Dry Eye in the Contact Lens Patient
Although there are myriad reasons why patients drop out of contact lens wear, ocular surface disease, and dry eye in particular, is a significant factor in many cases. At the same time, a diagnosis of dry eye does not have to mean the end of contact lens wear. Indeed, there are several potential strategies for keeping patients in contact lenses in spite of their dry eye disease.
But keeping dry eye patients comfortable in their contacts is no easy task. It requires the doctor to be keenly aware of the potential triggers that may exacerbate dry eye and it might mean thinking outside the box to find the right solution. It also means looking for signs of ocular surface disease in patients who do not fit the typical profile of the dry eye sufferer.
There has been a significant shift in the epidemiology of dry eye over the past decade or so and it is no longer unusual to see signs and symptoms of dry eye in men and younger patients—some even as young as teenagers. Again, there are many reasons why, but certainly the increased use of digital devices in our society is playing a role. Patients are spending up to 8 to 10 hours a day on their computers and phones (or more!) and they are not practicing good behaviors that help maintain a healthy ocular surface. As optometrists, we need to be educating patients to take frequent breaks, to be aware of the potential for device use to alter the blink rate, and that if they are sitting in a room with a fan or air conditioning while using their computer, they are doubling down on practices that trigger dry eye symptoms.
The need to make our patients aware of these behaviors is even more important among contact lens wearers, because not only are they prone to the same disease features evident in non-contact lens wearers, they are also using a refractive correction option that can be a significant trigger of dry eye disease. As a result, working with the contact lens patient who has dry eye can be tricky and there are many pitfalls to be aware of. The increased use of digital devices is just one of many factors that may lead to increased discomfort with contact lens wear.
In the latest installment of Dry Eye Coach, I am joined by Melissa Barnett, one of the foremost experts in contact lenses. In our interview, Dr. Barnett shared several pearls for identifying patients most at risk for contact lens dropout as well as strategies providers can use to keep patients happy. For instance, improvements in contact lenses technology now provides several options for patients with dry eye—even toric and multifocal technologies. According to Dr. Barnett, it may be possible to transition a patient to a daily replacement modality, which are less disruptive to the ocular surface. For other patients, she said, a change in the cleaning process may be just the thing to maintain all-day comfort in contact lenses.
Fortunately for our patients, we have also learned a lot about treatment protocols and how to address the multitude of dry eye triggers and causes. As I discussed with Dr. Barnett in our far-ranging interview, many of the mainstays of dry eye treatment—including pharmacologic options, preservative-free tear replacement, and expression of impacted meibomian glands—are equally applicable to contact lens patients. The bottom line point is that while managing dry eye in contact lens patients may require a slightly different mindset, the core principle of dry eye treatment remains the same: It is all about positioning the patient for the best chance for success with treatment options so that they experience minimal or no disruption to their quality of life.