This article was originally published in a sponsored newsletter.

Ocular surface disease (OSD) is an extremely common condition defined by the loss of homeostasis of the tear film.¹ Myriad systemic conditions are associated with severe OSD. These include Sjögren’s disease, graft-versus-host disease, rheumatoid arthritis, Stevens-Johnson syndrome, systemic lupus erythematosus, and more.²

Sjögren’s disease ranks among the most frequent systemic, rheumatic, autoimmune disorders in the U.S., affecting as many as 1.4% of adults.³ It is second only to rheumatoid arthritis in terms of its prevalence in North America.³

Primary Sjögren’s significantly impacts the health-related quality of life of patients, contributing to symptoms such as dryness, chronic pain, depression, anxiety, both physical and mental fatigue, and neuropsychiatric symptoms.^4,5

In a large quality of life study in a primary Sjögren’s cohort using the Short Form 36 health survey,⁴ health-related quality of life impairment was severe. Individuals with high systemic activity reported more extreme symptoms. Among all symptoms, dryness, pain, and fatigue revealed the highest scores and the strongest association with health-related quality of life.

Many treatments are available to lubricate the ocular surface in individuals who have OSD, including ocular lubricants, topical medications, nasal stimulation, intense pulsed light, eyelid hygiene, punctal occlusion, autologous serum, and therapeutic soft and scleral lenses.

A survey evaluated the experience reported by individuals with dry eye disease (DED) and therapeutic soft or scleral contact lenses.⁶ Data included Ocular Surface Disease Index (OSDI), history of contact lens wear, systemic disease, and burden of care. The demographic data collected contained age, sex, and the first year that DED symptoms were noticed. Since this study was performed using patient-reported outcomes, the severity of DED was not known beyond reported OSDI scores.⁶

A total of 639 individuals completed the survey; the majority (533) were female, 90 were males, and 16 individuals preferred not to answer. Less than 15% (94/639) of individuals wore soft or scleral lenses for therapeutic purposes (47 soft lenses and 69 scleral lenses). Scleral lens wearers had a higher mean age and longer duration of ocular symptoms than therapeutic soft lens wearers.

Midday fogging was described by 75% of scleral lens wearers, and 60% of wearers required midday lens removal. Midday fogging and blurry vision were described in 62% of soft lens wearers, with almost one-third of wearers requiring lens removal and reapplication.

This study highlights the substantial time commitment required for dry eye treatment. Additionally, 72% of scleral lens wearers and 43% of soft lens wearers reported spending more than 20 minutes daily managing their DED.

This study emphasizes the financial burden associated with contact lens usage for individuals who have dry eye disease. Annually, scleral lens wearers incur the highest costs, averaging $1,500 (n = 63), compared to non-lens wearers at $500 (n = 371), and soft lens wearers at $700 (n = 43).

Lens removal and reapplication is a burden for wearers who may experience challenges with work productivity and other lifestyle activities due to the challenge of having specified lens solutions and supplies readily available.⁶

For soft contact lens wearers, midday fogging, including blurry vision, has not been evaluated. For individuals who have significant OSD, the tear film may be insufficient to sustain the use of soft contact lenses.⁷

However, given that midday fogging and blurry vision can adversely impact visual function and substantially increase the care burden for lens wearers, it is advised that practitioners assess patients experiencing these symptoms for eyelid inflammatory conditions and meibomian gland dysfunction.⁶

Reference(s):

1. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017 Jul;15:276-283.
2. Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017 Jul;15:334-365.
3. Helmick C, Felson D, Lawrence R, et al. Estimates of the Prevalence of Arthritis and Other Rheumatic Conditions in the United States. Arthritis Rheum. 2008 Jan;58:15-25.
4. Cornec D, Devauchelle-Pensec V, Mariette X, et al. Severe Health-Related Quality-of-Life Impairment Inactive Primary Sjögren’s Syndrome is Driven by Patient-Reported Outcomes: Data from a Large Therapeutic Trial. Arthritis Care Res (Hoboken). 2017 Apr;69:528-535.
5. Lackner A, Stradner MH, Hermann J, et al. Assessing health-related quality of life in primary Sjögren's syndrome-The PSS-QoL. Semin Arthritis Rheum. 2018 Aug;48:105-110.
6. Shorter E, Nau CB, Fogt JS, Nau A, Schornack M, Harthan J. Patient Experiences With Therapeutic Contact Lenses and Dry Eye Disease. Eye Contact Lens. 2024 Feb 1;50:59-64.
7. Nichols JJ, Sinnott LT. Tear film, contact lens, and patient-related factors associated with contact lens-related dry eye. Invest Ophthalmol Vis Sci. 2006 Apr;47:1319-1328.

Melissa Barnett, OD, FAAO, FSLS is the director of optometry at the University of California, Davis. She has received remuneration from ABB, Acculens, Abbvie, Azura, Bausch + Lomb, BCLA, Bruder, Bruno Vision Care, CooperVision, Dompé, Epion, JJVC Vistakon, Lentechs, Ocusoft, Orasis, RVL Pharmaceuticals, Sight Sciences, Science Based Health, STAPLE Program, Sun Pharma, Taursus, and Visus.