More than 30 million people in the United States have dry eye disease (DED), which may be the single greatest opportunity in medical eye care.1 But I’m not talking about treating dry eye patients specifically—even though this is critical, too—I’m referring to contact lens practices.
The Drop Out Rate
About 45 million Americans wear contact lenses, and up to 24% drop out each year.2,3 Assuming conservative numbers, that’s about 10 million people a year. A practice generates an annual income of about $330 per contact lens patient. So a loss of 10 million patients a year is a loss of $3.3 billion for the profession.
Imagine how much more we could thrive by trimming that dropout rate. The key isn’t a focus on the money, it’s a focus on what’s really important: the patient. These patients want to stay in their lenses and don’t want to develop chronic and progressive conditions such as DED.
A Better Exam
Uncovering early diagnostic clues is crucial for mitigating contact lens dropout. If a patient fully discontinues lens wear, it’s difficult to get them back into their lenses; but, if you catch them at an early stage, you can address the problem and keep them happy in their contact lenses.
For starters, ask patients the right questions. Knowing they have end-of-day discomfort, fluctuating vision, burning, watering, dryness or irritation is the first clue to a problem. How long they spend on digital devices and whether they feel the urge to use, or are using, rewetting drops or artificial tears are also important.
Next, express the meibomian glands or obtain meibography. Most dry eye associated with lens wear is evaporative, and pushing on the lower eyelid can quickly determine its presence. The longer you allow meibomian glands to obstruct, the greater the likelihood of inflammation and atrophy—the more gland loss, the harder it will be to get patients back in contact lenses.
Don’t Wait to Manage
If signs and early symptoms are present, address both the contact lens technologies and the DED/meibomian gland dysfunction (MGD).
Contact lenses. Today’s advancements include daily disposable lenses and better modulus/Dk silicone hydrogels and water gradient designs. Find lenses that retain more than 90% of their moisture or water content after 12 to 16 hours. If patients don’t want a daily disposable, consider recommending solutions with hyaluronic acid or preservative-free hydrogen peroxide.4 Artificial tears that work well with contact lenses can help with comfort during the day.
Disease management. These simple steps may delay dropout, but they won’t stop it. To give your patient the best chance at staying in contact lenses, address the underlying DED/MGD by treating three key components: biofilm, obstructed meibomian glands and inflammation.
For biofilm, the ideal treatment is belpharoexfoliation, lid scrubs or a combination of both. For MGD, consider thermal pulsation/expression and hydrating compresses. Research shows thermal pulsation can increase contact lens wear by as much as four hours.5 Another study found a hydrating compress increased contact lens wear time by 3.5 hours.6 For the inflammation, I have found topical treatment (lifitegrast or cyclosporine) works best, in addition to oral omega fatty acid supplementation and, potentially, doxycycline in advanced cases. In the end, your patient will have better contact lenses and use hydrating compresses, lid scrubs and omega fatty acids daily. That’s not much to prevent a chronic, progressive, life-interrupting condition.
Not only is it worth it to patients, it’s also worth it for our profession to the tune of about $3 billion a year.
Note: Dr. Karpecki consults for companies with products and services relevant to this topic.
1. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the beaver dam offspring study: prevalence, risk factors, and health-related quality of life. Am J Ophthal. 2014;157(4):799-806.
2. Cope JR, Collier SA, Nethercut H, et al. Risk behaviors for contact lens–related eye infections among adults and adolescents—United States, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(32):841-5.
3. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007;26(2):168-74.
4. Rah MJ, Merchea MM, Doktor MQ. Reducing dropout of contact lens wear with Biotrue multipurpose solution. Clin Ophthalmol. 2014 Jan 24;8:293-9.
5. Blackie C. 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. 2018:12:169-83.
6. Ablamowicz AF, et al. The effect of the Bruder moist heat eye compress on contact lens discomfort in contact lens wearers. University of Alabama, Birmingham. 2018.