Hello, and thanks for joining me this month for the September issue of Optometric Management. In our dry eye column, we talked about contact lens dropout and the importance of looking at the lids. Now, I'd like to go over a 3-step plan for you when you have a patient who's suggesting that they want to drop out of their contact lenses. Remember, contact lens dropout isn't an event. It isn't 1 day when they say, "Forget it. I'm done with these lenses." It's a slow progression where the patient's becoming more and more frustrated about the comfort of their lenses and they slowly reduce their wear time until their wear time is so little that it's not really worth it to them to wear their contact lenses. Here's my 3-prong approach.
- Ask your patients how many hours they can comfortably wear their contact lenses and find out if that time has changed this year vs last year. Were they wearing them 14 hours a day last year, but only 8 hours a day this year? Is 8 hours a day getting them through their work day or do they really need 10 hours of comfortable wear to make it worth it to put the contacts in before they go to the office? Also find out what symptom makes them want to remove their contact lenses. Is it stinging and burning? Do they feel dry, gritty, or like there's a foreign body underneath their lenses?
- Look at the lids and the ocular surface. Now remember, we can find Demodex blepharitis by having our patient look down. We all know that collarettes on the lashes is a pathognomonic sign for Demodex blepharitis, and when we have Demodex blepharitis, we know there's going to be an increase in inflammation in the tear film as well as a decrease in meibomian gland function. We've learned that by treating Demodex blepharitis, we can improve the number of meibomian glands secreting liquid secretions. And so when we have more meibomian glands giving us meibum into the tear film, it can make contact lens wear more comfortable.
- Track how well your patients are doing once you put them on a treatment for either the inflammation or the meibomian gland dysfunction. Once you've ruled in the root cause of your patient's discomfort, you can track their progress as they increase their wear time instead of dropping out of their contact lenses.
To summarize as we wrap up the article for this month, remember to ask your patients about how many hours of comfortable contact lens wear they're feeling this year. Look at the lids, the tear film, and the cornea to find the root cause of their discomfort. And finally, track your patient's progress to see if their comfortable wear time can increase. I hope you enjoy this month's article!
