Contact Lens Spectrum Supplements

Special Edition 2017

Contact Lens Spectrum

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c l s p e c t r u m . c o m C O N T A C T L E N S S P E C T R U M S P E C I A L E D I T I O N 2 0 1 7 13 DR Y EYE DX AND TX A M B E R GAU M E G I A N N O N I, O D Dr. Gaume Giannoni is a clinical profes- sor at the University of Houston College of Optometry and is the director of the Dry Eye Center at the University Eye Institute. She also sees patients in a private practice set- ting. She is a consultant or advisor to Alcon, Allergan, Shire, and Johnson & Johnson Vision Care. tion, and blepharitis, no matter how mild. Ensure that patients are using tear supplements correctly, prefer- ably those without preservatives or red-eye reducers, and educate them on environmental contributors, in- cluding air vents, smoking, and pro- longed use of digital devices. Patients who have autoimmune disease may have an inflammatory component driving their DED, so good control of their overall dis- ease state combined with topical cyclosporine or lifitegrast may help reduce local inflammation and im- prove ocular surface health. Consider Lens Material or Solution Changes If you've addressed the items above and your soft lens patient re- mains symptomatic, consider more frequent replacement to reduce lens deposits and eliminate irritat- ing preservatives. Although silicone hydrogel lenses are the material of choice for many practitioners, dry eye patients may actually have more difficulty with protein buildup and poor wetting with this material; a hydrogel lens could be a better choice in such cases. If soft lenses lenses are filled with nonpreserved, sterile solution that bathes the eye during wear. Severe dry eye patients may have to remove, clean, and re- fill their lenses at least once during the day due to posterior lens fog- ging and/or poor surface wetting, but most patients will agree that it's a small price to pay for significantly improved comfort and eye health. Scleral lenses are typically worn as a daily wear modality; however, they've also been used successfully as extended wear lenses in severe, non-healing cases. However, the risk of microbial keratitis is signifi- cantly higher (30%) (Rosenthal et al, 2000; Schornack et al, 2008). The Future Soft lenses for ophthalmic drug delivery could dramatically change the way we treat our dry eye patients in the future. Drug delivery via a contact lens would increase contact time of the medication with the eye and improve drug bioavailability by as much as 10 to 50 fold (Chauhan and Radke, 2001; Li and Chauhan, 2006). There is much to do to make this modality fully viable, but elimi- nating a daily drop from a complex, multi-drug regimen could signifi- cantly impact quality of life. CLS For references, please visit www. clspectrum.com/references and click on document #SE2017. are no longer tolerable, GP lenses are a great choice for many dry eye patients. Although these same is- sues can occur with GPs, they don't absorb moisture from the eye to stay hydrated; therefore, more tears are available for the ocular surface. Give Orthokeratology a Try Although it may seem counterin- tuitive to put a dry eye sufferer in an overnight lens, orthokeratology (OK) can be a great option, because daytime lens wear is eliminated. Studies have demonstrated im- proved comfort and dryness scores with OK when compared with sili- cone hydrogel wear, with one study also demonstrating improved gob- let cell density (GarcĂ­a-Porta et al, 2016; Carracedo et al, 2016). I have had excellent personal success with my OK lenses, which were initially fit 8 years ago to help relieve daytime lens discomfort. When More Is Required For patients who have severe exposure damage or filamentary keratitis, a well-fitting scleral or mini-scleral lens can dramatically improve the ocular surface. These CONTACT LENSES FOR OCULAR SURFACE DISEASE D ry eye disease (DED) affects millions of people world- wide (Lemp, 2007). It is such a common clinical prob- lem that approximately one out of every three patients who seeks care from an ophthalmologist reports symp- toms (Lemp, 2008). With contact lens dropout rates remaining steady, we obviously want to do what we can to keep all of our patients in their lenses. How can we facilitate comfortable wear, and which lens choices are best for significant DED? Improve Tear Film Stability and Reduce Inflammation Treat seasonal allergy, lid wiper epitheliopathy, meibomian gland dysfunc-

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