Eyeworld

EW FEATURE 48 Good habits for healthy eyes • December 2018 AT A GLANCE • Contact lenses are widely used, but there are many reasons why pa- tients may find them uncomfortable or choose to stop using them. • Dry eye, allergies, infection, poor lens hygiene, and increasing age are common contributors to lens intolerability. • Evolving contact lens materials continue to improve the experience of lens use; the development of more dry eye treatments may also increase lens comfort. • Although there are the usual surgical risks associated with LASIK, the one- time risk is likely lower compared to the cumulative, everyday risk of contact lens wear. by Vanessa Caceres EyeWorld Contributing Writer Contact lens intolerability "is often multifactorial and difficult to pinpoint precisely," said Christo- pher Starr, MD, associate professor of ophthalmology, and director of the cornea fellowship, refractive surgery, and ophthalmic education, Weill Cornell Medicine Center, New York Presbyterian Hospital, New York. "Typically it's a combination of sensitivity or allergy to the lens material and/or solutions as well as chronic dry eye disease, often associated with meibomian gland disease." The risk for the latter in- creases with time, age, and frequent contact lens wear. As more dry eye treatments develop, it will be interesting to see if these are able to improve the ability to wear lenses, said Francis Price Jr., MD, Price Vision Group, Indianapolis. "We now have a vari- ety of treatments for that, including supplements, intense pulsed light treatments, and combined heat and compression devices." A study with a 3-year follow-up from Dr. Price and Marianne Price, PhD, Cornea Research Foundation of America, Indianapolis, found that 14% of the contact lens wearers discontinued use during the study, mostly due to dry eye. 2 More reasons for discomfort Allergies, including giant papillary conjunctivitis (GPC), also play a role in contact lens discomfort, said Francis Mah, MD, director, cornea and external disease, and codirector, refractive surgery, Scripps Clinic, La Jolla, California. Although these patients often are managed by optometrists, the small percentage who don't improve end up visiting ophthalmologists, he said. However, as trends have shifted to the use of disposable contact lenses, GPC has become less common, Dr. O'Brien said. Contact lens infection—some- thing often linked to poor lens hygiene—can lead patients out of their lenses. "Microbial keratitis, especially when involving a highly virulent or indolent pathogen such as Pseudomonas, MRSA, fungus, or Acanthamoeba, is among the most feared complications of contact lens wear," Dr. Starr said. "[Infections] have been most commonly associated with gram-negative organisms, but gram positive microbes such as Staphylococcus aureus and Strepto- coccus pneumoniae species can lead to contact lens-associated red eye and other problems limiting use of contact lenses. … Microbial keratitis is the most severe and fortunately the least common microbial-driven adverse response with contact lens wear," Dr. O'Brien said. Discussing with patients what increases the risk for ocular infec- tion—such as sleeping in lenses, exposing the lenses to water, and not cleaning and changing the lenses as prescribed—is a crucial part of patient education, Dr. Mah said. However, even though infection occurrences are low, it can be hard to find patients who follow all of the hygiene rules, he added. Because of the risk for infection, many ophthalmologists are not fans of extended-wear lenses. As Dr. Starr remarked, "While the Food and Drug Administration has approved some lenses for sleeping in, in general I recommend against these. Sleeping with a foreign body in your eye is simply not a good idea, even if the lens is approved for it," he said. The only time that Dr. Francis Patients love their contacts, until they don't C ontact lenses provide millions of patients with improved vision. Howev- er, dry eye, allergies, and infections, among other causes, continue to affect patients' ability to comfortably use contacts. Contact lens users—and the ophthalmologists and optometrists who treat those patients—face a number of challenges and opportu- nities that affect the lens-wearing experience. Dry eye Eye doctors hear it all the time—pa- tients choose to stop wearing con- tact lenses. What's going on to make them stop wearing the lenses? "A study among North Amer- ican contact lens wearers found that nearly 80% of them reported discomfort, while 77% reported dryness, 1 " said Terrence P. O'Brien, MD, professor of ophthalmolo- gy, and Charlotte Breyer Rodgers Distinguished Chair in Ophthalmol- ogy, Bascom Palmer Eye Institute, University of Miami. "Many patients who have had to stop or reduce con- tact lens wearing time indicate that their quality of life is significantly affected, both in terms of perceived better vision with their contacts as well as personal image based on physical appearance." Challenges and opportunities abound for contact lens users Infectious keratitis with extended wear contact lens Source: Francis Price Jr., MD Diffuse multifocal corneal subepithelial and anterior stromal infiltrates in soft contact lens wearer using a multipurpose disinfection solution Source: Terrence O'Brien, MD

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