Managing the care of patients with contact lens-related dry eye
Excerpted from page 16 of the May/June 2021 edition of AOA Focus.
Contact lens wear has been cited as one of the risk factors for dry eye. Melissa Barnett, O.D., who lectures extensively on dry eye disease, specialty contact lenses and novel technologies, offers practical advice. Principal optometrist at the University of California Davis Health Eye Center, Dr. Barnett will become chair of the AOA Contact Lens and Cornea Section in June.
1. Address digital device use.
“When the eyes are in upward gaze viewing digital devices, an increase in palpebral fissure size can expose the ocular surface, leading to tear film destabilization,” says Dr. Barnett. “When the palpebral fissure is narrowed in downward gaze, it may result in a stabilized tear film. Inform patients to set up their workspaces so their eyes are in a slightly downward gaze when viewing digital devices. Objects viewed at (approximately 90 centimeters or approximately 35 inches) with a downward gaze angle (10 degrees) correlated with improved subjective comfort and dry eye parameters. Proper lighting, altering chair position, lowering computer monitors and a desktop humidifier may help minimize computer-related dry eye symptoms. Blinking exercises (gently closing eyes for two seconds, opening eyes, again gently closing eyes for two seconds, followed by squeezing eyes closed for two seconds) have been shown to prevent screen-related ocular damage. It is important to educate patients about why these strategies are essential and coach them on their use throughout the day when at a computer, using handheld devices or playing video games. Every patient should learn the 20-20-20 rule: Every 20 minutes, look at something 20 feet away for 20 seconds.”
There are numerous daily replacement contact lens options to increase lens comfort, Dr. Barnett says.
2. Refit patients in daily replacement contact lenses.
“According to the Tear Film and Ocular Surface Society Contact Lens Discomfort classification working group, adjusting the replacement frequency to daily was among the several recommendations described to prevent contact lens discontinuation,” she says. “In addition, in a study that evaluated corneal infiltrate events (CIEs), reusable contact lens wearers had a 12.5 times increased risk of CIEs compared to daily disposable wearers. If parameters allow, I encourage all new wearers to start with daily replacement contact lenses. For contact lens patients who are not complaining about discomfort, daily replacement contact lenses may prevent future problems.”
3. Switch to hydrogen peroxide solution.
For reusable contact lens wearers, hydrogen peroxide (H2O2) systems are an option because they are easy to use, safe, comfortable and efficacious, Dr. Barnett says. “H2O2 produces free radicals that act as oxidizing agents, which destroy microorganismal cell membranes and essential cell components, exerting a biocidal effect,” she says. “Studies have demonstrated that multipurpose solutions give rise to significant staining and that H2O2 solutions result in minimal corneal staining.” Just 13% of those using multipurpose solutions were compliant, compared to 100% of those who used H2O2 solutions, reports the Centers for Disease Control and Prevention lens care guidelines.
Dr. Barnett also cited recent scientific and clinical evidence that found hydrogen peroxide solutions promote comfortable lens wear and are easy to use, have minimal interactions with lenses or the ocular surface, provide antimicrobial efficacy and support ocular surface health. Patients using the H2O2 system also were more likely to comply with a practitioner’s lens care brand recommendation (79% vs. 34%), four times more likely to use fresh solution for daily disinfection and seven times more likely to replace the lens case as recommended, she says.
4. Recommend moist heat compress therapy.
“The application of localized heat to the meibomian glands improves meibum secretion, making warm compresses a commonly prescribed treatment,” Dr. Barnett says. “Researchers at the University of Alabama at Birmingham School of Optometry specifically investigated the effects of moist heat compress treatment on contact lens discomfort in subjects who had contact lens-related dry eye. These findings suggest that moist heat compress treatment could be an effective first-line treatment for contact lens wearers who have discomfort. Those who used the moist heat compress increased comfortable wear time of their contact lenses by up to three hours.”
5. Ask patients about their facial and eye products.
“For those with dry eye and/or contact lens wearers, it is important to ask which products are being used for their faces and eyes,” Dr. Barnett says. “Many cosmetic products contain chemicals that may increase ocular irritation, blepharitis, meibomian gland toxicity and even cause, or exacerbate, dry eye disease.” Any product that a person, whether woman or man, applies around the eyes can cause problems. Consider recommending to patients nonirritating products, says Dr. Barnett, who suggests two online resources for learning about the ingredients in cosmetics: the Think Dirty® app and the Environmental Working Group's Skin Deep®. “A healthy tear film is important for all patients, especially for those who wear contact lenses,” she says.
Contact Lens and Cornea Section
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