During these unpresented times of the COVID-19 pandemic, we have been propelled to evaluate best practices for contact lenses. Contact lenses are safe to wear during a pandemic, according to the latest available scientific evidence from the American Academy of Optometry and  the American Optometric Association, among other eye care-related organizations. Contact lenses also are an effective form of vision correction, can be comfortable and provide good peripheral vision.
 
Since many people are working from home and are using digital devices more than ever before, it is important to optimize contact lens comfort, as it is a major indicator of a patient’s lens satisfaction.¹ Satisfied, comfortable patients continue in their use of contact lenses, thus reducing contact lens dropout, a challenge for even the most highly skilled contact lens practitioner. Contact lens dropout remains highly prevalent, ranging at around 15% to 20%.^2-8 To address dropout, we must identify and manage discomfort issues.
 
A multitude of approaches have been proposed to alleviate contact lens discomfort, and in my practice, I have found that the least complicated interventions are among the most effective. Read on for my top five practical ways to enhance comfort.
 
Note that during the pandemic, we can utilize telehealth in clinical practice, which may improve: 1) patient engagement with remote monitoring, 2) healthcare quality and access to care, 3) practice efficiency and 4) patient satisfaction.

1. Recommend Moist Heat Compress Therapy

Research shows that the application of localized heat to the meibomian glands improves meibum secretion, making warm compresses a commonly prescribed treatment.^9,10,11  Researchers at the University of Alabama at Birmingham School of Optometry specifically investigated the effects of moist heat compress treatment on contact lens discomfort in subjects who had contact lens-related dry eye (CLDE).¹² Their findings show that moist heat compress treatment could be an effective first line treatment for contact lens wearers who have discomfort. The researchers also found that those using a moist heat compress daily had improved meibomian gland function and experienced steeper declines in their overall Eye Discomfort Assessment scores. Subjects who used the moist heat compress increased comfortable wear time of their contact lenses by up to 3 hours.
 
When combined with a complete ocular hygiene routine, including hypochlorous acid sprays and cleansing wipes, I have found the benefits of the compress are additive. These products are available from multiple manufacturers and can be dispensed directly from your office. In our practice, we recommend a pre-assembled kit that includes all three products.

2. Refit Patients in a Daily Disposable Contact Lens Modality

Increased options in daily disposable lenses represent another method to increase lens comfort.¹³ In fact, adjusting the replacement frequency to daily was among the several recommendations described by the Tear Film and Ocular Surface Society contact lens discomfort classification working group to prevent contact lens discontinuation.¹⁴ Also, in a study that evaluated corneal infiltrate events (CIEs), reusable contact lens wearers had a 12.5 times increased risk of CIEs compared to daily disposable wearers.¹⁵
 
I also encourage all new wearers to start with daily replacement contact lenses, if parameters allow. For returning contact lens patients who are not complaining about discomfort, daily disposables may prevent future problems. Even if patients don’t feel ready to make a change, I make it a priority to present the option of daily disposable lenses and document the discussion. That way, at the next yearly visit patients are familiar with this option.

3. Switch to a Hydrogen Peroxide Solution

I almost always recommend hydrogen peroxide solution to patients who do not wear daily disposable contact lenses. In my experience, hydrogen peroxide systems help eliminate problems such as giant papillary conjunctivitis, allergic conjunctivitis and dry eye. An article that examined recent scientific and clinical evidence concluded that hydrogen peroxide solutions promote comfortable lens wear, are easy to use, have minimal interactions with lenses or the ocular surface, provide antimicrobial efficacy and support ocular surface health.¹⁶ The article concludes that there is compelling evidence to suggest H₂O₂ solutions as a first-line contact lens care recommendation for many wearers of reusable contact lenses.

4. Proactively Correct for Astigmatism and Presbyopia

Apart from reduced comfort, the other of the top two reasons patients discontinue contact lens wear is poor vision. The two are often related because patients experience poor vision as discomfort.¹⁷ This data stresses the importance of accurate vision correction in contact lens wearers.
 
Often, patients are satisfied for decades in their spherical designs, but with digital device use, especially with the pandemic, and age, the challenges compound. Where once small amounts of astigmatism were tolerable, when compounded with prolonged digital device use and ocular surface disease, like dry eye disease, patients can begin to struggle. In addition to proactively managing and treating tear film issues, inflammation, meibomian gland dysfunction and Demodex blepharitis, we need to consider whether a patient is ready to move to a multifocal or toric contact lens. Either of these options can give patients that extra boost of visual comfort needed to remain happy contact lens wearers.

5. Address Digital Device Use

Considering the uptick in the presence of digital devices among average Americans, it’s no wonder that dropout persists. Although lens technology has improved, and we now have better materials and surface treatments, it also is perfectly reasonable to ask patients to participate in their ocular wellness, which also will facilitate comfortable contact lens wear. Case in point: Patients do not think about blinking. Let’s teach them why it’s so important and coach them on strategies to use throughout the day when at a computer, using hand-held devices or playing video games.
 
Let’s also explain proper ergonomics and provide related handouts, as needed. Some patients also are willing to perform blinking exercises. At the very least, let’s teach every patient the 20-20-20 rule: Every 20 minutes, look at something 20 feet away for 20 seconds.

Provide Optimal Care 

Finally, the need for follow-up cannot be over-emphasized. A prospective study of 100 new contact lens wearers found that 72% of those in a test group who received a follow-up call became successful contact lens wearers, compared with 56% in the control group.¹⁸ We can use telehealth to stay connected to our patients while providing optimal care.
 
Discomfort can be overcome in most contact lens wearers. The key is communication. By asking the right questions and finding the cause of the patient’s discomfort, we can recommend effective interventions that address discomfort and proactively encourage wellness strategies. OM
 

DR. BARNETT is a principal optometrist at the University of California Davis Eye Center in Sacramento, specializing in anterior segment disease and specialty contact lenses. She is a past president of the Scleral Lens Education Society. She is an advisor to and/or has received honoraria or travel expenses from ABB Optical Group, AccuLens, Alcon, Allergan, Azura, Bausch + Lomb, Bruder Healthcare, Contamac, CooperVision, Dompé, EveryDay Contacts, EyeEco, Johnson & Johnson Vision, Mojo Vision, Ocusoft, Oyster Point, Percept, Raayonnova, RVL Pharmaceuticals, ScienceBased Health, SynergEyes, Tangible Science, Tarsus, and Visioneering Technologies.

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