Contact lenses: managing discomfort and keeping patients healthy and happy in lenses

Philadelphia-During the American Optometric Association’s Optometry’s Meeting, Mile Brujic, OD, moderated a debate on contact lenses among Melissa Barnett, OD, FAAO, David Kading, OD, FAAO, and Jack Schaeffer, OD, FAAO. Topics ranged from lenses from lens discomfort to mitigation of microbial keratitis to the use of daily disposable lenses.

When it comes to contact lens discomfort, Dr. Kading says that the reason patients are under reporting their discomfort is because ODs aren’t asking the right questions. He highly recommends asking patients to rate their lens comfort at the beginning of the day vs. the end of the day, as well as the beginning of the wear cycle vs. the end of the wear cycle.

“We have to be optometrists, not lens salesmen. If it’s not the contact lens itself that is the problem, it is a medical issue,” says Dr. Schaeffer.

Dr. Barnett agreed, and when the conversation turned to multifocal lenses, she stressed the importance of treating the ocular surface.

“When we’re talking about multifocal lenses, we’re talking about an older patient. We need to address the ocular surface. You can make any change you want-soft, gas permeable, it doesn’t matter-but you need a healthy ocular surface,” she says.

Cost is a major factor in why daily disposables aren’t making up more of the contact lens market, says Dr. Schaeffer. But Dr. Kading says cost shouldn’t be a barrier. He says he prescribes two-week or monthly lenses only when there isn’t a modality available in a daily disposable lens.

“When you, as a doctor, think something is the healthiest option for your patient, you need to have that discussion with your patient,” he says.

And while Dr. Schaeffer agreed that daily disposables are a great option for young patients, he highly recommends following up with these patients regularly.

“Children are dirty, filthy animals. Every child should be seen every six months to make sure he is compliant,” he says, even if the child is using a daily disposable lens.

How should you protect your patients from the dangers of noncompliance, such as microbial keratitis?

“A lot of this goes back to hand washing. We need to teach our patients to wash their hands before handling any contact lens,” says Dr. Barnett. “We also need to warn them about not showering or swimming with their contact lenses in, tell them about cleaning their cases, and go over solutions. And we have to give them proper instructions on every visit.”

“Control your extended wear patients. It’s as simple as that because the majority of these cases are coming from extended wear patients,” says Dr. Schaeffer.