Despite the impressive advances made in contact lens materials and designs, anywhere from 16 percent to 20 percent of contact lens wearers drop out of contact lenses each year. “If we can maintain a comfortable contact lens experience, we can optimize contact lens vision and comfort and keep our patients happy,” says Melissa Barnett, OD, FAAO, FSLS, FBCLA, principal optometrist at University of California (UC), Davis, Eye Center in Sacramento, California. The first step in the process is often overlooked: optimizing the ocular surface before fitting a patient with contact lenses. “The rate of meibomian gland dysfunction (MGD) in the population is about 86 percent,” says Dr. Barnett. “We are treating MGD even in young patients and at a very high rate among contact lens wearers.”
Start with education
Dr. Barnett says that providing patients with the understanding that an optimal ocular surface is going to result in the best possible contact lens-wearing experience works to keep patients in contact lenses successfully and to return for contact lens examinations. She works in two locations at UC Davis—the ophthalmology clinic is where she fits many patients with medically necessary contact lenses, especially scleral lenses. Because patients need their specialty contact lenses to function, she fits them on the day of the appointment. Even so, she reviews the importance of treating the ocular surface and MGD.
At the UC Davis Student Health and Wellness Center, she typically sees patients with normal corneas. “I inform patients that it is ideal to have a good starting point to get the best success with contact lenses,” she says.
Dr. Barnett is a believer in doing everything she can to jumpstart the healing process. “I recommend an eyelid cleanser, such as OCuSOFT HypoChlor® Gel or OCuSOFT Lid Scrub Foaming Cleanser. I recommend commercial warm compresses and Omega supplementation. Additionally, I remind them to take frequent breaks when staring at the computer screen or smart phone or reading. I also recommend preservative-free artificial tears that may be used with contact lenses or a prescription eye drop for dry eyes to use without contact lenses,” she says. “I prefer to give my patients multiple management options to obtain the best possible results.”
Often, the results are fast and promising. “I’ve even had allergy patients with rather severe ocular surface disease follow these steps in addition to a prescription steroid or mast cell stabilizer and get considerable relief quickly,” she says. She typically sees patients back about a week later for the contact lens fitting. It is especially important to treat the ocular surface prior to contact lens fitting when fitting multifocal contact lenses.
OCuSOFT has a variety of products that she recommends, including Retaine® PM ointment, which she likes for its larger size, and Retaine® Liposome Spray, which is helpful for eczema and atopy.
One question she asks all of her current contact lens wearers is whether their contact lenses are comfortable at the end of the day. She also asks if they need to blink to bring things into better focus. “It’s so important to evaluate the entire ocular surface, which includes staining the cornea and conjunctiva, examining the conjunctiva for dry eye, flipping the eyelids to evaluate for lid wiper epitheliolopathy and giant papillary conjunctivitis and evaluating for MGD.”
It’s common to find symptoms that can be addressed. In her presentations on the ocular surface, she notes that 30 percent to 50 percent of contact lens wearers have dry eye symptoms, and between 22 percent and 37 percent, depending on the study, of patients with contact lens-intolerant eyes have meibomian gland abnormalities.
“A defective lipid layer or tear film can lead to eye irritation and ocular surface disease. If we can detect and treat the inflammation, patients will be more successful with contact lenses.”