contact lens management
Beating the "Red Eye" Blues
New contact lens technology helps solve all-too-common problems.

SUSAN RESNICK, O.D., F.A.A.O.

Clinical practice presents us with an ever-changing variety of contact lens challenges. What we may be overlooking, however, are those marginally satisfied "everyday" patients -- those who have end-of-day redness and irritation -- who may not complain. Mild redness and irritation are conditions many soft contact lens wearers have grown accustomed to and, perhaps, have come to accept as an inevitable aspect of lens wear. Your patients may even be reluctant to share this information with you for fear that you'll advise discontinuing lens wear.

Red means danger

While redness from contact lens wear is generally not clinically significant, it can cause significant dissatisfaction in patients and can signify some real risks for your practice. You may lose these less-than-satisfied patients to spectacles, refractive surgery or another practitioner. So, how can we be proactive in our attempt to improve ocular comfort in our contact lens wearers and at the same time improve patient retention?

Start by asking the right questions: How many hours each day do you typically wear your contact lenses? How do your eyes look and feel toward the end of the day? Which solutions are you using to clean and store your contact lenses?

The answers to these questions allow you to assess your patient's current level of satisfaction. One additional question to ask at this point is whether the patient has taken a break (of one to several days) from contact lens wear and whether his eyes look and feel the same way at the end of a day with spectacle wear.

The latest contact lenses, such as the Acuvue Advance, can improve ocular comfort.

If you're sure it's the lens . . .

If you've determined that the problems are contact lens-related and not attributable to a change in contact lens solutions or noncompliance with prescribed replacement regimens, then the next step is to perform your clinical evaluation at the end of a day. Ask your patient to come in wearing his lenses. After checking visual acuities and performing an over-refraction, conduct your usual careful slit lamp evaluation both with and without the contact lenses. Next, rule out lens spoilage and movement or centration problems. Conclude your examination with tear film, corneal and conjunctival evaluation both with and without vital staining.

The presence of bilateral, mild, diffuse conjunctival hyperemia without clinically significant corneal staining, edema or circumlimbal changes often typifies the clinical findings in those patients complaining of late-day redness and discomfort. Objective and subjective clinical presentation will vary with environmental conditions and lifestyle factors such as ambient humidity, air quality, computer use and smoking.

Here's what you can do

We often have little to no control over our patients' environments and lifestyles. And in spite of the ever-increasing array of lens lubricating and comfort drops, as well as the availability of enhanced multipurpose solutions containing components to improve lens wettability, patients often cite only temporary relief and balk at the expense or inconvenience. You'll achieve the most significant change in your contact lens patients' ocular comfort and appearance with a change in lens material.

Fortunately, the major contact lens manufacturers haven't relented in their efforts to bring to mark newer and better materials to help us be heroes to our patients.

Riding to the rescue

The newest addition to our arsenal is Acuvue Advance contact lenses with Hydraclear from Vistakon. This lens boasts the physiologic advantages of the latest in silicone polymer chemistry in concert with enhanced hydrogel technology.

In contrast to previously available designs, however, the Acuvue Advance lens with its proprietary internal wetting agent Hydraclear, its higher water content, and its lower modulus of elasticity, offers patients the immediate and expected comfort of a hydrogel lens. It is indeed this synergy of technologies that has proven most effective in reducing lens awareness, decreasing redness and improving late-day comfort for a majority of my patients. You'll find the two-week disposability, ease of handling and Class I ultra-violet light blocking mean no sacrifice in comfort, but every opportunity to surprise and delight your patients who didn't think white eyes were possible with contact lenses.

Now you're ready

So, keep your clinical "radar" on heightened alert for potential contact lens drop-outs. After all, you are now better equipped than ever to manage the signs and symptoms of marginal red eyes. With its significantly increased level of oxygen delivery and decreased level of lens dehydration, Acuvue Advance with Hydraclear will undoubtedly set the new standard for two-week disposability.

DR. RESNICK IS A PRINCIPAL IN THE NEW YORK CITY-BASED SPECIALTY CONTACT LENS PRACTICE OF DRS. FARKAS, KASSALOW, RESNICK AND ASSOCIATES. SHE IS A FELLOW OF THE AMERICAN ACADEMY OF OPTOMETRY AND A DIPLOMATE OF ITS CORNEA AND CONTACT LENS SECTION. CONTACT HER AT DR.RESNICK@EYEWISE.COM.