5 steps for better contact lens wear

By David Kading, OD, FAAO, and Mile Brujic, OD, FAAO

Dr. Brujic

Patients who wear contact lenses are constantly searching for a cleaner, more comfortable lens. Consider these 5 steps to help recommend a cleaner, healthier lens wearing experience.

1 Rub lenses

Although many patients have adopted a no-rub regimen for lenses that require lens care, rubbing still has significant value.

Part of the reason for not rubbing may be because of previous package labeling, and part may be secondary to complacent instructions given to patients by practitioners when recommending care solutions.

Within the past 3 years there have been three new contact lens solutions on the market; none have no-rub labeling. It is incumbent upon the eye-care practitioner (ECP) to educate patients on this vital habit to optimize lens-wearing success.

It has been well established that patients who rubbed their lenses reduced deposits on the surfaces of contact lenses compared with patients who simply rinsed and stored their lenses.¹

In the era of silicone hydrogel (SiHy) lenses, it has been well established that SiHy lenses have very different deposition characteristic profiles than their hydrogel predecessors.²

Hydrogels tend to deposit more proteins than SiHys, and SiHys tend to deposit more lipids than hydrogels.³

Certain care systems are better designed to effectively remove lipids from the surfaces of lenses.⁴

It is incumbent upon us as ECPs to recommend strongly the solutions we want our patients to use and to reinforce proper use of the solutions, including correctly rubbing the lens.

Dr. Kading

2 Identify allergy sufferers

Patients who suffer from allergies tend to produce excessive mucous and discharge while their allergies are active.⁵ Allergy patients are more likely to be symptomatic of contact lens discomfort. This is a concern particularly because the prevalence of allergies tends to be between 20%-40% of the population.⁶ Also, 70% of those who have systemic allergies will also have ocular symptoms.⁷

Although some of our patients will come in when symptomatic or let us know of allergy symptoms at other times of the year, many of our patients won’t tell us of ocular symptoms, even when questioned, leading to under-diagnosing the condition.⁸

Patients, at times, will minimize certain symptoms during contact lens checkups because those patients may think that our recommendation would be to discontinue contact lens wear. These patients will, unfortunately, attempt to self-treat with over-the-counter options or temporally limiting lens wear.

Not identifying these patients during yearly visits is a concern. That’s why we have our patients bring in any CL-care products to appointments.

This will give us an accurate view of what our patients are actually using, including using drops for discomfort during allergy season.

Fortunately, we have effective options to help patients with allergies, but it ultimately depends on us to identify these patients. Prescribing an effective mast-cell stabilizer/anti-histamine combination will help allergy patients by reducing symptoms and the amount of discharge.

Also, recommending a peroxide care system works well for these patients by providing maximum disinfection with a high level of cleaning efficacy.

(Photo courtesy of Transitions Optical)

3 Be vigilant about compliance

It may sound surprising, but daily disposable contact lenses (DDCLs) should be replaced daily, 2-week lenses should be replaced every 2 weeks, and monthly lenses on a monthly basis. The compliance rate of each of the lens modalities varies significantly. DDCLs win the compliance battle because 88% of patients replace them as scheduled. Two-week lenses have a 48% compliance rate, while monthly lens wearers replace lenses with 72% compliance.

In fact, 2-week lens wearers wear their lenses on average for 27 days (2.6x the manufacturers’ recommended replacement frequency (MRRF) and 1-month wearers wear theirs for 47 days on average (1.5x the MRRF).^9,10

Manufacture s set these replacement schedules based on their impressions of what will provide the patient with the optimal lens-wearing experience. So, it is essential for both doctors and patients to follow this replacement schedule.

Some patients may need to replace lenses on a more frequent basis, but exceeding the recommended replacement schedule may put the patient at risk for suboptimal lens experiences, including deposit buildup.

Although it seems obvious that replacing lenses is better for patients, researchers discovered that patients achieved better end-of-day comfort, better vision, better end-of-day comfort at the close of the lens wearing cycle (2-week or 1-month), and better vision at the close of the lens wearing cycle (2-week or 1-month).¹¹

By having patients follow the MRRF with a reminder that it will enhance the lens-wearing experience, we can help them gain better comfort and better vision.

4 Understand contact lens solutions can improve surface qualities

CL solutions are a vital part of patients’ contact lens-wearing experience. When a patient doesn’t replace his lenses on a daily basis, it is crucial that he use a contact lens solution that is compatible with the lens.

Many of our patients are wearing SiHy lenses, and as such, the solution that patients use should reflect the technology.

Many of the soft lenses that we prescribe have a hydrophobic (water-repelling) backbone.

However, when patients initially place them on their eyes, the lenses have hydrophilic (water-loving) sites on the lens surface. As the tear surface becomes unstable throughout the day and begins to break up, the hydrophilic groups will migrate into the lens that produces a hydrophobic surface.¹²

One study, looking at the capabilities of a newer contact lens solution, found that the solution’s unique wetting agent would embed itself into the hydrophobic areas, which recreates the hydrophilic nature of the lens.¹²

Older technology solutions, such as private label and generic, do not have the wetting capabilities designed specifically for SiHy lenses because they were invented prior to SiHy lenses hitting the market.

Ensure that each patient is using the lens solution that you recommended during the annual exam. Be sure to explain to patients the rationale of why you are prescribing it. By making certain that patients are using updated solutions, you can help to keep the surface of their lenses clear so that deposits don’t have a chance to become embedded on the lens surface.

5 Consider DDCLs for patients who continue to have problems

DDCLs provide us with a viable option to help reduce deposition on the surface of lenses. With the lens being replaced every day, the previous day’s wear is never a factor.

There are a number of options with DDCLs.

A variety of prescriptions and parameters are available in hydrogel materials. Vistakon and Alcon currently have the only SiHy daily disposable lenses on the U.S. market.

References

1. Cho P, Cheng SY, Chan WY, Yip WK. Soft contact lens cleaning: rub or no-rub? Ophthalmic Physiol Opt. 2009 Jan;29:49-57.

2. Nichols JJ. Deposition on silicone hydrogel lenses. Eye Contact Lens. 2013;39:20-23.

3. Cheung SW, Cho P, Chan B, Choy C, Ng V. A comparative study of biweekly disposable contact lenses: silicone hydrogel versus hydrogel. Clin Exp Optom. 2007;90):124-131.

4. M. Senchyna, P. Stauffer, J. Davis,et al. Characterization of a multi-purpose lens solution designed for silicone hydrogel materials. Poster presented at the Association for Research in Vision and Ophthalmology, May 2-7, 2010, Fort Lauderdale, FL.

5. Lemp MA. Contact lenses and associated anterior segment disorders: dry eye, blepharitis, and allergy. Ophthalmol Clin North Am. 2003;16:463-469.

6. Saban DR, Calder V, Kuo CH, et al. New twists to an old story: Novel concepts in the pathogenesis of allergic eye disease. Curr Eye Res. 2013;38:317-330.

7. Katelaris CH, Bielory L. Evidence-based study design in ocular allergy trials. Curr Opin Allergy Clin Immunol. 2008;8:484-488.

8. Abelson M. Allergic Diseases of the Eye. Philadelphia, PA: W.B. Saunders Co; 2000.

9. Dumbleton K, Woods C, Jones L, et al. Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in the United States. Eye & Contact Lens. 2009;35:164-171.

10. Dumbleton K, Woods C, Jones L, Fonn D. The relationship between compliance with lens replacement and contact lens-related problems in silicone hydrogel wearers. Cont Lens Anterior Eye. 2011;34:216-222.

11. Dumbleton K, Woods C, Jones L, et al. Comfort and Vision with Silicone Hydrogel Lenses: Effect of Compliance. Optom Vis Sci. 2010;87:421-425.

12. Epstein A, Stone R. Surface and polymer chemistry: the quest for comfort. Rev Cornea Contact Lens. 2010;247:15-19.

David Kading, OD, FAAO

Dr. Kading owns a three-physician, two-location practice in the Seattle area.

Mile Brujic, OD, FAAO

Dr. Brujic is a partner in a five-physician, four-location practice in northwest Ohio.

Together, Drs. Kading and Brujic own Optometric Insights. Either one or both have received honoraria for consulting, performing research, speaking, or writing from: Alcon Laboratories, Allergan, Bausch + Lomb, Contamac, CooperVision, Essilor, Nicox, Paragon, SynergEyes, Transitions, Valeant Pharmaceuticals, Vistakon, and Valley Contax.

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