The Conundrums With Geriatric Patients and Contact Lenses

Contact lenses are an invaluable asset in the treatment and management of our patients, but they do not come without risk. Although considered relatively safe, certain health conditions (such as those illustrated in this article) may cause contact lenses to be more harmful than beneficial, especially in older patients. To address this, we first need to understand why the elderly are wearing contact lenses. We then need to recognize some of the common ailments that affect the elderly and how these ailments might make contact lens use riskier. Let’s take a deeper dive here.

ELDERLY PATIENTS AND CONTACT LENSES

Up to 7% of people 65 years of age or older wear contact lenses, a number that will continue to increase as our elderly population grows.¹ Many of these patients wear contact lenses to achieve a visual acuity not obtainable through glasses or to improve ocular comfort. Those who wear contact lenses for nonmedical reasons may do so because they’ve never worn glasses before and want to maintain feelings of independence and youth, or they simply prefer to go glasses-free.

THE EFFECTS OF AGING ON LENS USE

With aging comes a decrease in visual function and a change in health. One of the most common developments with aging is the onset of dementia or other cognitive function degeneration. In the United States alone, about 32% of adults 65 years of age or older have dementia.² The associated changes are progressive and begin with mild memory loss often not noticed by the patient in the early stages that can lead to loss of all cognitive function. The most common type of dementia is Alzheimer disease, which affects over 7 million Americans.³ If a patient forgets to take their lenses out, this puts their eyes at elevated risk and could lead to further ocular complications.

Arthritis is another common geriatric ailment. It is associated with inflammation, swelling, tenderness, stiffness, and/or pain of one or more joints. Approximately 1 in 4 Americans has arthritis.⁴ Osteoarthritis and rheumatoid arthritis are the most common forms of arthritis, with osteoarthritis being the second most common chronic condition among older American adults.⁵ The typical signs patients affected by arthritis exhibit are slow movement, limited range of motion or movement, swelling or disfiguration (particularly in the joint areas), and complaints of pain or discomfort. If a patient is unable to insert or take out their contact lenses properly or chooses to leave their lenses in to avoid additional discomfort, this will create a situation that puts the eyes at risk.

Other common conditions that can affect mobility and dexterity are Parkinson disease and multiple sclerosis. Parkinson disease is a degenerative brain condition that disrupts the body’s motor system. Multiple sclerosis is also a degenerative central nervous system disorder marked by weakness, numbness, and loss of muscle coordination that typically occurs at a younger age but becomes progressively more debilitating over time. Parkinson disease affects one in every 100 elderly people, whereas multiple sclerosis affects one in every 1,000 elderly people.^6,7 Common signs of these conditions include movement issues, such as shaking, coordination difficulties, and difficulty balancing or walking. Vision and ocular motility issues, fatigue, signs of depression, and slurred speech may also be observed. As with arthritis, these conditions may make handling contact lenses difficult, creating an unsafe environment when inserting or removing contact lenses.

Diabetes is a metabolic disease that can damage vital organs, such as the eyes, nerves, and circulatory system. Type 2 diabetes is the most common metabolic disease in older adults, affecting up to 33% of people 65 years of age or older.⁸ Ocular changes associated with systemic changes in diabetes may compromise the performance of contact lenses. Immune changes may affect the eye’s ability to protect itself from insult. Skin changes may cause lid structure changes, leading to irritation and discomfort. Nerve sensitivity changes may lead to receptive and sensation changes, creating an environment that compromises the eye’s ability to sense issues with the contact lenses. Brain issues leading to memory changes may compromise proper contact lens wear as mentioned earlier.

Although not a disease, the risk of a stroke increases with age and may cause temporary or permanent changes that can lead to some of the concerns mentioned previously.

WHEN HARM PREVAILS

As physicians, it is our responsibility to do no harm. We tend to view contact lenses as a means to improve our patients’ lives, but we must also recognize the circumstances in which wear may cause more harm than good. Addressing this issue often means taking elderly patients out of their contact lenses. Unfortunately, there is no clear or easy way to do this. While each situation is unique, always clearly and concisely explain to your patient your concerns and why they are significant when it comes to their ocular health. Expect to be met with resistance and frustration from the patient. If taking them out of their contact lenses is not feasible, you will need to think of alternatives. This may include having the patient follow up often enough to minimize the risk between visits and/or arranging a support system for the patient whose responsibility is handling their lenses. I have personally gone as far as performing a regular home visit to replace an extended-wear contact lens for a patient. All in all, in this population, when lenses are clearly offering the patient significant benefit, we need to put every effort into minimizing any potential risk the lenses are posing to an already vulnerable patient.