Help contact lens wearers to create a plan for symptom onset

The beginning of spring is the start of allergy season for many patients suffering from seasonal allergic conjunctivitis (SAC). Signs include conjunctival injection, chemosis and lower tarsal follicular reaction. For a patient who wears glasses, these symptoms can be an annoyance. For contact lens-wearers, it can mean a disruption or even discontinuation of their contact lenses. Early intervention can keep patients comfortable and satisfied.

BE PROACTIVE

Regardless of the time of year, ask contact lens patients if they suffer from allergies and follow-up by inquiring about the potential effects on their wear time. This is something patients will not necessarily bring up off-season when they are symptom-free. Engaging and educating them with a plan before they have issues will provide the patient with the most benefit.

DISCUSS MEDICATIONS

Discuss oral or topical treatments patients may be using to treat their allergies and educate them that oral antihistamines can contribute to ocular surface dryness, which may exacerbate their contact lens intolerance.¹

For contact lens patients who are experiencing this issue, topical OTC antihistamine eye drops can be an option because they directly target the ocular surface. For patients who have more severe symptoms, consider pulse treatment with a topical steroid.

Practitioners may shy away from steroids because of the risk of an IOP response and cataract, but, used with caution, a steroid can be necessary to relieve symptoms. Practitioners also can prescribe a steroid that is less likely to lead to increased IOP. Additionally, make sure to discuss potential side effects and monitor pressure.

For any of these options, remember to educate patients about only instilling medicinal drops before and after lens removal. However, differentiate this from low viscosity artificial tears, the frequent application of which during wear is useful in curbing symptoms by diluting allergens and quelling ocular dryness.

CONSIDER DAILY DISPOSABLES

Despite properly cleaning and disinfecting, there can be an accumulation of deposits and allergens during the contact lens cycle. This results in increased lens awareness and discomfort before lens replacement that can lead to temporary or permanent dropout for SAC patients. Many of these patients will be able to return to lens wear and maximize wear time by transitioning to a daily disposable lens. Daily replacement lenses are available in expanded parameters, including toric and multifocals. Consider providing the patient with trial lenses.

OFFER RELIEF

A proactive approach helps ensure patients who have SAC continue successful contact lens wear. This is a practice benefit for increased billable exams, annual lens supplies and referrals. OM

REFERENCES

1. Ousler GW 3rd, Workman DA, Torkildsen GL. An open-label, investigator-masked, crossover study of the ocular drying effects of two antihistamines, topical epinastine and systemic loratadine, in adult volunteers with seasonal allergic conjunctivitis. Clin Ther. 2007 Apr;29(4):611-6.

DR. DENAEYER practices at Arena Eye Surgeons in Columbus, OH. He is a shareholder of Precision Ocular Metrology LLC, has financial interest in Visionary Optics’ scleral lenses, is a consultant to Visionary Optics and has received lecture or authorship honoraria from Contamac. You can contact him at gdenaeyer@arenaeyesurgeons.com.