OSD patients and contact lens wear

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Gretchyn Bailey, NCLC, FAAO: Hi, everyone. I am Gretchyn Bailey, and I am with Optometry Times®. I am joined today by Dr. Melissa Barnett. Thank you so much for taking the time to talk with me today.

Melissa Barnett, OD: Well, thank you, Gretchyn. Thank you for the invitation.

Bailey: Oh, of course, always. I know you had a fabulous lecture cooking for the Dry Eye Everything meeting, and you are talking about new updates for contact lenses for ocular surface disease patients. So, what is new? What are you discussing, and what do doctors out there need to know?

Healthy precautions

Dr. Barnett: During this pandemic time, contact lenses are safe and healthy to wear. I think that is a really important message that we need to get out there because initially, there was a lot of miscommunication both amongst doctors and patients, where, perhaps, they were being told that contact lenses were not safe, unhealthy to wear, and to wear glasses, instead.

With the proper precautions, contact lenses are safe and healthy to wear. Of course, that includes proper hygiene, replacing daily replacement lenses on a daily basis, using solutions properly, not sleeping in lenses, and most importantly, if you are sick or ill, not to wear contact lenses.

Other things that are really important for contact lenses, for ocular surface disease, are different solutions like hydrogen peroxide solution for our specialty lens wearers, different coatings, like plasma treatment and Tangible Hydra-PEG. I spoke about Tangible Boost as well and talked about new technologies and daily replacement lenses. And also, I talked about the importance of managing the ocular surface for these patients. So, maximizing treatment and management strategies for myobian [GB1] gland dysfunction and blepharitis and demodex. And how to use different medications with contact lenses.

Another important message that we are talking about now is the importance of giving patients guidance on proper face creams and makeups to use with contact lenses so that they don’t dry out. I also spoke about how face masks induce ocular dryness, especially in contact lens wearers. There is a new study that came out on that. And then the new in-office disinfection guidelines for contact lenses which were just released.

So, it is important to disinfect every single contact lens, a diagnostic lens if it is being used on more than one patient. If a patient has an active infection, to throw it away immediately in the biohazard waste, and also to be disinfecting these contact lenses in non-neutralized hydrogen peroxide solution. For at least 3 hours and having a log and reference for each specific contact lens and each diagnostic set.

Bailey: That sounds like a bit of documentation and a bit of work that needs to be managed well and overseen in the office just to make sure that nothing falls through the cracks.

Dr. Barnett: Definitely, but it is a safe way for our patients to prevent infection and then also could lead them to empirical fitting for example for contact lenses.

Bailey: Right.

Dr. Barnett: So, you don’t have to use those diagnostic lenses.

Preventing infection

Bailey: So, I have a question going back to what you said initially about contact lens wear during the COVID-19 pandemic. You said following guidelines, just standard wear and care, suggestions and recommendations that we give to patients that they are quasi compliant with. If you had to specify one thing that you think doctors should be emphasizing to patients during this time, what would that be? Because obviously, contact lenses are safe to wear if you follow the regular guidelines, you will be fine. But is there something that you would emphasize?

Dr. Barnett: Well, there are multiple things so, you know me.

Bailey: (Laughs) Multiple is fine.

Dr. Barnett: So, washing hands, right? Not touching our eyes, not touching mucous membranes when we are wearing contact lenses and glasses, I will say. If a patient, say, has 2 contact lens prescriptions, like a daily replacement and a 2-week replacement, switch it over to that daily replacement lens because it is a clean healthy lens, reduces the risk of microbial keratitis and corneal infiltrative events. If they, say, are topping off their solution, adding more solution—not to do that. If they are not disinfecting lenses, to disinfect them every single night.

And then of course, if they have any symptoms at all—cold, flu, COVID, whatever it might be, to stop contact lens wear. And then, another question that has been coming up a lot is, if contact lenses fittings for new patients can be done and yes, they can be done, as well. And for trainings, this could be done with videos. We have plastic barriers in our office now and just making sure that everyone is safe. But new patients can get into contact lenses, even during this pandemic.

Bailey: That is a really good message to make sure everybody hears because you are right, there was a lot of disinformation flying around out there and that is really key.

So, if we switch our focus briefly just to contact lenses and ocular surface disease, what are your top couple of tips for doctors trying to help patients maintain their contact lens wearing, I don’t want to say schedules, but remaining in contact lenses as much as they can, while trying to maximize whatever they are doing for the ocular surface.

Compliance

Dr. Barnett: So, 1, is the same tip—being compliant with contact lens wear.

Bailey: Always a problem.

Dr. Barnett: Number 2 is really going over the eyelid hygiene. You know, I talked to my patients about diet and taking breaks on the computer. I mean, during this pandemic, as we are talking about it, we are all on digital devices so much. Even children with distance learning schools—much more than before. So, I worry about their meibomian glands and myopia progression, and that is a whole other conversation. Things I am worried about, but also getting back to the ocular surface disease, really going over solutions, going over all products that are being used, and establishing some routine so that patients are compliant.

So, my patients who follow our plan do very, very well. Patients in general, just people in general, are not so compliant. So, if we can get into a routine and then, say, if they have an exacerbation of their dry eye, Sjögrens syndrome or graft versus host disease (GVHD), or whatever it might be, that they contact us so we can do a telehealth visit even, and go over symptoms and treatment and management options for them, even if they don’t feel comfortable coming into the practice right now.

Bailey: Those are all really good pieces of advice. Thank you so much for taking the time to talk with me today.

Dr. Barnett: Thank you, Gretchyn. It is always great to talk to you.

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