Every year, approximately 16% of patients drop out of contact lens wear—a rate that hasn’t changed in more than 20 years.1,2 But two decades ago, we didn’t have daily disposable lenses, silicone hydrogel technologies, water gradient contact lenses or lens solutions with hyaluronic acid. So why, with today’s better materials, designs and modalities, is the dropout rate similar? The truth is, these advances have probably prevented a significant increase in that dropout rate that would have been caused by the explosion of digital devices.
A Digital Dilemma
Smartphones, tablets and other digital devices are here to stay, and we can anticipate an upward trend in the development of meibomian gland dysfunction (MGD) and dry eye disease (DED) in our patients.
Studies show that the average patient blinks about 15 to 20 times in normal conversation, but this can decrease by 60% to 75%, or even more, while using a digital device.3-5 This lack of proper blinking can result in MGD.
Furthermore, contact lenses are a known contributor to functional changes in the meibomian glands and may also contribute to MGD.6,7 So, we must be proactive in screening all patients—and contact lens wearing patients in particular—who spend numerous hours using a digital device.
Catching changes early will help us prevent gland loss, disease formation and contact lens dropout.
Wellness Three Ways
One of the best ways we can care for our contact lens patients is by taking a wellness approach. Advanced diagnostic technology, patient education and early disease management are key to preventing contact lens dropout.
Diagnostics. Assessing for DED and MGD often involves gland expression, tear film break-up time measurement, meibography and a thorough slit lamp examination with special attention to the lid margins, lashes and assessment for blepharitis. For DED, perhaps the easiest and most accurate diagnostic approach is osmolarity and a validated questionnaire such as the DEQ-5.8 Specular microscopy may also come in handy for DED suspects.
Education. Patients with few, if any, symptoms are less likely to be compliant with treatment or a wellness approach unless we spend time educating them on why it is important. Clinical videos and digital slit lamp images can help patients understand both the disease and the benefits of treatment.
Management. The first step for patients showing abnormality in any of the DED tests is switching to daily disposable or higher technology lenses or better contact lens solutions.
A diagnosis of DED would also prompt treatment to control inflammation and overcome tear film insufficiency. If MGD is noted, you should recommend daily hydrating heat compresses, lid debridement, blink exercises and thermal pulsation treatments. Blepharitis treatment could include mechanical cleaning of the eyelids and daily lid hygiene. Endothelial stress signs would prompt a prescription for a daily disposable or higher technology lens.
DED and MGD patients can still wear contact lenses, but treatment is key to keeping them comfortable and safe.
To ensure patients stay happy and healthy in their contact lenses, we must assess for possible complications at each visit to catch changes early and initiate or modify treatment.
Hopefully, we can use these tools to give patients the potential for a lifetime of contact lens wear—and overcome a dropout rate nearly as high as new fits each year. If we can maintain ocular health, provide early DED and MGD treatment and combine this with our knowledge of the best lenses and solutions, perhaps we truly can allow patients the option of lenses for life.
1. Rumpakis JM. New data on contact lens dropouts: an international perspective. Rev Optom. 2010;147(1):37-42.