggest is vision, and that’s anything from zero to 18%, and it tends to be more in the presbyopes as we might expect.

It’s also been looked at more recently in terms of neophytes. One study looked at if we follow people over time, how many people dropout over a year. They found 25%—slightly higher if it’s multifocal (more toward 50%). But, the majority of those 25% dropped out in the first month and 47% within 60 days. [It’s important to] work with patients to understand that there might be things that are not so comfortable, but that we can potentially work on it with them.

It is not just the discomfort per se, it’s about how that’s managed: the expectations, how we enhance materials, and what they do with the lenses to make sure that they are comfortable.

That same [research] group has looked at taking people who have discontinued in the past and trying to get them back into lens wear, and 77% could be successfully refitted. Some of that was about optimizing vision, but obviously comfort is a big driving factor.

Q: Dr. Jones: As a clinician, you have fitted a new patient with lenses, everything seems to be OK. Is there a follow-up that we need to do early on?

A: Dr. Wolffsohn: People have suggested a buddy system. Someone, perhaps the person who taught them [application and removal], could give them a phone call a couple of weeks after fitting to check how they’re getting on.

The other thing we learn from those neophyte studies is that the patient is doing this largely because of vision. So, if we’re compromising on vision…then they’re more likely to drop out. So, if we get good vision, we’ll probably tolerate a little bit less comfort.

Q: Dr. Jones: For more experienced wearers—what evidence do we have about the various options clinicians have to fit lenses available today? Can we optimize comfort?

A: Dr. Wolffsohn: There are some things that don’t seem to impact comfort: ionicity, the Dk/t, modulus, and stiffness. Dehydration didn’t seem to come out in those studies, although there are newer materials that suggest that this might be a thing. In vitro wetability didn’t come out. Tear exchange, and even deposits, although there’s a caveat on that in terms of whether there is an active protein, then it may have more of an impact. But low water content [did impact] comfort, and lubricity is really one of the major driving factors.

There are quite a few lens materials now that are absolutely no different to an emmetrope and actually are better than a spectacle wearer at the end of the day. We play down, “Oh well, you know contact lenses can be uncomfortable,” but actually wearing spectacles all day long and having something perched on the end of your nose can also be uncomfortable. I think contact lenses have a fantastic place, and by practitioners optimizing them, they can give people better comfort than they would get from their spectacle correction.

The other thing not to forget is fit. We need to fit lenses so they don’t have excessive movement and they’re not too thick.

Q: Dr. Jones: When we look at the patients in terms of what their ocular surface looks like, do we have any evidence that maybe one of the things we’re missing is trying to optimize the environment in which that lens is being placed?

A: Dr. Wolffsohn: Lots. There are studies that show that if you have someone with a poor ocular surface/tear film to start off with, they are much more likely to drop out. Managing their ocular surface—things like blinking, meibomian gland optimization, lid hygiene—are going to make general wear more comfortable; evidence shows that they’re then more likely not to drop out of lens wear. So, management of the anterior eye prior to lens fitting is really important.

Q: Dr. Jones: So just setting aside the fact they’re a contact lens patient, if this were a patient with dry eye, we would do the same sort of management?

A: Dr. Wolffsohn: Absolutely, and not just dry eye. Dry eye is symptomatic, but there are people with ocular surface disease (OSD) who are not symptomatic. But we’re going to challenge their ocular surface, because we’re now splitting up the tear film; that contact lens, even at its thinnest, is going to be at least 10-times thicker than the tear film, and there is potential of friction and interaction with the lids.

We’ve got to be careful with those who have masked OSD. For them, dropout is going to be far more likely because “I was comfortable before and these lenses have made me uncomfortable.”

Q: Dr. Jones: What can we expect in the future in respect to contact lens comfort?

A: Dr. Wolffsohn: There are various areas that people will continue to work on. Even with the lenses that we have on the current market, [dehydration rates] vary over a 20-minute period from 20% to over 40% dehydration, so that’s going to have a big impact on the ocular surface. Coatings, things like water gradients, will really bathe the ocular surface in something that’s much more like tears while maintaining those fantastic bulk properties that we need for things like high-oxygen transmissibility.

Drug delivery and leeching materials. We’ve had our internal wetting agents, polyvinylpyrrolidone, hyaluronic acid, and then polymers such as polyvinyl alcohol. But there are lots of unique technologies now to aid surface wetting. That is all about that lubricity and making this something that really induces no friction to the ocular surface.

I’m very excited about the potential for a contact lens to actually be the solution for dry eyes rather than the cause. If a lens goes over the surface and reduces the friction between the ocular surface and the lids, that would be fantastic.

The other area is around solutions. We know that no solution is a good solution in terms of comfort. Companies are still innovating in this area to make lens wear safe, but also to optimize the actual surface of the lens. CLS

References

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2. Chalmers R. Overview of factors that affect comfort with modern soft contact lenses. Cont Lens Anterior Eye. 2014 Apr;37:65-76.
3. Coles MLC, Brennan N. Coefficient of friction and soft contact lens comfort. Optom Vis Sci. 2012 Oct; 88:e-abstract 125603.
4. Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. 2013 Jan;39:93-99.
5. Jones L, Efron N, Bandamwar K, et al. TFOS Lifestyle: Impact of contact lenses on the ocular surface. Ocul Surf. 2023 Jul;29:175-219.
6. Jones L, Brennan NA, González-Méijome J. The TFOS International Workshop on Contact Lens Discomfort: report of the contact lens materials, design, and care subcommittee. Invest Ophthalmol Vis Sci. 2013 Oct 18;54:TFOS37-TFOS70.
7. Kuc CJ, Lebow KA. Contact Lens Solutions and Contact Lens Discomfort: Examining the Correlations Between Solution Components, Keratitis, and Contact Lens Discomfort. Eye Contact Lens. 2018 Nov;44:355-366.
8. Nichols JJ, Chalmers RL, Dumbleton K, et al. The Case for Using Hydrogen Peroxide Contact Lens Care Solutions: A Review. Eye Contact Lens. 2019 Mar;45:69-82.
9. Papas EB, Ciolino JB, Jacobs D, et al The TFOS International Workshop on Contact Lens Discomfort: report of the management and therapy subcommittee. Invest Ophthalmol Vis Sci. 2013 Oct 18;54;:TFOS183-TFOS203.
10. Peterson RC, Wolffsohn JS, Nick Joachim, Winterton L, Lally J. Clinical performance of daily disposable soft contact lenses using sustained release technology. Cont Lens Anterior Eye. 2006 Jul;29:127-134.
11. Ramamoorthy P, Sinnott LT, Nichols JJ. Treatment, material, care, and patient-related factors in contact lens-related dry eye. Optom Vis Sci. 2008 Aug;85:764-772.
12. 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.
13. Stapleton F, Tan J. Impact of Contact Lens Material, Design, and Fitting on Discomfort. Eye Contact Lens. 2017 Jan;43:32-39.
14. Sulley A, Young G, Hunt C. Factors in the success of new contact lens wearers. Cont Lens Anterior Eye. 2017 Feb;40:15-24.
15. Sulley A, Young G, Hunt C, McCready S, Targett MT, Craven R. Retention Rates in New Contact Lens Wearers. Eye Contact Lens. 2018 Sep;44 Suppl 1:S273-S282.
16. Vidal-Rohr M, Wolffsohn JS, Davies LN, Cerviño A. Effect of contact lens surface properties on comfort, tear stability and ocular physiology. Cont Lens Anterior Eye. 2018 Feb;41:117-121.
17. Walther H, et al. In vitro dehydration of daily disposable and frequent replacement contact lens materials. In preparation.
18. Wolffsohn JS, Hunt OA, Chowdhury A. Objective clinical performance of ‘comfort-enhanced’ daily disposable soft contact lenses. Cont Lens Anterior Eye. 2010 Apr;33:88-92.
19. Young G, Riley CM, Chalmers RL, Hunt C. Hydrogel lens comfort in challenging environments and the effect of refitting with silicone hydrogel lenses. Optom Vis Sci. 2007 Apr;84:302-308.


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