Retain patients and recapture dropouts with a tandem approach.
Discomfort and dryness are the top reasons patients tell me they’ve stopped wearing their contact lenses. Because I treat dry eye disease (DED), I also see many patients who would like the convenience of wearing contact lenses, full time or part time, but they assume that’s not an option for them. With the right strategy, it’s possible for virtually all of these patients to achieve the comfortable contact lens wear they want.
My strategy is to approach DED management and contact lens wear as tandem goals. We manage the underlying causes of DED and improve ocular surface health, then fit patients with the best lens technologies for their specific needs. By addressing both DED and contact lens fitting together, my patients in their 20s are comfortable and successful in contact lenses—and so are my patients in their 60s and everyone in between.
In our practice, we ask every person if their eyes ever bother them, feel dry, or get uncomfortable throughout the day. Everyone who answers “yes” completes a Standardized Patient Evaluation of Eye Dryness questionnaire, which tells us their symptoms and DED severity. We also get a history of what they’ve done to improve the problem (for example, which artificial tears they use and how often).
In the exam, I stain almost every patient and look for signs of dryness, including low tear breakup time. I also examine lids and lashes for meibomian gland dysfunction (MGD), blepharitis, and corneal and conjunctival inflammation. During the refraction, I have patients blink to see if it affects their vision. With a detailed view of their DED and its causes (aqueous deficient, MGD, or both; mild, moderate, or severe; underlying causes and/or environmental factors), I’m ready to recommend an approach for management as well as the best contact lens for the patient.
» OptiLight: For patients with moderate to severe DED due to MGD, I recommend OptiLight (Lumenis) light-based treatment. It reduces inflammation at the root of DED; helps restore meibomian gland form and function; and improves meibum quality, which in turn improves the tear film. Every one of my patients has told me they had improvement after OptiLight. Even my patients with severe MGD and some loss of meibomian glands have significant (25%-50%) improvement, and cases without gland dropout have an even greater response. After four 15-minute in- office procedures, spaced 2 to 4 weeks apart, it’s common to see patientssignificantly reduce their dependence on medication or artificial tears. The procedure is appropriate for adults. I’ve treated patients from their 20s to their 70s with OptiLight.
» Artificial tears: Some contact lens patients with mild discomforthaven’t tried artificial tears or are using vasoconstrictors or preserved tears that can exacerbate DED. I recommend they get a bottle of preservative-free artificial tears (iVIZIA, Théa; Refresh Relieva, Allergan; Systane Complete, Alcon) to use several times a day, including in the morning before their eyes start to feel dry. I also tell them to continue using tears after they remove their contact lenses to help the ocular surface rehydrate.
» Strategies to increase tear volume: Other DED therapies can help increase tear volume if a patient’s specific medical history or presentation calls for it. Immunomodulator drops (Cequa, Sun Ophthalmics; Restasis, Allergan; Xiidra, Novartis) can help combat aqueous deficiency, particularly in postmenopausal women and patients with autoimmune disease. We can also increase tear volume using punctal occlusion, but only after we address the underlying inflammation to avoid trapping poor-quality tears and inflammatory mediators on the ocular surface.
» Daily disposable contact lenses:I always recommend daily disposable contact lenses for a more comfortable, successful experience. Patients get fresh, clean, comfortable lenses every day. The silicone hydrogel materials used in 1-day lenses are designed for all-day comfort and ocular surface health with high oxygen permeability and water content. My go-to lens is the Acuvue Oasys MAX 1-Day (Johnson & Johnson Vision), which my patients tell me are still comfortable at the end of the day and reduce their visual fluctuation. MAX lenses block blue light, which improves glare and night vision and makes vision more stable. Dailies TOTAL1 (Alcon) are also excellent, as are MyDay (CooperVision), which now include MyDay Energys to reduce dryness and fatigue from digital eye strain. Acuvue Oasys MAX 1-Day, Dailies TOTAL1, and MyDay are available in torics and multifocals. I explain to patients that 1-day lenses are a little pricier, but the technology, materials, and all-day comfort are worth it.
Once I’ve fitted my patients, I explain that they need to tell me right away if DED symptoms return over time, so we can alter the management plan to ensure they stay in their lenses. I also continually upgrade their lenses when something new and beneficial comes along. That helps us stay ahead of DED, and it ensures that patients learn about the latest lenses from me and understand that I’m always looking out for their care.
By approaching DED management and contact lens fitting as tandem goals, I’m able to fit just about anyone who wants to wear contacts, even if they’ve already dropped out. For example, since the COVID-19 pandemic began, I’ve seen a major increase in patients in their 40s, 50s, and 60s who’ve dropped out of contact lenses and are able to start wearing them again with DED treatment and advanced technology 1-day multifocals. Daily disposables also make it easy for any patient who drops out to get back into wearing contact lenses at least part time for specific tasks, rather than not at all. The ultimate goal is to get them into the modality they prefer for their vision and lifestyles, and that’s what we’re able to achieve.