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Survey: Self-reported dry eye higher in contact lens wearers
The survey found that contact lens wearers were more likely than spectacle wearers and emmetropes to report dry eye symptoms.
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Even with high-oxygen silicone hydrogel lenses now on the market, people who wear contact lenses are still the most likely to report symptoms of dry eye, according to a survey.
Jason J. Nichols, OD, MPH, PhD, and colleagues at Ohio State University conducted the survey in 2004 to compare self-reported dry eye disease across contact lens wearers, spectacle wearers and subjects not requiring refractive correction.
The survey, the results of which were published in a recent issue of Investigative Ophthalmology and Visual Science, asked subjects to answer questions about symptoms of dryness and light sensitivity. They were asked to report the frequency of these symptoms and their intensity at three times of day, morning, afternoon and evening. They were also asked a self-assessment question: Do you think you have dry eyes?
“A lot of the tests we do for dry eye aren’t reliable, and so oftentimes they don’t seem to relate to the symptoms that patients tell us they have,” Dr. Nichols said in an interview. “There has been a lot more emphasis recently placed on symptoms of dry eye in terms of defining dry eye.”
The results of the survey, which was completed by 893 subjects, showed that contact lens wearers were most likely to report dry eye disease (52.3%), followed by spectacle wearers (23.9%) and clinical emmetropes (7.1%).
“The frequency of dry eye symptoms that contact lens wearers have relative to spectacle wearers and people who don’t use either really emphasizes the fact that contact lens wearers have lots of problems with dryness,” Dr. Nichols said. “Really, we don’t understand the mechanisms or why they get dryness. ... They all have symptoms and live with symptoms on a daily basis.”
The overall frequency of dry eye in the survey sample was 28.7%, with 3.5% of respondents reporting severe symptoms — at least a grade 4 out of a possible 5 for both symptoms.
New materials
Dr. Nichols said the survey results indicate that challenges remain for the contact lens industry and contact lens practitioners. New lens materials may have improved results, he said, but patients still experience dry eye symptoms.
“I think this is something not only researchers and clinicians need to try to understand, but also companies need to think about relative to their development of new materials and care systems for contact lenses,” he said. “It used to be that getting more oxygen through the lens was the issue, but now that we have silicone hydrogel lenses, that’s not so much of an issue. I think industry is going to have to refocus on dryness and comfort in order to keep people in lenses.”
Dr. Nichols said some studies have suggested that the silicone hydrogel materials may decrease dry eye prevalence, but others have not.
There’s a thought that maybe the silicone hydrogels aren’t as wettable or biocompatible as a traditional soft contact lens, he said.
Spectacle wearers
Another surprising finding of the survey, Dr. Nichols said, was that significant numbers of respondents who do not wear contact lenses reported dry eye symptoms — 7.1% of emmetropes and 23.9% of spectacle wearers.
One potential explanation might be that some of the spectacle wearers are former contact lens wearers, he suggested.
“Maybe the spectacle wearers group consists of a certain percent of contact lens wearers who dropped out of lens wear due to the discomfort and dryness that they had,” Dr. Nichols said.
Even after controlling for age and gender, spectacle wearers were still twice as likely as emmetropes to report dry eye, he said.
“Another finding in the study was how many women compared to men reported dry eye,” Dr. Nichols said. “That’s ... consistent with other findings in literature that potentially women are more likely to have reports of dryness and dry eye.”
No quick fix
The finding that more than half of contact lens wearers report dry eye symptoms indicates that the problem will not be fixed quickly, Dr. Nichols said.
“This study emphasizes how many people out there who are wearing these modes have this problem,” he said.
Contact lens wearers who report dry eye symptoms can be switched to lenses with different materials or to a different care regimen to attempt to create more wettable lens surfaces, Dr. Nichols said.
“I think in the industry now, ... a lot of the multipurpose care solution companies are working on reformulating their products to address comfort,” he said. “But there is no magic bullet that will solve everyone’s problem at this point. That is true in contact lens wearers, spectacle wearers or emmetropes.”
Dr. Nichols said he and colleagues are conducting a follow-up study to determine the dropout rate for contact lens wearers and factors causing dropout and discontinuation.
“Dry eye is a difficult disease to study, and there are so many different etiologies of dry eye. I suppose it will keep us all busy for a long time,” he said.
For Your Information:Reference:
- Jason Nichols, OD, MPH, PhD, can be reached at The Ohio State University, 338 West 10th Ave., SL Hall, Rm 101, Columbus, OH 43210; 614-292-4979; 614-688-4474; jnichols@optometry.osu.edu.
- Nichols JJ, Ziegler C, et al. Self-reported dry eye disease across refractive modalities. Invest Ophthalmol Vis Sci. 2005;46:1911-1914.
- Daniele Cruz is an OSN Staff Writer who covers all aspects of ophthalmology.