AOA 2026: Managing dry eye with contact lenses

Langis Michaud, OD, MSc, FAAO, FSLS, FBCLA, FEAOO, of the Universite de Montreal School of Optometry, discussed contemporary approaches to managing dry eye in contact lens wearers, emphasizing both accurate diagnosis and thoughtful lens fitting. Speaking at AOA Optometry’s Meeting 2026 in Phoenix, Arizona, he noted that new guidelines from the DEWS III workshop have simplified the diagnostic process, making it easier to identify dry eye, whether patients are overtly symptomatic or not. Once diagnosed, dry eye should be treated proactively, and contact lenses can be integrated as part of a broader therapeutic strategy rather than viewed solely as a source of discomfort.

He reviewed several options, including bandage contact lenses and amniotic membrane lenses, which can support both visual function and ocular surface comfort. Michaud underscores that contact lens discomfort—particularly end-of-day discomfort—is multifactorial. Environmental contributors such as allergen exposure can exacerbate symptoms, so minimizing triggers is important. Clinical strategies to enhance comfort include switching to daily disposable lenses, optimizing lens hygiene, and stabilizing the tear film, sometimes with adjunctive medications such as topical cyclosporine.

A practical clinical pearl he offers is to observe patient behavior during refraction: frequent blinking to clear letters, or fluctuating responses to “1 or 2,” strongly suggests marginal or more advanced dry eye, later confirmable at the slit lamp. He stressed that tear film issues should be addressed before proceeding with contact lens prescribing.

Beyond materials, Michaud argued that modern practice often neglects true lens fitting. Rather than “throwing” a lens on the eye without customization, practitioners should consider sagittal relationships. Recent studies indicate that an optimal sagittal depth is approximately 200–300 microns greater than the ocular sagittal height, promoting appropriate movement and tear exchange. He concluded by advocating a case-by-case philosophy: every contact lens wearer should be considered a potential dry eye patient, with aggressive management of lid disease and tear film instability to secure many years of successful, comfortable lens wear.