A few steps may improve your patient’s ocular surface

In Ohio, winter means cold, overcast and darkness by 5 p.m. Our furnaces are on at home and at work. Our visual world is often consistent with high amounts of digital device use; therefore less blinking. This all creates the perfect storm for frustration with contact lens wear. That said, there are times when contact lens wear can actually improve the ocular surface during this dry time.

Have you considered fitting contact lenses for dry eyes? These steps can help you accomplish this.

1 EVALUATE UNDERLYING CONDITIONS

Whether your patient is struggling as an existing contact lens wearer or is new to lens wear, carefully evaluate and optimize the ocular surface. Use fluorescein and lissamine green to assess the lid wiper area and overall ocular surface. Do not overlook the meibomian glands; imaging, expression or a combination of the two is a crucial step.

After achieving a baseline starting point of the ocular surface, treat any underlying conditions appropriately. The severity of the dryness will dictate the appropriate course of treatment for that patient and, what’s more, optimizing the ocular surface is critical to success with contact lenses during the dry season.

2 PROVIDE THE “HOW”/”WHY”

Discuss with each patient how their environment and condition affects good quality vision and comfortable contact lens wear. If our patients are struggling with end-of-day dryness or blurry vision, they need to understand why they have these symptoms and what you can do to help.

For example, I often compare the cornea to a windshield of a car. “If that outer surface of our eye dries out, it affects how clearly we see. Just like if a windshield is dirty or fogged over it is difficult to see where your car is going, so too can the surface of your eye become scratchy and irritated as your eyelids blink more and your tear glands work harder for clear vision.”

3 UTILIZE APPROPRIATE TECHNOLOGY

Today’s eye care professionals are fortunate that many of the new contact lens technologies are able to help patients overcome a poor ocular surface. Novel approaches via contact lens manufacturers can improve success with contact lens wear, if we know about them and offer them to our patients.

Explain to your patient how newer contact lens designs have enhanced wetting agents added into the lens matrix, which can actually improve ocular dryness. These wetting agents allow the eyelids to glide over the surface of the contact lens and prevent that intermittent blurred vision that occurs throughout the day.

CL FOR DRYNESS

A contact lens-wearing 16-year-old female patient presented complaining about blurred vision, and her mom thought her vision had changed since her last eye exam six months ago. She came in prior to ordering another supply of contact lenses. After refracting the patient to exactly the same prescription, I evaluated the ocular surface, and it was moderately dry with inferior superficial punctate keratitis in both eyes. She was refit, with the same prescription, into a newer technology daily disposable contact lens designed to enhance comfort. She returned two weeks later with no visual complaints and an improved ocular surface.

GIVE IT A TRY

Look for ways to provide your patient the best wearing experience, especially in the driest time of the year. OM

DR. MILLER is a partner at Eyecare Professionals of Powell, Ohio. Dr. Miller has received honoraria for consulting, lecturing, research or acting in an advisory capacity from: Alcon, Allergan, Bausch + Lomb, J&J Vision Care, Revolution EHR and Shire.