How to Improve the Contact Lens Wearing Experience

When it comes to contact lenses, the number of options continue to grow steadily, which means the days of dealing with unsuccessful lens fits and unhappy new contact lens wearers are becoming a distant memory.

That said, these lenses don’t fit themselves. We still need to know what’s available and how to choose the right fit. This is especially true when dealing with dry eye and meibomian gland dysfunction (MGD), which can sideline contact lens-wearing time. Let’s talk about some strategies for improving our patients’ contact lens-wearing experience.

KNOW YOUR OPTIONS

The types of lenses available haven’t changed much in recent years. Standard contact lens options fall into one of two categories: hydrogel (water-loving [hydrophilic] polymers) or silicone hydrogel materials. Silicone hydrogel lenses are more widely prescribed now, especially for patients with dry eye. The silicone makes them more oxygen permeable than hydrogel lenses.

Aside from material, the next factor to consider is wearing schedule. Contact lens fitters must assess their patients’ lifestyle needs, hygiene habits, risks, benefits, and ability to comply with a wearing schedule to determine the most suitable wearing schedule for the best outcome.

Extended Wear Contact Lenses

For patients who insist on the option, there are lenses approved for weekly and monthly extended (overnight) wear; however, they are strongly discouraged in clinical practice due to their increased risk of microbial keratitis and corneal ulcers.¹ The silicone hydrogel material reduces the risk of corneal hypoxia, but not infection.² Extended wear schedules are also an option for patients with unpredictable schedules or those who have difficulty removing their lenses due to dexterity issues or similar circumstances.

Reusable Lenses

Planned replacement, or reusable, lenses are worn and replaced either on a weekly, biweekly, or monthly schedule. Most reusable lenses are made with silicone hydrogel materials, so they have good oxygen permeability, and may be available in a wider range of prescriptions, especially for patients who need toric and multifocal options. This is a good, safe option for budget-conscious patients who are compliant with their care and replacement schedules.

Daily Disposable Lenses

Daily disposable contact lenses are typically the best option for patients, as they are convenient, more hygienic, and encourage lens wear compliance. Patients are also less likely to experience protein and lipid deposits that can lead to discomfort and issues such as giant papillary conjunctivitis,³ and daily disposable lenses lessen the likelihood of infections, particularly microbial keratitis.

Patients with allergies should always be prescribed daily disposable lenses. Because they will use a new lens every day, there is less opportunity for allergens to build up on the lens. Patients who lead active lifestyles also tend to prefer daily disposable lenses, especially if they are frequently participating in outdoor sports or activities where allergens and debris can build up on their lenses.

Two drawbacks that patients commonly bring up are cost and plastic waste. While daily disposable lenses can cost more, there are several cost-effective options available, especially when patients leverage manufacturer rebates. In addition, there is a cost savings when considering contact lens solution is no longer needed. As for the issue of plastic waste, some contact lens companies offer recycling programs for the blister packs, boxes that the lenses come in, and even the lenses themselves.^4,5 We encourage patients to keep their lenses and blister packs and return them to us throughout the year or at their annual exam. We collect them and turn them over to a company that recycles them for us.

CHOOSING THE RIGHT FIT

With the goal of improving the contact lens wearing experience top of mind, choosing the right fit is of high importance. Taking a patient-centered approach is key in pursuit of this goal. Thus, it is imperative to never over-promise and to instead under-deliver on the capabilities of a contact lens.

Thoroughly assess the patient’s refractive error and needs before recommending a contact lens type. For example, certain prescriptions are only available in planned replacement lenses (eg, high astigmatism, high minus/plus, multifocal torics). It’s also important to understand the patient’s work life and hobbies. For patients with presbyopia who work on the computer all day, consider a multifocal lens that will give them a range of vision, but know they may still have to supplement their vision with readers for certain tasks. Some patients only want to wear contact lenses socially or for sports. Daily disposables are ideal for these patients. Regardless of lens type, it’s crucial to assess and manage any ocular surface disease prior to fitting a patient in contact lenses.

It may be prudent to perform corneal topography before choosing a lens to rule out any corneal irregularities, such as keratoconus, which could affect your patient’s success with contact lens wear. Corneal topography also provides an objective measurement of horizontal visible iris diameter and overall corneal shape, which is valuable information. Most contact lenses come in a standard base curve and diameter, leaving little room for adjustment, but if you consider these data points during the fitting process, you will improve the patient’s contact lens experience by choosing the most appropriate lens option. (Certain brands of soft contact lenses can be custom made for patients with more specific visual needs that can’t be accommodated with readily available designs.)

Patient Education and Compliance

The best way to improve patient compliance is through education. If we don’t ask specific questions such as the examples below, we likely won’t gather the information we need to discern whether a patient is actually being compliant.

Example Question No. 1: How Often Do You Sleep in Your Contact Lenses? I purposely ask this question this way because it creates an opening for the patient to be honest with me. It lets them know it’s okay if it happens from time to time. In addition, it allows patients to proudly tell me it never happens, which I love to hear. If patients are consistently sleeping in their lenses, take time to educate them on the risks. If sleeping in their lenses appears to be unavoidable, I will switch them into a lens that is approved for extended wear.

Example Question No. 2: How Often Do You Dispose of Your Lenses? Again, this is an open-ended question. If the patient is compliant, no further discussion is needed, but if not, I discuss the possibility of switching to a wear schedule that may be more conducive to their lifestyle. If they cannot remember to change their biweekly or monthly lens, then a daily disposable is the clear choice for them.

Example Question No. 3: What Solutions Do You Use to Clean and Store Your Lenses? I always encourage patients to use branded cleaners rather than generics out of an abundance of caution, and I urge them to rub their lenses in addition to soaking them. I also talk about cleaning their cases monthly or disposing of their old case every time they buy a new bottle of solution. If I have sample solutions, I readily give them out to all patients to help avoid any confusion on which type to purchase.

Additional Considerations

To maximize a patient’s visual experience, it’s important to fully correct any existing astigmatism. It is tempting to give the patient a spherical equivalent prescription, but if they have 0.75 D or more of astigmatism, be sure to prescribe a toric contact lens.

Monovision has been a long-time option for patients with presbyopia, but we now have many innovative multifocal lenses available that offer better optics than ever before. Multifocal contact lenses allow binocularity, and most patients are more comfortable and happier with their vision in these designs. They offer a range of vision, whereas monovision lenses have two specific focal points, which can be visually limiting.

For patients who are on digital devices all day, there are several lenses available that offer advantages. MyDay Energys and Biofinity Energys (CooperVision) offer a +0.3 D digital boost, and Acuvue Oasys Max 1-Day (Johnson & Johnson Vision) offers a blue light filter.

MANAGING DRY EYE AND MGD

Contact lenses disrupt the normal tear layer, essentially splitting it into two layers: the pre and post contact lens tear layer. This disruption/bisection of the tear layer can be problematic for patients who already deal with dry eye, and it can cause dry eye symptoms in patients who don’t already have dry eye. Contact lens wear affects ocular surface homeostasis by reducing lipid layer thickness, reducing overall tear volume and tear breakup time, as well as increasing tear evaporation.^6-8

Without a healthy lipid layer, tears evaporate almost instantaneously, leaving the ocular surface or contact lens vulnerable to desiccation. There have been reports that contact lens wear may contribute to MGD due to the interaction of the glands with the lens causing trauma to the glands.^9,10 This is controversial, but plausible.

Regardless, this is why it’s important to do an ocular surface assessment before you fit a patient with lenses. If it’s determined they have dry eye disease, be sure to treat and manage their signs and symptoms first. Taking this initiative beforehand will certainly improve patient success.

OPTIMIZING CONTACT LENS CARE FOR EVERY PATIENT

Selecting the right contact lenses requires a comprehensive understanding of both available options and the unique needs of each patient. By thoroughly assessing lifestyle, ocular health, and compliance factors, practitioners can ensure more successful outcomes and enhanced comfort for their patients. With the growing variety of lenses on the market and a patient-centered approach, optometrists can continue to provide effective, personalized solutions for all contact lens wearers.