Combatting the Fall DED Surge

As fall approaches, many of us optometrists see an uptick in symptoms related to dry eye disease (DED). The combination of cooler and drier temperatures, indoor heating, and seasonal allergies creates the perfect storm for ocular surface disruption. I see this surge every year in my Portland-based dry eye specialty practice, which I founded in 2013.

Too often, patients believe that a DED diagnosis means they can never wear contact lenses again. That misconception is something I actively work to dispel. With the right technologies and thoughtful ocular surface management, we can keep our patients comfortably in lenses, even those with challenging ocular surfaces.

The Fall DED Spike

Every fall, patients present with familiar complaints: dryness, burning, fluctuating vision, fatigue, and reduced lens tolerance. Environmental changes play a large role—indoor heating strips moisture from the air, allergy season lingers longer than many expect, and digital device use spikes (and the blink rate drops) as people return to school or settle into work routines. All these factors exacerbate tear film instability and evaporation.

For patients already managing DED, this seasonal stress pushes them into symptomatic territory. For contact lens wearers, it often means shorter wear times, discomfort, or complete dropout. I do my best to meet these challenges proactively with modern lens materials and comprehensive surface management.

Breaking the Myth That DED ≠ Contact Lenses

Too many times, I meet patients who wore contacts comfortably in their 20s or 30s but abandoned them as dryness developed with age. By the time they reach their 50s or 60s, many people assume glasses are their only option. Yet, patients in this age bracket want the convenience of contact lenes. They lead active lives that include hobbies, travel, and social events for which glasses are cumbersome and/or undesirable.

Thus, the misconception that they aren’t candidates for contact lenses is a disservice to dry eye patients. With today’s daily disposable silicone hydrogel materials, and especially new tear-stabilizing technology that helps to retain moisture without pulling water from the tear film or the surrounding tissues, we can often restore patients to successful contact lens wear.

The key is treating the ocular surface first—we must optimize meibomian gland function, reduce inflammation, rehabilitate the tear film, and ensure corneal health. Then, we can choose the right lens material that complements the tear film instead of competing with it.

Why Daily Disposables Are My Gold Standard

In my clinic, more than 95% of contact lens wearers are in silicone hydrogel daily disposables, because I consider this the healthiest option for patients. I find that all my contact lens wearers, those with DED and otherwise, have the most success with these lenses, because they impart significant benefits for ocular health:

• Reduced allergen load: Especially critical in fall when ragweed and mold spores linger, daily replacement lenses minimize re-exposure to allergens that cling to reusable lenses.
• Improved surface integrity: Eliminating cleaning solutions and deposits reduces chemical and mechanical insult to the ocular surface.
• Enhanced compliance: Patients are freed from cleaning regimens, which decreases the risk of improper care compounding their symptoms.

When patients are hesitant to transition to the daily option due to cost, I’ll often suggest that they keep at least one box on hand for peak allergy season, because even with a careful cleaning regimen, it’s difficult to remove all allergens from the lens’ surface.

My Go-To Lenses for DED

Among daily disposables, my top choice is the family of Acuvue Oasys Max 1-Day lenses (Johnson & Johnson) that combine the breathability of silicone hydrogel with a polyvinylpyrrolidone (PVP) wetting agent that maintains hydration throughout the day. PVP retains moisture within the lens matrix without pulling water from the ocular surface or destabilizing the tear film. This lens also has a very low rate of surface evaporation,^1-4 which is excellent for patients with a history of dry eye symptoms.

Another feature that I like about these daily lenses is that they offer blue-light–filtering capabilities—they filter 60% of blue light,¹ and block 100% of UVB and 99.9% of UVA wavelengths. Beyond offering protection from these harmful ultraviolet rays, I believe the blue light filter helps reduce the visual noise of halos and starbursts from oncoming headlights when patients drive at night. Additionally, patients appreciate having UV and blue light protection in their contact lenses, as they already understand these concepts from using skincare and glasses.

I receive great patient feedback on these lenses; most say they can wear them comfortably all day, and they experience fewer visual fluctuations when they use a computer. I like that the lenses are available in toric, multifocal, and multifocal toric designs to fit a wide range of visual needs.

Managing Severe DED Cases

For patients with advanced DED, once their symptoms are under control and I’m attempting to get them back into contact lens wear, I individualize their lens schedules. If they can only tolerate lenses in short bursts, like for social events or exercise, that’s okay. The goal is to empower them with options. In fact, I’ve used 2-week silicone hydrogel contact lenses in some eyes with severe DED as therapeutic or “bandage” contact lenses, given their biocompatibility and tear-stable technologies. As long as the ocular surface is optimized, these lenses do not set patients’ ocular surface back; instead, they offer moments of visual freedom without compromising the progress of their treatment.

Leading with the Best

When it comes to recommending contact lenses, I believe in leading with the best option. Too often, I see practitioners hesitant to offer premium daily disposables out of concern for cost. I frame this discussion in terms of wanting to give my patients the healthiest, most advanced lenses, so they know that the health of their eyes, the quality of their vision, and the quality of their wearing experience are all important to me. Of course, if cost is a barrier, then we can discuss alternatives, but I always leave this decision up to my patients.

1. JJV Data on File 2022. TearStableTM Technology Definition.

2. JJV Data on File, 2022. CSM Subjective Responses ACUVUE® OASYS MAX 1-Day Contact Lenses – Retrospective Meta-analysis.

3. JJV Data on File 2022. Effect on Tear Film and Evaluation of Visual Artifacts of ACUVUE® OASYS MAX 1-Day Family with TearStable™ Technology.

4. JJV Data on File 2022. Material Properties: 1-DAY ACUVUE® MOIST, 1-DAY ACUVUE® TruEye®, ACUVUE® OASYS 1-Day with HydraLuxe™ Technology and ACUVUE® OASYS MAX 1-Day with TearStable™ Technology Brand Contact Lenses and other daily disposable contact lens brands.