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Daily disposable contact lenses cause less damage to ocular surface
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A study comparing different types of contact lenses found that daily disposable options cause less damage to the ocular surface and less increase of proinflammatory cytokines as compared with reusable options.
Seventy-one individuals who had not previously used contact lenses were randomized to wear for 3 months daily disposable hydrogel contact lenses (group 1), daily disposable silicone hydrogel contact lenses (group 2) or reusable silicone hydrogel contact lenses (group 3). All subjects were told to wear their contact lenses every day for approximately 10 hours.
At baseline, month 1 and month 3, all patients answered the Ocular Surface Disease Index (OSDI) questionnaire and underwent tear functional tests, including tear osmolarity, Schirmer testing and tear break-up time (TBUT). A sample of tears was collected to measure inflammatory cytokines levels. At baseline and 3 months, cellular changes occurring on the ocular surface were assessed by impression cytology.
At 3 months, a significant difference was found in the level of all inflammatory cytokines between the groups, with the highest level in group 3 and the lowest in group 1. A significant increase in OSDI score and a significant decrease in TBUT and Schirmer test was observed in group 3. Impression cytology showed progression of the Nelson grade in all three groups, with the most progression in group 3, followed by group 2 and the least in group 1. Progression to grade 3 was found in 23% of the eyes in group 3 and none of the eyes in the other groups. Reduction of goblet cell density (GCD) was significant in all three groups.
This study confirmed that the use of soft contact lenses leads to an increase in the level of proinflammatory cytokines and to cellular changes in the conjunctiva. However, daily disposable contact lenses seem to cause less damage.
“Frequent replacement of lenses prevents accumulation of deposits on the lens and provides more comfortable use of contact lenses,” the authors wrote. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Justin Kwan, OD, FAAO
A typical practice sees 109 patients each week (Nichols et al.). One-third of these are contact lens-wearing patients. In 2018, 69% of contact lens wearers (including both soft and gas permeable) were using silicone hydrogels. Growth in the daily disposable market translated to 35% of wearers in this healthier modality.
While this study reported important findings in the first 3 months of soft contact lens wear, results from longitudinal studies will be valuable to ascertain possible progressive insult to the ocular surface. For instance, meibomian gland expressibility and atrophy were shown to worsen for the first 2 years of soft contact lens wear in young individuals but not worsen much beyond that time point (Alghamdi et al.).
It is widely understood now that a reusable lens with chemically based multipurpose solutions creates a low-grade inflammatory environment that logically worsens deeper into the wear cycle. To be fair, the choice of lens for group 3 (PureVision 2, Bausch + Lomb) had a high modulus, thick edge and earlier generation of surface wetting technology. Surprisingly, Willcox and colleagues found no relationship between ocular comfort and tear cytokine levels.
Ocular surface changes in the environment of soft contact lens wear tend to happen in the early stages but are often subclinical. It is up to the clinician to risk stratify for each patient to promote the healthiest ocular surface long term while achieving the best possible vision and comfort in a low modulus, daily disposable lens whenever possible.
References:
Alghamdi WM, et al. Ophthalmic Physiol Opt. 2016;doi:10.1111/opo.12278.
Nichols J, Fisher D. Contact Lens Spectrum. January 2019.
Willcox MD, et al. Mol Vis. 2015;21:293-305.
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