CLINICAL

  contact lenses

Contact Lens Wellness Care

Are you prescribing contact lenses that keep the ocular surface healthy?

JASON R. MILLER, O.D., M.B.A., F.A.A.O.

Ocular surface disease (OSD) affects contact lens wear in variable ways every day. Signs and symptoms range from mild corneal irritation and contact lens removal early in the day to chronic complaints of dryness symptoms (watering, burning, foreign body sensation) and, eventually, can lead to contact lens dropout.

As clinicians, we must be able to correctly identify the warning signs of OSD and prevent this from happening in order to keep contact lens patients comfortable and happy. This starts with prescribing lenses that keep the ocular surface healthy.

Contact lens surface

Multiple factors are important for comfortable contact lens wear but, with regard to a healthy ocular surface, these two are critical:

1. A clean contact lens surface. A lens that does not build up surface lipid deposits or bacteria provides improved comfort and health to the ocular surface.

2. A moist contact lens surface. A lens that stays wet affords comfort and provides an enjoyable wearing experience.

Promoting wellness

If the contact lens surface is consistently unclean or dry, it can be the result of the contact lens material, the wearing schedule or contact lens solution. Therefore, these factors need to be evaluated.

During the contact lens follow-up appointment, carefully evaluate the lenses on the eye, then have the patient remove the lenses, and check his or her cornea. If you see signs of a problem, such as contact lens adhesion, corneal or conjunctival staining, infiltrates, etc., something in the patient’s regimen needs to change.

If the signs or symptoms are severe, it may be best to first temporarily discontinue the contact lens and treat the ocular surface. Otherwise, consider developing a system that caters to the patient’s needs and specific circumstance. My first choice is to refit the patient with a one-day disposable contact lens. If that does not work, or the patient refuses it, upgrading the lens or solution technology may alleviate the condition.

▶ Contact lens materials. If the lens material is the problem, consider a switch. For example, for patients wearing a hydrogel lens, consider a switch to silicone hydrogel lenses. Specifically, newer generation silicone hydrogel lenses generally have a high-oxygen permeability (Dk/t), lower modulus and high water content, which helps to minimize hypoxic stress to the cornea.

▶ Wear schedule. The daily disposable lens market is growing, and new designs maximize comfort by enhancing lens moisture. A new contact lens daily provides the cleanest on-eye experience and minimizes the chance of the complications discussed earlier.

▶ Contact lens solution. There has been much debate as to which solution works best with various lenses and which brand provides the most comfort. It is important to evaluate the situation and provide a recommendation based on the patient’s needs. That may be prescribing a peroxide-based solution, or simply providing him or her with directions on how to use their solution properly.

A personal approach

Choosing the right contact lens for the patient’s ocular health is not a decision to take lightly. There is no perfect lens for every single patient. Therefore, a multifactorial approach is key to keeping your patients happy and healthy in their contact lenses. OM

DR. MILLER IS A PARTNER IN A PRIVATE PRACTICE IN POWELL, OHIO, AND IS AN ADJUNCT FACULTY MEMBER FOR THE OHIO STATE UNIVERSITY COLLEGE OF OPTOMETRY. SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.