New advances are keeping patients with dry eye or those who use digital devices in contact lenses longer.
In my practice, patients present on a daily basis complaining of new discomfort in contact lenses that they’ve worn for years. In the past two years, contact lens manufacturers have addressed the complaint and have made major improvements to their lens arsenal to combat two major causes of lens dropout: digital eyestrain and dry eye.
TREATING THE OCULAR SURFACE
First and foremost, treatment of the ocular surface is paramount to successful contact lens wear. We have every patient over the age of 18 complete a dry eye questionnaire before they are even brought back for the work-up. It’s amazing how many patients are off the chart on the symptomology score, but as soon as I mention treating their dry eye, they retort, “Oh, that only happens when I wear my contacts.” If I see signs behind the slit lamp that directly contradict that statement, like meibomian gland dysfunction for example, I educate patients that no contact lens I put on their eye will feel good. I start them on a dry eye regimen and bring them back for the contact lens evaluation. The plan depends on the eye. I always recommend HydroEye, a dry eye supplement from ScienceBased Health, as the first defense along with warm compresses using a Bruder mask and drops (Restasis, Xiidra and Freshkote lubricant eye drops are at the top of the list).
Once the ocular surface is clear, the goal is to prevent these symptoms from returning. My number one recommendation to every patient with any contact-lens-related dryness are daily disposable lenses. With patients wanting to wear contacts for longer hours and later into their lives, I usually start with a daily that has a full family of products (sphere, toric and multifocal) such as clariti 1 day lenses from CooperVision and Biotrue ONEday contact lenses from Bausch + Lomb. The Biotrue lens is specifically designed for digital device use due to its non-blink-activated rewetting system. Patients appreciate hearing this, and I have had multiple patients describe both of these lenses as a “breath of fresh air” for their eyes.
If a patient is not interested in a daily disposable lens because of cost, several monthly options are available. Bausch + Lomb’s ULTRA has the same hydration system as the Biotrue ONEday lenses.
CooperVision recently launched Energys, a digital device lens in the Biofinity family. The aspheric optics help with end-of-day awareness and strain that patients tend to experience when looking at computers for eight hours a day. In addition, Alcon just released AIR OPTIX plus HydraGlyde (which will replace the AIR OPTIX Aqua) that helps prevent end-of-day discomfort as well.
Don’t forget that a part of lens discomfort could be from straining to see. How many early presbyopes walk in the office refusing to admit that they cannot read up close anymore? Now couple that with long hours of near demand and it is a recipe for disaster. A vast majority of patients need to see clearly at multiple distances. This can only be achieved in multifocals. Will it take more chair time? Yes. Will it take more follow-ups to get it right? Yes. Come up with an “all inclusive” plan or set your fees appropriately for follow up visits, but I assure you, it will be worth it because these patients will be yours for life. Plus, they will recommend you to family and friends. Again, I always talk multifocal first. I mentioned the Biotrue ONEday for Presbyopia and clariti 1 day multifocal lenses before. I also like Alcon’s family of DAILIES because they are available in a medium add. With the DAILIES Total1 Multifocal, comfort and vision are excellent.
As for monthly lenses, ULTRA, Biofinity and Alcon’s AIR OPTIX plus HydraGlyde are all excellent options for ideal vision and comfort. The key to success with multifocals from any manufacturer is setting the patient up for realistic expectations. Vision is almost always going to be sharper in their glasses, but the contact lenses can give them functional vision at all ranges.
Another tip for successful contact lens wear in patients with dry eye is solution compatibility. It is up to us to educate the patient about the difference between generic and name brand solutions. If they are already using a good solution, like Blink RevitaLens from Johnson & Johnson Vision, adding a peroxide-based solution, such as CLEAR CARE PLUS from Alcon, can be just the boost the lens needs to extend wearing time to the end of the day.
For those dealing with severe dry eye patients and who enjoy prescribing specialty lenses, the use of scleral lenses can be considered for the treatment of the ocular surface disease. Giving the patient a well of hydration throughout the day can make or break the patient’s ability to function with contact lenses.
Patients with dryness, either contact-lens-induced or otherwise, can now wear contacts with lens formulary improving by leaps-and-bounds every year. You can make a major impact in your patients’ lives with just a little more chair time that equates to a vast improvement in quality of life. Your patients will be extremely grateful to have an eye doctor who took the time to listen and work with to find the right lens for them.
Brooke S. Kaplan, OD, is in private practice in Mountain Brook, AL.