Eyeworld

49 EW FEATURE December 2018 • Good habits for healthy eyes Price recommends extended wearing of contact lenses is when the lenses protect the eye from exposure or are used as a bandage for an epithelial defect. Eye doctors also generally steer patients away from cosmetic color contact lenses, which can be a po- tential source of infection, Dr. Mah said. Cases of severe microbial ker- atitis in children and young adults sharing cosmetic contact lenses have been reported, Dr. O'Brien noted. Age—or more specifically, reaching presbyopic age—can affect a patient's desire to wear contacts as well. Dr. Mah has patients who choose to stop wearing lenses because they don't want to use multifocal or monovision contacts. Additionally, difficulty manipulating lenses due to age or arthritis lead a small number of patients to stop using contacts, Dr. Marianne Price said. Despite discomfort with lenses, getting patients out of their contacts is not always as easy as it sounds. "Often I have patients in tears, asking, 'How am I supposed to live, work, or drive without my con- tacts?'" Dr. Mah said. "The problem is abuse of the lenses. They need a contact lens holiday." Most of these patients may need to use topical steroids and one of the commercial- ly available agents for dry eye. "I tell them they'll eventually be off every- thing and back in their contacts, but they won't stop Restasis [cyclospo- rine, Allergan, Dublin, Ireland] or Xiidra [lifitegrast, Shire, Lexington, Massachusetts]. The main problem they had was dry eye," he explained. Improving lenses The technology associated with contact lenses continues to improve, potentially improving use and creat- ing new opportunities for lenses and lens users. "New polymers for contact lenses and new shapes are continu- ally being developed," Dr. Marianne Price said. Eyes that have more difficult fits now have access to more scleral contact lenses, which can be particularly helpful in keratoconus and post-keratoplasty eyes. New lens designs have evolved to improve ocular comfort. This includes newer silicone hydrogel materials that are more comfortable to wear and do not sacrifice high oxygen permeability of the silicone material, Dr. O'Brien said. "Contact lens research has endeavored to im- prove overall comfort by increasing water content, decreasing the modu- lus, lowering contact angle hystere- sis, and adding surface coatings and plasma treatments," he said. Dr. O'Brien also cited newer technology such as the develop- ment of antimicrobial films to coat contact lenses with material to in- hibit microbial colonization, smart contact lens storage cases that could detect a potential case contamina- tion, wearable electronics to help monitor ocular health status, and regenerative technology that could be used in patients previously not suitable for contact lens wear. LASIK versus contact lenses If a patient wants to go beyond the use of glasses for better vision and does not have a cataract, what would be better to recommend— contact lenses or LASIK? In a study of 1,800 patients followed over a 3-year period that compared continued contact lens wear to LASIK, 2 97% of those who wore contact lenses before they had LASIK said that they preferred LASIK, according to Dr. Francis Price and Dr. Marianne Price. These same patients had an easier time with night driving post-LASIK and actually had some improvement in dry eye symptoms compared with patients who continued wearing contact lenses. The risk for contact lens wear is cumulative, particularly with pa- tients who choose to wear the lenses overnight, Dr. O'Brien said. "While laser vision correction with LASIK or PRK as surgical procedures have their own potential risks, compli- cations, and adverse events, studies have shown these to be of statisti- cally low probability for properly selected patients, with the one-time procedural event performed by experienced refractive surgeons," he explained. EW References 1. Begley CG, et al. Characterization of ocular surface symptoms from optometric practices in North America. Cornea. 2001;20:610–8. 2. Price MO, et al. Three-year longitudinal survey comparing visual satisfaction with LASIK and contact lenses. Ophthalmology. 2016;123:1659–66. practical tips and pearls for contact lens wearers 10 1. Wash and dry hands before every contact lens manipulation. Minimize contact with tap water. 2. Remove contact lenses nightly before sleep to reduce complications. Avoid wearing them overnight. 3. Clean and disinfect lenses after removal using only sterile contact lens multipurpose disinfection solutions. Rub the contact lens, even if it's labeled as a "no rub" solution. 4. Maintain a clean contact lens storage case and change it regularly. 5. Avoid moistening contact lenses prior to insertion in the eye with any non-sterile solution (tap water, saliva, or homemade saline solutions). 6. Do not wear contact lenses while swimming, showering, or bathing. 7. Minimize the use of preservative-containing or viscous eye drops during contact lens wear. 8. Replace contact lenses frequently according to recommendation, such as daily, weekly, or biweekly. Do not extend beyond the prescribed wearing time. 9. Have regular ophthalmic examinations. 10. Remove the contact lens immediately if symptoms of ocular discomfort, redness, or pain occur. Seek professional eye care promptly. Source: Terrence O'Brien, MD Editors' note: Dr. Mah has financial in- terests with Alcon (Fort Worth, Texas), Allergan, Bausch + Lomb (Bridgewater, New Jersey), Johnson & Johnson Vision (Santa Ana, California), Novartis (Basel, Switzerland), and Shire. Dr. O'Brien has financial interests with Alcon, Allergan, and Bausch + Lomb. Dr. Francis Price and Dr. Marianne Price have financial interests with Al- con, Allergan, and Haag-Streit (Koniz, Switzerland). Dr. Starr has financial in- terests with Allergan, Bausch + Lomb, BlephEx (Franklin, Tennessee), Bruder (Alpharetta, Georgia), Kala (Waltham, Massachusetts), Novartis, Quidel (San Diego), Shire, Sun Pharmaceutical (Mumbai, India), and TearLab (San Diego). Contact information Mah: mah.francis@scrippshealth.org O'Brien: tobrien@med.miami.edu Price: fprice@pricevisiongroup.net; mprice@cornea.org Starr: cestarr@med.cornell.edu

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