We see it repeatedly in our practices—patients who wear contact lenses successfully for years—all day, every day. They continue with successful wear throughout their teens, 20s, and 30s.
Then, things start to change.
Those individuals who once were successful contact lens wearers and were adamant about never upgrading their contact lenses begin to ask you if there are advancements that may make them more comfortable.
We ODs must educate patients on the newest generation of contact lenses and refit them in either advanced disposable contact lenses that require care solutions or daily disposables. Often these modern designs will be enough to temporarily improve some patients’ wearing experience and provide them with relief.
Previously from Dr. Brujic and Dr. Kading: Why you should add upper lid eversion to your comprehensive exam
Constant refitting not the answer
When patients return, they once again bring up discomfort and look to pursue a newer contact lens design. Patients may again find temporary comfort, but before long they are back in our offices asking for newer, more comfortable contact lenses.
We ODs have found ourselves in the trap of refitting—constantly searching for a contact lens that is more comfortable for our patients. Though we are both technologically savvy ODs who wish to pursue the latest advancements for our contact lens wearers, we realized we were trying to address patients’ discomfort by refitting them each time and expecting different results.
We began to look at the ocular surface to help determine what may be contributing to underlying contact lens discomfort. We have a number of diagnostic and treatment options for our patients that can help in our battle of contact lens discomfort and help these individuals resume normal, comfortable contact lens wear.
Causes of contact lens discomfort
Dry eye blepharitis syndrome (DEBS) is a term proposed by researchers meaning that dry eye and blepharitis are a continuum of the of the same disease. They describe that bacterial survival in high concentrations lead to the formation of biofilms on the lid margins.1
At low densities, bacteria may function commensally on the lid margin. As bacteria start to communicate with one another, certain genes become activated, producing virulence factors such as homoserine lactones (HSLs) which are present in high concentrations within the biofilm. Several of these virulence factors cause inflammation when they are secreted from the bacteria. These include proteases, lipases, hyaluraonidase, and collagenase.1