|CooperVision’s Proclear 1 Day lenses contain phosphorylcholine, a molecule that attracts and surrounds itself with water.|
With all the advances in lens materials and after care, comfortable cl wear is a very attainable goal for today’s dry eye sufferers.
An incredible amount of science goes into the development of contact lenses and contact lens solutions. When it comes to patients having dry eye symptoms with lens wear, we must be good investigators to determine the full scope of the problem. Here’s an example of problem-solving a patient’s contact lens intolerance.
A new patient, aged 35, indicated she has been a contact lens wearer for 20 years and currently was unhappy with her lenses. The main problem was that she was fit with two-week disposable lenses, but was having trouble getting 10 days of wear time out of them. She complained that the lenses felt filmy, dry, and very uncomfortable after even just a few days. The patient was unsure of the brand of her lenses, only that she was supposed to wear them for two weeks.
When I asked about lens care, she used whatever solution was on sale at the time, and removed and cleaned the lenses every night. With severe allergies in the spring and fall, contact lens use was limited during those seasons. Following questioning about past ocular history, I learned the patient had a few instances of giant papillary conjunctivitis (GPC) and had to take a break from wearing her contact lenses at various times.
While looking at her lenses on her eyes during the slit lamp examination, I found that her lenses were very heavily deposited with lipids and proteins. This was one of the main contributing factors for her having to dispose of the contact lenses more frequently. The buildup also most likely caused the episodes of GPC experienced in the last few years.
The following are possible solutions to this patient’s problems.
CHANGE THE MODALITY
One option for this patient would be to refit her into a daily disposable lens, a great option for patients who are heavy lens depositors. Daily disposables provide a clean lens surface daily, thus eliminating any chance for build-up. These lenses are perfect for patients who are prone to GPC, as there will be
|CIBA VISION’s Focus DAILIES provides lubricity and enhanced wetting characteristics.|
no mechanical irritation between lens and eyelid with fewer deposits.
The patient also mentioned that she suffered from allergies. Daily disposables are my “go to” lenses in this case. Using a clean lens every day eliminates the buildup of allergens on the lenses. While this patient didn’t have a solution sensitivity, these lenses are also ideal for patients who do.
CooperVision Inc.’s Proclear® 1 Day (omafilcon A) has a 60% water content and contains phosphorylcholine, a molecule that attracts and surrounds itself with water. This lens is an option for those who experience dry eyes and utilize the daily disposable modality.
CIBA VISION’s Focus® DAILIES® with AquaRelease™ is available in spherical, multifocal, and newly expanded astigmatic powers. Polyvinyl alcohol (PVA) is released from the lens into the tear film over the course of the day to provide all-day comfort with its lubricity and enhanced wetting characteristics.
VISTAKON, Division of John-son & Johnson Vision Care, Inc., has the 1-DAY ACUVUE® and the 1-DAY ACUVUE MOIST™ lenses, both made from an etafilcon A material that is 58% water. 1-DAY ACUVUE MOIST incorporates LACREON™ Technology to address end-of-day dryness. The wetting agent, polyvinylpyr-rolidone (PVP), makes the surface of the lens more hydrophilic, resulting in improved comfort, wetness, and longer comfortable wear times. Both of these daily disposables are available in an 8.5mm and 9.0mm base curve.
EMBRACE NEW LENS TECHNOLOGY
Another way to handle this case would be to refit the patient into a silicone hydrogel lens.
CooperVision’s two newest lenses, the monthy replacement Biofinity® lens and the two-week
|Prescribing specific multipurpose solutions, like Alcon’s OPTI-FREE RepleniSH, can solve dry eye issues.|
replacement Avaira®, are suitable for dry eye patients. Both lenses feature the Aquaform® Comfort Science™, which offers a naturally wettable material without the need for surface treatments or wetting agents. Biofinity is available in both sphere and toric and has a low modulus and high Dk/t of 160, supplying soft lens comfort with high oxygen transmissibility with extended wear approval. Avaira is designed for daily wear and is a good entry level silicone hydrogel.
VISTAKON’s ACUVUE OASYS® with HYDRACLEAR® PLUS line has a 38% water content and contains an increased amount of its wetting agent, resulting in a lens that feels moister, smoother, and also has increased oxygen transmissibility. ACUVUE OASYS is available in two base curves (8.4mm and 8.8mm), and in both a toric (8.6mm) and multifocal design (8.4mm).
CIBA’s latest silicone hydrogel lens, the lotrafilcon B AIR OPTIX® AQUA, combines the high oxygen transmissibility of the O2OPTIX with the new AQUA moisture system. This moisture agent lubricates lenses for initial comfort, and maintains the comfort and moisture all day. The ultra-smooth surface also retains wettability and resists deposits.
A NEW ‘SOLUTION’
The patient claimed she used whatever contact lens solution happened to be on sale. One of the easiest ways to solve dry eye issues related to lens deposition is to change the lens solution. I will often prescribe a non-preserved solution to my heavy depositing patients. These systems, such as CIBA’s Clear Care® disinfecting and cleaning solution and Abbott Medical Optics (AMO) Oxycept® UltraCare®, provide more consistent tear film wettability and decreased lipid, protein, and debris buildup on the lens.
Prescribing specific multipurpose solutions is also important. Many of the new silicone hydrogel lenses are more compatible with certain lens care systems, such as Alcon Laboratories, Inc.’s OPTI-FREE® RepleniSH®, which contains added moisturizers that help keep lenses well hydrated. Caution your patients to avoid generic multipurpose solutions as these tend to contain biguanides, which can cause burning or irritation. Also equally important is the replacement schedule and digital rubbing of these lenses to keep them lipid and protein free.
This patient encounter is very typical. How you treat and what you prescribe may vary, but making specific recommendations is essential.
Jennifer L. Stewart is in private practice at Norwalk Eyecare in Norwalk, CT.
WHERE TO FIND IT
Abbott Medical Optics (AMO)
Alcon Laboratories, Inc.
800-451-3937 • optifree.com
800-241-5999 • cibavision.com
800-341-2020 • coopervision.com
VISTAKON, A Division of Johnson & Johnson Vision Care, Inc.
800-843-2020 • jnjvisioncare.com