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BLOG: Contact lens intolerance: The canary in the dry eye coal mine
It’s been roughly 30 years since I last fit a contact lens of any type. With any luck, I’ll make it at least 30 more. Like most anterior segment specialists I have become the contact lens “problem guy.” My staff describes me as “Doctor No,” the doctor who has to tell a patient they can no longer wear their contact lenses. As a dry eye disease guy, this is getting to be a bigger and bigger part of my average clinic day. Contact lens intolerance means DED.
Seriously, it’s so common it’s becoming a joke. A patient — man or woman — comes into the office with some version of, “I’ve worn my daily wear contact lenses all day for 20/30/40 years and now I can hardly stand them after 2 hours.” Oh sure, sometimes it’s a bit more subtle than that (my vision gets blurry at night after I come home from work), but one thing remains a constant: taking the contact lenses out solves the problem.
Contact lens intolerance due to dryness is our throwback problem. All contact lenses are drying agents, even the very best “dry eye” contact lenses like Acuvue Oasys Dailies (Johnson & Johnson Vision Care). Take a drying agent, put it on a surface that is barely lubricated enough and voila! Dry eye symptoms. The fact that contact lenses suppress the blink reflex and that your patient is probably parked in front of a screen all day just adds insult to injury. Thank heavens nobody wears rigid gas permeable contacts anymore. Can you imagine the dry eye carnage from a silicone polymer lens today?!
You don’t need to work very hard to know who has a problem. Your contact lens patients are going to lead with this complaint. It’s not too hard to find objective evidence in these folks, either. Trust me, they want to continue to wear their contact lenses, and they are going to develop a deep, visceral hate for any eye doctor who tells them “no more contact lens wear.” Fearing that news, they will have waited as long as they possibly could before coming in, and they will be in “crisis” mode. Don’t mess around with artificial tears here. This is a “full code” medical emergency in your patient’s eyes, and you should go right to your big guns like Restasis (Allergan) and Xiidra (Shire).
Your patient will expect you to pull out all the stops and resuscitate that canary.
Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.