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With your help, allergy patients can be successful contact lens wearers
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Allergy patients are not automatically discounted as candidates for contact lens wear, but the reality for many of these patients is that there will be times when their lenses are less than comfortable, regardless of the modality they choose.
As a clinician, you discuss this in advance with allergy patients so there are no unrealistic expectations. From there, you can help patients manage their allergy symptoms throughout the year and still experience successful contact lens wear.
First, diagnose allergy
First, clinicians must confirm that the patient is allergic and rule out other sources of inflammation that can mimic allergy, said Robert Ryan, OD, who is in practice in Rochester, N.Y.
"We often have patients, contact lens wearers in particular, who complain of itchy, burning, stinging eyes. One of the possibilities that jumps into our minds when we hear these hallmark complaints is allergy," he said. "But conditions that can mimic an allergy response include dry eyes, blepharitis or other forms of lid and ocular surface disease."
Dr. Ryan also takes a detailed history to categorize the allergy as seasonal, environmental or hay fever.
Charlotte Tlachac, OD, in private practice in Alameda, Calif., said most of her allergy patients suffer seasonally. "It's important to determine what the patient is allergic to because some allergies, such as a food allergy, do not affect contact lens wear," she said.
Dr. Tlachac also asks patients if they are currently experiencing complications while wearing contact lenses. "If they're not experiencing trouble, then you keep in mind that they have an allergic profile and you might need to make adjustments down the road," she said.
Discuss contact lens options
Dr. Ryan's next step involves discussing the list of contact lens options, specifically, the differences between rigid and soft lenses. "In many cases, patients who have an allergic-type profile may be better suited to rigid lens wear," he said, "because these lenses have a very low propensity to absorb anything, such as allergens, into their matrix owing to low water content."
Soft contact lenses, on the other hand, have higher water content, which means they have a greater propensity to absorb allergens into their material and can exacerbate conditions for a predisposed allergy patient, he said.
Discuss medications
Dr. Tlachac then takes time to discuss any and all allergy medications her patients may be taking.
"The medication aspect is critical because of what it means to how allergic the patient is," she said. "If patients are taking medication on a daily basis, that's a more severe allergy profile, and you may have to do several things to manage that. If they're only taking a medication seasonally, they will likely have normal success with their contact lenses during the course of the rest of the year."
Regardless of how often patients use allergy medications, she said, all agents have one thing in common - they tend to dehydrate. "In many cases, regular-use lubricating drops may be necessary to replace the fluid the medication is removing. These drugs also dilute the mucus that builds up in the eye when you're having an allergic reaction," she said.
Patients who take allergy medications daily or frequently may find the most success with frequent replacement lenses, Dr. Tlachac said. "We tend to go to the shorter lens lives the more allergic a patient is, because the shorter the life of the lens, the less chance there is for things to build up on it that the patient is allergic to."
Patients who are minimally allergic and wear traditional lenses are advised by Dr. Tlachac to boost their lens care regimen during allergy season by enzyming twice a week, increasing lubricating drops during the day, decreasing their wear time and taking a mid-day break to rinse and re-insert their lenses.
If an allergy patient takes medication daily or more frequently, she considers a frequent replacement lens. "There are a lot of soft contact options today, and this makes a frequent replacement lens a good consideration," she said. "You can get them in almost any prescription, and even in custom colors."
New materials, new options
Patients who are not suitable rigid lens wearers, have had poor response or are simply opposed to rigid lenses should be directed toward soft lens materials that discourage deposits and encourage ocular surface wettability, Dr. Ryan said.
"A compounding factor here is that a patient's own tear proteins, which deposit on the lens surface, can, in higher concentrations, cause an allergic response," he said. "Hydrophilic lenses, which have superior surface wettability, are less likely to attract and absorb surface deposits."
Dr. Ryan said that, in his practice, 2-week, daily wear, disposable contact lenses are the most popular modality among allergy patients.
Another option for patients is a daily disposable contact lens. "The obvious benefit is that it is very unlikely for a significant amount of allergen to deposit on the surface of the lens because it's worn for 1 day and then discarded," Dr. Ryan said.
In her practice, Dr. Tlachac also advises allergy sufferers to alternate their lens wearing patterns throughout the year.
"Patients who have the most severe allergies and are concerned about cost often use 1- or 2-week disposables during the nonallergy season and then switch to 1-day lenses when their allergies are bad," she said. "This tends to be a nice mix of convenience and minimizing symptoms and discomfort because it's very rare for a patient to have high allergy response year-round."
Is it the solution?
One aspect that should not be overlooked is the lens care system the patient is using.
"We direct patients with allergic profiles who wear hydrophilic contact lenses toward the preservative-free systems," Dr. Ryan said.
These options can be discussed with patients to find out if they have financial concerns about the cost of maintaining a particular modality.
"Is it better for the patient to maintain one pair of rigid lenses," Dr. Ryan said, "or the second option of perhaps a 2-week replacement schedule? Then, there is the most expensive option, which is daily disposable lenses."
The option of wearing daily disposable lenses may become more of a reality for many patients soon, Dr. Ryan said, as the cost is reduced and becomes "what most patients feel is a reasonable expenditure for lens care and wear."
Dr. Tlachac said rigid lenses do have a place when discussing lens care because these solutions are not absorbed into the lenses, and patients can insert rigid lenses with nonpreserved saline if necessary.
"Unlike a soft lens, rigid gas-permeable lens solutions are not retained in the eye for a long time, so there are fewer solution-related allergies," she said.
In addition to their regular lens care regimen, which might include a lubricant, Dr. Tlachac advises mild allergy sufferers to try an over-the-counter solution to rinse and soothe their eyes. "If their symptoms are moderate to severe, however, I may want to go to a prescription medication that's designed to reduce itching and swelling with an antihistamine or mast-cell stabilizer component," she said.
Educate patients
The most important aspect of treatment is to educate patients about which medication is best for their allergy symptoms, Dr. Tlachac said. "Patients need to understand that over-the-counter decongestants tend to be combination drugs to be used purely for itchy symptoms."
She asks patients if their symptoms are more burning than itching and, if so, she recommends an artificial tear or saline to solve the problem.
"If patients overuse the decongestant drops, their body adapts to it and causes a rebound dilation and perhaps long-term complication," she said. "It's an education issue, and patients should be told to use those drugs on a symptom-basis only, not every morning upon waking up."
For Your Information:- Robert Ryan, OD, may be contacted at 169 Rue de Ville, Rochester, NY 14618; (716) 271-2990; fax: (716) 271-6321. Dr. Ryan has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any company mentioned.
- Charlotte Tlachac, OD, may be contacted at 1429 High Street, Alameda, CA 94501; (510) 522-5097; fax: (510) 522-0815; e-mail: tlachac@earthlink.net. Dr. Tlachac has no direct financial interest in any of the products mentioned in this article, nor is she a paid consultant for any company mentioned.