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Contact lens discomfort is a challenge we face daily in our practices. According to the Tear Film & Ocular Surface Society (TFOS) International Workshop on Contact Lens Discomfort, between 12% and 51% of lens wearers discontinue contact lens wear, and discomfort is the leading cause.1 Most of the time, these patients can be satisfied by minor modifications to lens fit, modality, care system, or simply a reduction in wear time. But what about patients who want to wear contact lenses in extreme outdoor environments, such as while skiing, surfing, or hiking, where they are exposed to harsh elements?
Fear not: There is hope for these patients. We can simplify the solution into two steps—optimize the ocular surface and choose the best lens.
TO THE POINT
Patients who endure extreme outdoor environments may still be interested in contact lenses. Although these circumstances present a challenge, there are solutions.
ASSESS THE EYE, FIX THE EYE
If the ocular surface is compromised, there is less chance of success when a contact lens is placed on the eye. This problem may be magnified in adverse conditions. Evaluate for dry eye disease, meibomian gland dysfunction (MGD), blepharitis, and allergy in patients who are interested in wearing contacts in extreme environments. A 2015 study showed that, in a population aged 18 years and greater, only 27% had no evidence of either allergic conjunctivitis, dry eye, or MGD.2
Assess tear film breakup time, tear quantity and quality, and corneal and conjunctival staining. Evert the lids to view the palpebral conjunctiva, and express and image the meibomian glands. Patients who spend a lot of time outdoors may also have pingueculae or pterygia, which can become inflamed by contact lens friction or lens tightening. Address each condition as needed. Punctal occlusion has been shown to improve lens comfort,3 as has cyclosporine.4
Optometrists often depend on innovation in contact lens technology to ensure successful wear, but our opportunities may also lie in proactively evaluating and optimizing the patient’s ocular surface prior to lens fitting. When we take the time to do this, it enhances patients’ perception of our practice and may also reduce contact lens dropout. It is time well spent.
CHOOSE THE BEST MODALITY, LENS DESIGN, AND MATERIAL
The findings of the 2013 TFOS workshop on contact lens discomfort, available through the TFOS website,5 are an excellent resource to consult when patients want to wear contacts in challenging environments. Other recommendations to maximize comfort include the following:
• The lens material should have a low coefficient of friction.6
• Thin lenses are better tolerated than thick ones. Choose a thin edge, too, for less lid interaction.7
• Daily disposables have been shown to be the most comfortable modality.8
• Fit a steep lens with minimal movement, as excessive lens movement is less comfortable for patients.9
USE COMMON SENSE
When possible, patients should wear goggles or sunglasses with UV light protection to decrease exposure to the effects of wind and sun. Proactive use of contact lens rewetting drops is also a good idea; it enables longer lens-wearing times by reducing lens friction. Patients should consider limiting their wearing time to the activity itself. Many of my patients use lenses for swimming and surfing and then discard them when they get out of the water.
Scleral lenses—large-diameter rigid gas-permeable lenses that vault the cornea—may also be used to provide better comfort in tough conditions. The bowl of the lens is filled with solution, which keeps the surface of the cornea hydrated and can provide very sharp vision by masking any corneal irregularities. The large diameter keeps the lens stable and comfortable. There is a learning curve involved in both fitting and wearing scleral lenses, but it can be overcome. The pros easily outweigh the cons when the alternatives are glasses or contact lens intolerance.
When you hear about a patient wanting to wear contacts in harsh environments, embrace the opportunity. It can mean a quality-of-life win for them and a grateful patient for you.
1. Dumbleton K, Caffery B, Dogru M, et al. The TFOS International Workshop on Contact Lens Discomfort: Report of the Subcommittee on Epidemiology. Invest Ophthalmol Vis Sci. 2013;54(11):20-36.
2. Kwan J, Harthan J, Optiz D, et al. Prevalence of stand-alone ocular surface disease and their mixed counterparts. Optom Vis Sci. 2015;92:E-abstract 155044.
3. Li M, Wang J, Shen M, et al. Effect of punctal occlusion on tear menisci in symptomatic contact lens wearers. Cornea. 2012;31(9):1014-1022.
4. Hom, MM. Use of cyclosporine 0.05% ophthalmic emulsion for contact lens-intolerant patients. Eye Contact Lens. 2006;32(2):109-111.
5. The TFOS International Workshop on Contact Lens Discomfort. 2013. http://www.tearfilm.org/tfoscldreport-english/tfos-cld-report-index.htm. Accessed September 28, 2017.
6. Coles C, Brennan N. Coefficient of friction and soft contact lens comfort. Paper presented at: American Academy of Ophthalmology Annual Meeting; November 10-13, 2012; Chicago.
7. Jones L, Brennan NA, González-Méijome J, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the contact lens materials, design, and care subcommittee. Invest Ophthalmol Vis Sci. 2013;54(11):TFOS37-70.
8. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007;26(2):168-174.
9. Young G. Evaluation of soft contact lens fitting characteristics. Optom Vis Sci. 1996;73(4):247-254.
From the BMC Archive
Preventing Contact Lens Dropout
Interviews with David Kading, OD; Melissa Barnett, OD; and S. Barry Eiden, OD Swipe Right for Better Sight
Scott Schachter, OD
• private practice, Advanced Eyecare and the Eyewear Gallery Optometry, Pismo Beach, Calif.
• financial disclosures: none relevant
• @pismoeyedoc; firstname.lastname@example.org