Silicone hydrogel contact lens wear may increase dry eye symptoms, ocular discomfort
Key takeaways:
- Silicone hydrogel contact lens wearers had decreased TBUT but higher rates of ocular surface staining and worse meiboscores vs. controls.
- OSDI scores also were higher among lens wearers vs. controls.
Wearing silicone hydrogel contact lenses may result in several adverse effects on the ocular surface and meibomian glands, some of which appeared to worsen with extended screen time, according to a study in Contact Lens & Anterior Eye.
“Although [contact lens (CL)] wear is assumed to be an effective and safe method to correct refractive errors, it may cause many changes in the ocular environment, such as preocular tear film instability, corneal hypoxia and epithelial cell damage,” Dilan Colak, MD, FEBOphth, from Medicana Ataköy Hospital in Istanbul, and colleagues wrote. “These changes in the ocular environment lead to ocular discomfort symptoms like dryness, irritation and fatigue.”
The researchers recruited 50 individuals (mean age, 25.8 years; 64% women) who had been wearing silicone hydrogel contact lenses daily for at least 6 months and 50 age- and sex-matched controls (mean age, 25.9 years; 46% women) who had never worn contact lenses to participate in a cross-sectional study assessing the effects of the lenses on meibomian glands, corneal structure and ocular surface parameters.
All participants underwent a routine ophthalmic exam, as well as ocular surface and tear film evaluations, meibography and in vivo confocal microscopy (IVCM) measurements and corneal sensitivity assessment, measured via the Cochet-Bonnet aesthesiometer. Participants also were asked to complete the Ocular Surface Disease Index questionnaire.
According to results, endothelial cell density was significantly lower (P = .01) and polymegethism rate was significantly higher (P < .001) in the contact lens group compared with the control group.
In addition, researchers reported total meiboscores of 2.64 ± 1.08 (1-5) for the contact lens group and 1.22 ± 0.95 (0-4) for the control group, also a significant difference (P < .001).
Although tear breakup time was shorter among contact lens wearers vs. controls (P = .01), corneal fluorescein staining was higher (P = .04) and appeared to be associated with visual display terminal (VDT) work time (P = .05). OSDI scores (P < .001) also were higher in the contact lens group.
Further, biomicroscopic evaluation showed that 34% of the contact lens group and 20% of the control group had meibomian gland dysfunction, which was not a significant difference. The researchers also reported no significant difference in corneal sensitivity between the two groups.
“Although there are many studies on this subject in the literature, there is no other study evaluating the relationship between: IVCM, meibography, ocular surface parameters and VDT work effects altogether,” Colak and colleagues wrote. “The results of this study could contribute to the literature and the future studies about CL-wear effects on ocular surface and possible mechanisms of CL-related ocular discomfort.”
Perspective
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This study offers valuable insights into the complex interplay between soft contact lens wear, specifically silicone hydrogel lenses, and the health of the ocular surface and meibomian glands. Despite potential limitations such as sample size and selection bias, which are common in many research studies, this investigation represents a significant step forward in understanding the challenges faced in clinical practice.
As optometrists, we must acknowledge these limitations while also recognizing the study’s contributions to our understanding of ocular surface alterations associated with contact lenses, including increased ocular discomfort, tear film instability, ocular surface inflammation and associated corneal epithelial cells changes. These effects on the ocular surface of silicone hydrogel contact wearers were similar irrespective of number of years of wear — from less than 5 years to more than 10 years — and were exacerbated by screen time (visual display terminal exposure).
Understanding the side effects of devices we prescribe is paramount in optometric practice, and addressing dry eye syndrome in contact lens wearers has historically proven challenging. This study’s findings contribute to our comprehension of these challenges and aim to improve patient care and management strategies. Although silicone hydrogel contact lenses are known to be more ocular surface compatible, allowing more oxygen to the eye than other soft contact lenses, this research represents a crucial step forward in unraveling the complexities of contact lens-related ocular surface alterations among wearers.
The study provides a solid foundation for further research and clinical exploration. By building upon these findings, we can enhance our ability to address the challenges posed by dry eye in contact lens wearers, ultimately improving patient outcomes and quality of life.
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