© 2022 MJH Life Sciences and Optometry Times. All rights reserved.
© 2022 MJH Life Sciences™ and Optometry Times. All rights reserved.
Tools and therapies for dry eye with contact lens wear
Dry eye disease is a huge problem for contact lens (CL) wearers. The statistics are impressive, with 50% of all CL wearers reporting discomfort at the end of the day and more than 25% stopping CL altogether, according to Milton M. Hom, OD, FAAO. who shared his pearls for managing his CL patients. He is in private practice in Azusa, CA.
The important points to confirm during the all-important history-taking are the lens type, lens care products used, replacement schedule, environmental conditions, symptom onset, systemic and ocular diseases/conditions, and drop/oral medication use.
Outdoor air pollution is a primary culprit, followed by use of digital devices, which can cause ocular redness, itching, and scratchiness. The symptoms increase in CL wearers working on electronic devices when exposed to air-conditioning and heating units.
CL wearers who used electronic devices longer than 4 hours daily showed increased bulbar, limbal, and lid redness and lid roughness, with reduced tear break-up time and Schirmer results. (see Figures 01 and 02)
Diabetes, high blood pressure, glaucoma, autoimmune disease, headache, allergy, and asthma all contribute to CL discomfort.
Diabetes is perhaps the worst offender, with 52.8% having been reported to have dry eye symptoms compared with 9.3% of controls.In line with this, the higher the hemoglobin A1c, the higher the rate of dry eye.1 Diabetes also causes decreased corneal sensitivity and affects the nerve architecture, which increases the potential for development of corneal ulcers.2 The adverse effects of diabetes on the cornea sets off a cascade of tissue disruption that can ultimately lead to abrasions.3
Use of steroids can stimulate glucose production that is sufficiently high to impede the production of extra compensatory insulin, resulting in steroid diabetes, and interference with glycemic control, Dr. Hom mentioned.
Dr. Hom advises using questionnaires to ferret out the soft CL wearers who might benefit from clinical attention to the CL-related symptoms. Use of the Contact Lens Dry Eye Questionnaire is 1 such way to identify these patients. Using questionnaires, patients can grade their scores to best represent their discomfort levels.
Another avenue to symptom relief may be achieved with use of daily disposable CLs. They have been reported to provide significant and stable reduction in [soft] CL-related symptoms 4 Examples of these available CLs are Dailies Total (Alcon) with 33% water in the design, Precision 1 (Alcon) with 51% water, Infuse (Bausch & Lomb [B&L]) with moisturizers.
Rewetter drops can be used with CLs to moisturize the corneal surface before and immediately after inserting the CLs. Many rewetters are versions of multi-purpose solutions. Dr. Hom prefers using the more modern types of rewetters that are based on artificial tears.
Such rewetters include Sodium hyaluronate.It is a natural moisturizer that is contained in Blink drops, and Biotrue (B&L), and Refresh Relieva (Allergan).
Newer CL materials are being introduced to increase patient comfort.B&L offers its monthly Ultra CL. A silicone hydrogel that is 46% water. The Total 30 (Alcon) delefilcon A is a monthly lens.
Dr. Hom also advised that optometrists not overlook a change in CL solutions. Peroxide products such as Clear Care (Alcon) and Peroxiclear (Bausch Health) did not differ in subjective ratings of comfort, dryness, or vision, but peroxide was reported to provide longer periods of comfort when used with hydrogel lenses.
Another factor that affects comfort is that CL wearers may have underlying ocular conditions that do not respond to a change in CL material or solutions.
A favorite of Dr. Hom’s are anti-histamine drops. Over the counter Ketotifen (Zaditor, Alcon) may be useful to relieve ocular itching associated with allergy for up to 12 hours.
Oral omega-3 essential fatty acids have been used to reduce CL discomfort by addressing ocular inflammation, with various formulations attempted; however, the tear break-up time, and ocular limbal and bulbar redness, blepharitis, tear production and staining did not respond significantly. However, oral and topical application to address CL discomfort did have a positive effect and reduced proinflammatory cytokines.5
Other factors that can cause CL discomfort among CL wearers are the presence of Demodex, a mite that thrives in the eyelashes; meibomian gland discomfort is very common and commonly used therapies include warm compresses and moist heat compresses to reduce gland blockage.
A debate has raged about whether CL wear causes the meibomian glands to atrophy. However, the jury remains out about that topic as well as the ability of meibography to predict meibomian gland function.
This article was adapted from Dr. Hom’s presentation at the Southern Congress of Optometry International. Dr. Hom is a consultant to numerous manufacturers of CLs and related products.