Mask wear and vision correction, which is the best option?

Background

The global pandemic caused by the COVID-19 virus led to millions of deaths and severe social disruption. According to the scientific community’s most recent findings, the primary route to the virus’ transmission is through airborne droplets that originated from the upper respiratory tract.^1-3

Before there was sufficient evidence supporting the effectiveness of face masks in controlling viral spread, the World Health Organization (WHO) had advised against their use.⁴ There were concerns that widespread public use of medical masks might deplete supplies available to health care workers.

Data from studies have since shown that the use of face masks can help prevent viral transmission.^5,6 They are effective at reducing airborne pathogens that can infect people and contaminate the environment.

Related: Ocular findings of COVID-19

Spectacle fogging dangers

The effects of wearing a face mask have been widely associated with various deleterious effects including dry eye, skin allergies, breathing difficulties, and headaches.^7-12 Additionally, condensation can form on the lens surfaces due to the warm, humid environment. When wearing a face mask, this problem can be triggered by the lack of ventilation around the nose.

Having a hard time wearing a face mask is likely to prevent wearers from protecting themselves properly. Spectacle fogging also carries safety implications when it results in the wearer temporarily losing vision.

Solutions

Various solutions have been suggested to address the problem of spectacle fogging. Some include applying tape or clips at the top of the mask, moving the spectacles down the nose, or altering the angle of the nose.

Recent research findings point to contact lenses as the best resolution to the problem. Because contact lenses are maintained at room temperature for a long time, and the tear film is aqueous in nature, they can avoid experiencing surface condensation.¹³

Related: Contact lens overwear leads to short-term, long-term consequences

A study conducted by Eurolens Research at the University of Manchester in England is the first to compare 2 types of vision correction and their effects on face mask use. Investigators aimed to test the hypothesis that wearing contact lenses may improve the ocular and task-related abilities of masks.

Methods

The face mask used for this analysis was a Yeso-med Type IIR disposable surgical mask. It featured a pleated design with ear loops and a metal nose bridge. These masks were worn for at least 1 hour per day, 4 days a week, over 2 weeks, by 30 study participants.

Related: The many options of vision correction

Design

This study was a prospective, randomized, 2-arm parallel group investigation. At the initial visit, participants were randomly and equally distributed in one of 2 study groups. The first group remained in their habitual spectacles and the second group was fitted with the study daily disposable contact lens. Various baseline investigations were performed, including subjective refraction, visual acuity (logMAR), and slit lamp biomicroscopy.

Participants wore their assigned vision correction for at least 8 hours per day over a 2-week period.

Results

During follow-up visits, the time of wearing and use of the vision correction and facial masks were recorded.

After 2 weeks, participants completed a Quality of Life Impact of Refractive Correction (QIRC) questionnaire, as well as a 2-part face mask usability survey. They also assessed their ocular-related symptoms with visual analog grading scales (VAS).

The QIRC responses indicated that individuals who participated in various physical activities were able to enjoy them more with contact lenses than with glasses, when masks were worn.

Other reasons contact lenses were preferred include: breathability, heat, comfort on ear, and overall comfort. The study findings revealed that combining spectacles and masks can disrupt normal breathing patterns, as individuals attempt to avoid fogging, and result in a “heat sensation” from humid exhalation lingering behind lenses.

In conclusion, results showed higher subjective ratings for contact lenses versus glasses across multiple dimensions, including walking, driving, reading, computer use, exercising, socializing, wear, and comfortability.

“Eye care professionals should consider discussing these findings with all of their patients, even those who have never tried contact lenses before,” says Carole Maldonado-Codina BSc(Hons), MSc, PhD, MCOptom, FAAO, FBCLA. “Even if patients love their spectacles, there is an opportunity for dual wear, swapping their frames for contact lenses when they’ll be wearing a mask. It could be a relatively straightforward approach with positive implications for multiple aspects of a person’s daily life.”

References
1. Klompas M, Baker MA, Rhee C. Airborne transmission of SARS-CoV-2: theoretical considerations and available evidence. JAMA. 2020;10.1001/jama.2020.12458. Published online July 13, 2020. doi:10.1001/jama.2020.12458

2.Morawska L, Milton DK. It is time to address airborne transmission of coronavirus disease 2019 (COVID-19). Clin Infect Dis. 2020;71(9):2311-2313. doi:10.1093/cid/ciaa939

3. Ma J, Qi X, Chen H, et al. Exhaled breath is a significant source of SARS-CoV-2 emission. MedRxiv. Published online June 2, 2020. doi:10.1101/2020.05.31.20115154

4. World Health Organization. Rational use of personal protective equipment for coronavirus disease (‎‎‎ COVID-19)‎‎‎: interim guidance, 27 February 2020. https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf?sequence=1&isAllowed=y

5.Viola IM, Peterson B, Pisetta G, et al. Face coverings, aerosol dispersion and mitigation of virus transmission risk. IEEE Open Journal of Engineering in Medicine and Biology. 2021;(2):26-35. doi:10.1109/OJEMB.2021.3053215

6. Anfinrud P, Stadnytskyi V, Bax CE, Bax A. Visualizing speech-generated oral fluid droplets with laser light scattering. N Engl J Med. 2020;382(21):2061-2063. doi:10.1056/NEJMc2007800

7. Moshirfar M, West WB Jr, Marx DP. Face mask-associated ocular irritation and dryness. Ophthalmol Ther. 2020;9(3):397-400. doi:10.1007/s40123-020-00282-6

8. Niesert AC, Oppel EM, Nellessen T, et al. "Face mask dermatitis" due to compulsory facial masks during the SARS-CoV-2 pandemic: data from 550 health care and non-health care workers in Germany. Eur J Dermatol. 2021;31(2):199-204. doi:10.1684/ejd.2021.4007

9. Geiss O. Effect of Wearing Face Masks on the Carbon Dioxide Concentration in the Breathing Zone. Aerosol and Air Quality Research. 2021;21(2):1-7. doi:10.4209/aagr.2020.07.040

10. Kyung SY, Kim Y, Hwang H, Park JW, Jeong SH. Risks of N95 face mask use in subjects with COPD. Respir Care. 2020;65(5):658-664. doi:10.4187/respcare.06713

11. Ramirez-Moreno JM, Ceberino D, Gonzalez Plata A, et al. Mask-associated 'de novo' headache in healthcare workers during the COVID-19 pandemic. Occup Environ Med. 2020;78(8):548-554. doi:10.1136/oemed-2020-106956

12. Toksoy CK, Demirbaş H, Bozkurt E, Acar H, Börü ÜT. Headache related to mask use of healthcare workers in COVID-19 pandemic. Korean J Pain. 2021;34(2):241-245. doi:10.3344/kjp.2021.34.2.241

13. Purslow C, Wolffsohn JS, Santodomingo-Rubido J. The effect of contact lens wear on dynamic ocular surface temperature. Cont Lens Anterior Eye. 2005;28(1):29-36. doi:10.1016/j.clae.2004.10.001