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October 6, 2017
Practice Pearl
Paul Karpecki

Optometrist Paul Karpecki

Provides you with invaluable clinical information and management strategies for a host of ocular conditions—from dry eye and corneal infection to retinal artery occlusion and neuro-ophthalmic disease.

Contact Lens Dropout and Dry Eye

During the last 20 years, we haven't done enough to reduce contact lens dropout rates. While new contact lens materials, modalities and solutions have been helpful, we also need to improve our patients' ocular surface health.

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Today, the dropout rate for contact lenses wearers ranges from 16% to 18%.1 These numbers have remained largely unchanged during the previous two decades. That seems nearly impossible given the incredible innovations we’ve seen in contact lens technology over this period, including the advent of silicone hydrogel materials and preservative-free solutions. Yet, each year, more than $300,000,000 of potential revenue drops out of the industry. Almost makes you wonder if dropout rates would have exploded exponentially without the aforementioned innovations!

Several studies on meibomian gland function in contact lens wearers have indicated that lens wear dropout is associated with adverse changes in gland morphology, lid margin condition and meibum quality.1-3 Thus, it is imperative to look for these changes early, and treat them promptly before functional deficiencies occur.

It wasn’t so long ago that we were instructed to use NaFl dye to help diagnose dry eye disease.4 NaFl corneal staining is a late-stage indicator of DED, and would be the equivalent of waiting for peripheral field loss to manifest before initiating glaucoma therapy. Earlier diagnosis is key and can be confirmed by end-of-day contact lens discomfort, visual acuity fluctuation, osmolarity testing, meibomian gland expression, non-invasive tear film break-up time and meibography.

Once early changes are noted, you should focus on the treatment of all associated signs and symptoms, including inflammation, obstructed meibomian glands, and poor biofilm and tear film quality. In an early or mild cases of MGD in contact lens wearers, appropriate treatment may in-clude topical lifitegrast, an omega fatty acid supplement, hydrating compresses and lid scrubs. In more moderate cases, consider the addition of mechanical treatments, like thermal pulsation and Blephex. The combination of novel contact lens technologies and early MGD management may be the solution to lowering rates of contact lens dropout.

1. Arita R, Fukuoka S, Morishige N. Meibomian Gland Dysfunction and Contact Lens Discomfort. Eye Contact Lens. 2017 Jan;43(1):17-22.

2. Villani E, Ceresara G, Beretta S. In vivo confocal microscopy of meibomian glands in contact lens wearers. Invest Ophthalmol Vis Sci. 2011 Jul 13;52(8):5215-9.

3. Arita R1, Itoh K, Inoue K, Ophthalmology. Contact lens wear is associated with decrease of meibomian glands. 2009 Mar;116(3):379-84.
4. Wolffsohn JS, Arita R, Chalmers R, et al. Ocul Surf. 2017 Jul;15(3):539-574. TFOS DEWS II Diagnostic Methodology report.

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Newtown Square, PA 19073
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