visioncare

Keeping Out Allergy

Stop patients from discontinuing contact lens use simply because they experience allergy symptoms.

JENNIFER L. STEWART, O.D., NORWALK, CONN.

If you can find a way to keep patients in their contact lenses during allergy season, you will find that these patients become your biggest source of referrals.

More than 50 million people in the United States suffer from allergies, 70% to 80% of which report their allergies include ocular symptoms, many of them contact lens wearers.^1,2 Contact lens wearers may actually suffer from allergies more than nonwearers due to the way the body’s immune system responds to a contact lens coated with protein and allergens, causing inflammation. Many of these patients drop out of contact lens wear, citing dryness and discomfort, without realizing they have allergies.

Allergy patients can improve their symptoms by closing windows and using air conditioners in both their homes and cars.

Here, I will discuss how you can prevent contact lens cessation.

1 Identify them.

The first step in helping these patients is identifying them. I have patients complete a short survey before their exam, asking them questions about dry eye and allergy symptoms they may be experiencing, including those related to itching and watering.

Start asking questions of your contact lens patients, especially during allergy season. Are they suffering from dryness, discomfort or itchiness? Have they decreased contact lens wear or stopped altogether because of it? These patients often want to stay in their contact lenses, but don’t know which questions to ask or who can solve them. Be proactive.

I ask patients to describe the frequency of their symptoms as “never,” “mild,” “moderate” or “severe,” and then have a full discussion with them on ocular allergy and how I can help. This may include the discussion of using cold compresses, topical allergy medications and artificial tears, changes in contact lens solution and even prescribing different contact lens modalities.

Also, question patients on the use of over-the-counter medications they may be using both for allergy symptoms and to relieve itchy, dry eyes. I explain to patients that the allergy medications they are using may be exacerbating their symptoms, or that the medications they have been buying to treat their itchy eyes are not getting to the root cause, which many patients do not realize.

2 Reassure patients.

I explain to patients that my goal is for them to remain in their contact lenses, even during allergy season. This often alleviates patients’ stress and allows them to be more honest about their symptoms and treatment methods. I also say to patients, “This is a chronic condition that we need to manage over time rather than treat in the short term,” in order for them to be successful in contact lens wear. When I stress this, they are often so happy to hear they can continue to wear contact lenses that they do not mind the compromise.

But how can we achieve comfort in contact lens patients suffering from allergy symptoms, encourage compliance and also help our bottom lines?

3 Prescribe a different lens.

One of the best solutions to contact lens cessation is to prescribe daily disposable contact lenses. This modality lessens allergy symptoms for our patients and improve comfort. Explain to patients that, during allergy season, lenses become coated with protein, lipids and allergens that build up on the lens throughout the day and incite an allergic response, which causes discomfort when reusing lenses day after day.

Inform patients that daily disposable lenses also promote better compliance, less overwearing and less extended-wear. Patients can also use topical allergy medication more easily. Lastly, daily disposable lenses are very profitable and serve as a great way to improve your practice’s profitability.

For patients who may not want the additional cost of daily disposable lenses, or if their prescription is not available, there are other options. (For more on discussing the costs of daily disposables, visit www.optometricmanagement.com/articleviewer.aspx?articleID=107928). I often change these patients from a monthly modality to a one- or two-week disposable lens, thus lessening the time contact lenses have to build up with protein, lipids and allergens and cause discomfort. For these patients, I stress compliance and recommend web-based tools to help them remember to change their lenses as scheduled, such as the Acuvue Acuminder and LensAlert. I also strongly recommend discontinuing overnight wear, especially during allergy season.

4 Prescribe a hydrogen peroxide-based solution.

The elimination of multipurpose solution gives contact lens patients relief by decreasing the amount of preservatives and chemicals. Hydrogen peroxide-based solutions work for these patients because of their cleaning ability and preservative-free nature. I also advise patients to rub and rinse their lenses with all-care systems to decrease the amount of allergens on the lenses, and I tell patients using peroxide-based systems to rub their lenses with preservative-free saline.

5 Tell patients to avoid triggers.

I also discuss the need for environmental changes if they are suffering from allergy symptoms. I make the following suggestions:

► Wear wrap sunglasses when outside.

► Use the air conditioner in both the car and home and close windows.

► Avoid morning and early afternoon outdoor activities.

► Use high-grade air filters for home.

► Shower before bed to eliminate pollen and allergens from hair and clothing.

While we can’t expect our patients to live in a bubble, these small changes may make a large difference in their allergy symptoms.

6 Prescribe anti-allergy medications.

Patients almost always experiment with OTC medications to relieve symptoms, so it is our job to educate them on their best choices for therapeutics. I always stress that contact lens wearers should not use topical medications while wearing their lenses.

I also strongly recommend the use of lubricating drops to flush allergens and pollens out and to soothe and relieve discomfort.

Current options for patients include OTC vasoconstrictors (not recommended as they can mask hyperemia caused by inflammation and lead to rebound hyperemia), corticosteroids (use with caution and for short term), antihistamines, and combination treatments (antihistamine and mast stabilizing properties). The combination treatments are the most commonly used to relieve itching and inflammation, and include Olopatidine 0.1% & 0.2% (Patanol & Pataday, Alcon), Azelastine 0.05% (Optivar, Bausch & Lomb), Epinastine 0.05% (Elestat, Allergan), and Ketotifen fumarate 0.025% (Zaditor, Novartis and Alaway, Bausch & Lomb), all of which are OTC.

Be the problem solver.

My contact lens patients are more likely to have annual eye exams, as compared with spectacle wearers, and are more profitable to my practice.

We often think that we must attract new patients to grow our practices. However, by providing our current contact lens patients a much-needed service, we can improve patient loyalty and happiness, increase patient referrals and grow our bottom lines. Ask questions, provide solutions, improve patient quality of life, and become more successful. OM

1. American Academy of Allergy, Asthma & Immunology. Diseases 101: Asthma and Allergy Statistics. Available at: www.aaaai.org/patients/gallery/prevention.asp?item=1a (Accessed February 1, 2013).

2. Singh K, Axelrod S, Bielory L. The epidemiology of ocular and nasal allergy in the United States, 1988-1994. J Allergy Clin Immunol. 2010 Oct;126(4): 778-83.e6.

Dr. Stewart is in private practice at Norwalk Eye Care in Norwalk, Conn. E-mail her at JStewartOD@yahoo.com, or send comments to optometricmanagement@gmail.com.