CLINICAL

  CONTACT LENSES

MAKE IT WORK

OCULAR SURFACE DISEASE AND CONTACT LENS WEAR CAN CO-EXIST

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

OCULAR SURFACE disease (OSD), which includes dry eye disease (DED), affects millions of people. This condition often can complicate contact lens wear, even after a thorough ocular surface evaluation.

This patient may present with complaints, such as blurred or fluctuating vision or scratchy, irritated eyes. He or she may even consider dropping out of contact lens wear. Determine the underlying etiology, and address these issues to ensure the long-term health of your contact lens practice.

ETIOLOGY

The etiology of a patient’s OSD could stem from several places: the contact lens, the contact lens solution, or the patient may have true clinical OSD.

To find out exactly what we’re dealing with, we must thoroughly assess the health of the ocular surface and eyelids. This may reveal meibomian gland dysfunction (MGD), aqueous-deficient DED and/or ocular allergies.

To rule out contact lens-related dryness, ask the patient the right questions. I say, “I want to provide you with the optimal contact lenses for your eyes. Before I can do that, I need to go over a few questions with you concerning your wearing experience.” Questions include: “What time do you take your contact lenses out and why?” “How often do your eyes get red when you wear your contact lenses?” “Do you ever experience intermittent blurred vision throughout the day? If so, how often does this occur?”

Evaluate the lid wiper area with lissamine Green. Staining could signify potential comfort concerns.

Evaluate the contact lens fit and contact lens surface during wear. This may reveal poor wettability and/or poor fit, which would be contributing to the patient’s issues.

ADDRESS THE ISSUES

After performing a thorough ocular surface evaluation:

1. Identify and treat any underlying conditions. This could include meibomian gland dysfunction (MGD), ocular allergies or mild to moderate dry eyes. The patient may have some underlying MGD, which needs aggressive treatment, such as eyelid hygiene regimen along with an external or internal medication course.

2. Choose a contact lens material and wearing schedule. Select one that will enable the patient to achieve comfortable wear. For example, you may want to prescribe a daily disposable lens or, if the patient is already wearing one, upgrade him or her to a more recent daily disposable design that may provide longer, more sustained moisture to the ocular surface.

3. Follow through with the treatment program. Then, schedule the patient for a return medical follow up. Review his or her symptoms to ensure improved end-of-the-day vision. Evaluate his or her corneal staining at this visit to determine whether the condition is improving. Consider advising him or her about smoking, alcohol and environmental effects on dryness.

INCREASE SATISFACTION

These patients are in your practice on a regular basis. Take the time to identify and attack these issues! This will result in happy, healthy contact lens wearers, who can refer other potential contact lens wearers to your practice. OM

DR. MILLER is a partner at Eyecare Professionals of Powell, in Powell, Ohio, on the board of the Ohio Optometric Association and is an adjunct faculty member for The Ohio State University College of Optometry. To comment on this article, visit tinyurl.com/OMcomment.