Ocular surface and comfort
Unfortunately, only a certain level of comfort can be obtained by optimizing lens designs. ODs need to understand and appreciate the effects of the ocular surface and how it can influence contact lens wear. A healthy ocular surface will not guarantee a successful wearing experience but will maximize the chances of it occurring.
With the ocular surface, critical clinical consideration should be made to the health of the lid margins, conjunctiva, cornea, tear film, and all glands involved in producing the tear film.
Lid margins that become serrated over time can be a sign of chronic lid margin disease, resulting in poor lid dynamics. Excessive bacterial overpopulation can lead to signs of collarettes at the base of the lashes. Other signs include folliculitis, meibomian gland capping, and lid margin hyperemia. This can ultimately alter the quality of the meibum, affecting the tear film dynamics.5 Blepharitis has been shown to be a risk factor for comfortable lens wear, too.6
The lid wiper area is the small region just posterior to the line of Marx on the superior lid margin that provides much of the wiping capacity of the upper lid over the ocular surface. The lid wiper area can become inflamed and will absorb vital dyes, including fluorescein and lissamine green. This is called lid wiper epitheliopathy (LWE) and has been associated with contact lens discomfort.7-9
Inflammation has also been associated with contact lens discomfort. With advancing technologies, the ability to measure ocular surface inflammatory markers has improved. It has been recently demonstrated that elevated levels of leukotriene B4 are associated with symptomatic contact lens wear.10-12
Nutrition can influence ocular surface health and contact lens discomfort. Patients randomized to receive oral omega-3 supplementation showed improvements in contact lens comfort and a reduction in ocular surface inflammatory markers.13
A number of strategies may improve contact lens comfort through improving ocular surface health. Fortunately, there is significant information on ocular surface treatment strategies that have been found to help contact lens wearers have a more comfortable wearing experience.
Here, we will review several strategies that have been shown positive responses in studies to treat the ocular surface in order to improve patients’ contact lens comfort.
Also by Dr. Brujic: Increase contact lens comfort by paying attention to the lids
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12. Masoudi S, Zhao Z, Stapleton F, Willcox M. Contact lens-induced discomfort and inflammatory mediator changes in tears. Eye Contact Lens. 2017 Jan;43(1):40-45.
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15. Machalińska A, Zakrzewska A, Adamek B, Safranow K, Wiszniewska B, Parafiniuk M, Machaliński B. Comparison of morphological and functional meibomian gland characteristics between daily contact lens wearers and nonwearers. Cornea. 2015 Sep;34(9):1098-104.
16. Greiner JV. Long-Term (3 Year) Effects of a single thermal pulsation system treatment on meibomian gland function and dry eye symptoms. Eye Contact Lens. 2016 Mar;42(2):99-107.
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18. Kim MJ, Stinnett SS, Gupta PK. Effect of thermal pulsation treatment on tear film parameters in dry eye disease patients. Clin Ophthalmol. 2017 May 9;11:883-886.
19. Blackie CA, Coleman CA, Nichols KK, Jones L, Chen PQ, Melton R, Kading DL, O'Dell LE, Srinivasan S. A single vectored thermal pulsation treatment for meibomian gland dysfunction increases mean comfortable contact lens wearing time by approximately 4 hours per day. Clin Ophthalmol. 2018 Jan 17;12:169-183.
20. Bruder Healthcare. Bruder Announces Eyeleve Contact Lens Compress. Available at: https://www.prnewswire.com/news-releases/bruder-announces-eyeleve-contac.... Accessed 6/12/19.
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22. Mulder D, Kyser K, Rosenberg B, Connor D, Choat C, Narayanan S. Clinical effectiveness of lid debridement with blephex treatment. Invest Ophthalmol Vis Sci. 2015;56(7):4440.
23. Connor CG, Narayanan S, Miller W. Reduction in inflammatory marker matrix metalloproteinase-9 following lid debridement with BlephEx. Invest Ophthalmol Vis Sci. 2017 June;58(9):448.
24. Siddireddy JS, Tan-Showyin J, Vijay AK, Willcox M. A Comfortable Eye Needs Fats. Thesis competition at the University of South Wales, Sydney, 2015.
25. Giovagnoli D, Graham SJ. Inferior punctal occlusion with removable silicone punctal plugs in the treatment of dry-eye related contact lens discomfort. J Am Optom Assoc. 1992 Jul;63(7):481-5.
26. Geldis JR, Nichols JJ. The impact of punctal occlusion on soft contact lens wearing comfort and the tear film. Eye Contact Lens. 2008 Sep;34(5):261-5.
27. Hom MM. Use of cyclosporine 0.05% ophthalmic emulsion for contact lens-intolerant patients. Eye Contact Lens. 2006 Mar;32(2):109-11.
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