Print to PDF
  • About Us
  • Privacy
  • Contact Us

Contact Lens Update

Clinical Insights Based in Current Research

Search Our Site

  • Home
  • Browse Past Issues
  • Resource Library
  • Back to Basics
  • Useful Links
  • About Us
  • Contact Us

Clinical Insight

Contact lens discomfort solved through appropriate choice of lenses

April 28th, 2014

Download PDF

Anson ChanDr. Anson Chan is a clinical adjunct lecturer at the University of Waterloo's School of Optometry in addition to working in practice since 2002. He is an associate with TLC Waterloo as an on-call optometrist. 

A 43 year-old female who wore a Group IV material lens (Biomedics 55, Cooper Vision 8.6/14.2/+1.00 OD and +2.00 OS) for single vision was interested in exploring multifocal or monovision options. Her spectacle refraction results were +1.25 DS OD and +2.00 DS OS with +1.00 add. She was right-eye dominant. Slitlamp examination revealed no anomalies except low grade neovascularization of the cornea limbus region (<1 mm.) She typically bought whatever contact lens multipurpose solution was on sale, and was at that point using Bausch&Lomb Renu.

The initial attempt was to fit her with a Proclear EP (Group II) lens. The initial fitting parameters were 8.7/14.4/+1.25 OD and +2.00 OS. She tried the lenses for one week and reported unsatisfactory vision as well as the sensation of a “film” on her eyes near the middle of the work day.

After a discussion regarding expectations and a trial frame refraction, we decided to proceed with a monovision fitting: CIBA Vision AirOptix (8.6/14.2/+1.25 OD and 8.6/14.2/+3.00 OS.) The vision and fit was satisfactory after 20 minutes of lens wear, with binocular VA of 6/6 and 0.4 M distance and near, respectively.

At the one week checkup, she reported a dryness sensation that she had not experienced with her previous lenses. Slitlamp examination with fluorescein revealed no signs of corneal staining. The superior and inferior tarsal conjunctivae findings were unchanged from the previous fit. The obvious differential diagnoses would be contact lens related dry eyes, solution sensitivity or lens material sensitivity.

Solution sensitivity is difficult to detect after two hours of contact lens wear, so I had the patient return in the morning after she had the lenses in for an hour. Annular-pattern fluorescein staining of the cornea was detected, therefore the contact lens solution was at least one contributing factor to her discomfort. I started her on ClearCare (CIBA Vision) hydrogen peroxide based disinfecting system, and asked her to return in one week.

At the follow-up appointment, comfort was much better but she reported a greater foreign body sensation with the new lenses than with her old lenses. AirOptix has an older silicone hydrogel design that is stiffer (i.e. higher modulus) than traditional hydrogels. I was reluctant to give up the higher oxygen permeability of a silicone hydrogel material, so instead of switching her back to the “tried and true” Biomedics 55, I fitted her with the Biofinity lenses (8.6/14.0) in the same power permutation. Biofinity (CooperVision) is also a silicone hydrogel lens, but has a low modulus of elasticity (i.e. softer). At the one week follow-up visit, the patient reported good comfort and vision with the new combination of ClearCare solution and Biofinity lenses in a monovision system.

Discussion
Contact lens discomfort is all too common in optometric practice, and there is a tendency for both the practitioner and the patient to ignore the early signs of problems. Often, a patient reports dryness sensation (e.g. when using a computer at work) but says that it is “not too bad.” At this point the practitioner may be convinced by that statement, perhaps suggesting that use of artificial tears may help. In my experience, however, the next time you see the patient he or she may not be wearing contact lenses anymore because of the dryness problem.

If dryness is a concern, there is a problem with the lens care system, lens material/fit and the ocular surface. Instead of adding artificial tears into this mix to try to solve the problem, it is more logical to apply a differential diagnostic perspective and determine which part of the system is the problem. It may be more laborious, but try changing one variable at a time to see if there is any improvement. Explain to the patient what you are doing, and why you are doing it. In an age where patients can order contact lenses on line for a lower cost, patients come to their optometrists for contact lens fitting because they believe we have the expertise to make their contact lens experience a rewarding one. Do not disappoint them.

Related Articles

  • April 28, 2014

    Contact lens discomfort solved through appropriate choice of lenses

  • April 28, 2014

    Summary: 2013 Report of the Workshop on Contact Lens Discomfort

  • April 28, 2014

    Correlates of Subjective and Objective Measures of Ocular Discomfort

  • April 24, 2014

    Overview: 2013 report from the Tear Film & Ocular Surface Society’s Workshop on Contact Lens Discomfort

Issues

  • In-Office Procedures for Dry Eye
  • Multifocal Contact Lenses
  • Artificial Tears: An Update
  • Myopia: New Evidence and Best Practices
  • Neuropathic Pain
  • Specialty Rigid Lenses
  • Contact lens compliance
  • Pandemic update
  • Digital Devices and Dry Eye: A Growing Issue
  • The long and short of axial length
  • Using BCLA CLEAR with your patients
  • Helping your patients through allergy season
  • Getting the measure of meibomian glands
  • 2020: An extraordinary year
  • Scleral lens update
  • A dose of myopia
  • New news since TFOS DEWS II
  • COVID-19 Special Edition
  • Material considerations
  • Putting dry eye theory into practice
  • Getting started with Ortho-K
  • Infiltrates – an update
  • Staining
  • Myopia matters: Summarising the IMI reports
  • Lids and contact lenses
  • Myths
  • Revisiting patient compliance
  • Contact Lenses & Kids
  • Interprofessional Collaboration
  • Digital eye strain
  • New Dry Eye Technology
  • Update on Presbyopia
  • Taking stock of dry eye disease: DEWS II
  • Scleral Lenses
  • Pain and Sensation
  • Lab measurements in clinical practice
  • Control of pediatric myopia
  • Nutrition
  • Rethinking contact lens deposits
  • Extended wear
  • Daily Disposables
  • Eyelash Mites (Demodex)
  • Outsmarting bacteria with new technology
  • Youth and contact lenses
  • Sports Vision
  • Ocular effects of UV radiation from the sun
  • Eyelid Conditions
  • Makeup: Impact on ocular health
  • Myopia Control – Update 2014
  • The Growing Prevalence of Myopia
  • Cosmetic contact lenses
  • Contact lens discomfort – The essentials
  • Technology and contact lens research
  • It's A Question of Comfort
  • Contact lens materials
  • Let's talk about SICS
  • Conjunctival Controversies
  • Kids & Contact Lenses
  • One-day silicone hydrogel lenses
  • Solutions
  • Spotlight on Scleral lenses
  • Drug delivery via contact lenses
  • Ocular allergies
  • Reducing lens case contamination
  • Dry eye and meibomium gland dysfunction
  • Myopia Control
  • Presbyopia
  • Compliance and non-compliance
  • Lens care
  • Celebrating 50 years of contact lenses

Looking for another article?

Alcon coopervision Johnson&Johnson Vision Care

Newsletter Sign-Up

Sign-up for and start receiving our newsletter.

Site Map

  • Home
  • Browse Past Issues
    • Editorial
    • Feature Article
    • Clinical Insight
    • Conference Highlights
  • Resource Library
  • Back to Basics
  • Useful Links
  • About Us
  • Contact Us
© 2023 Contact Lens Update