When seeking to understand a patient’s contact lens wearing experience, a practitioner may typically ask the patient questions around their current wearing times, how comfortable their contact lenses feel, and their visual quality. But should we be seeking to ask and learn more?
The recent Tear Film and Ocular Surface (TFOS) Lifestyle Workshop1 examined the extent to which patient lifestyles and environments can have an impact on their ocular health and subsequent contact lens use.
As illustrated in the workshop results, there are countless instances where the lens-wearing experience can be impacted in ways that we might not have previously considered, from routine behaviours to usage of over-the-counter products, to daily workspaces.
When faced with a patient reporting a change to or decline in contact lens comfort, it’s always worth probing further to understand whether their symptoms are linked to certain environments, or if there have been any changes to the patient’s lifestyle or everyday activities which may be impacting their contact lens wearing experience.
To consider how a full understanding of patients’ lifestyle and visual needs may influence how practitioners modify their communication and management, let us take a deep dive into three unique groups of patients, each with their own specific yet overlapping needs to consider.
The New Contact Lens Wearer
Before fitting a patient new to contact lens wear, it’s important to take stock of all the different work and lifestyle factors that may impact their wearing experience from the outset. For example, an individual working outdoors, perhaps on a building site, will have increased exposure to UV radiation, airborne pollen, pollutants and particulate matter; all of which cause some measure of ocular irritation.2, 3
Younger patients may be more prone to taking risks and therefore have poorer compliance, with irregular sleeping patterns and not taking their contact lens out when showering, sleeping or napping, which can heighten the risk of a corneal infection or microbial keratitis.4
This sort of information can be crucial to the practitioner when providing any initial advice to the patient on how to best maximise and extend their contact lens use for convenience, comfort and quality of vision.
Every patient is different and it requires the practitioner to address, from the outset, the relevant lifestyle and environment factors, married with the patient’s own expectations of what their lens-wearing experience should look like. Lenses usually feel comfortable to the patient upon first application in the morning, but the key is to maintain that comfort through the day and throughout challenging situations; eg outdoor working, heavy screen use, air-conditioned rooms.
If you know a patient is going to be wearing their lenses in a challenging environment, be sure to select a contact lens that you are confident will maintain moisture and comfort. Once a patient has been successfully fitted with contact lenses, it’s important for practitioners to communicate the importance of regular follow-ups to ensure that the contact lenses continually meet any changing visual, ocular, or lifestyle needs.
It’s important to maintain that continuous dialogue to see how things are evolving and ensure that we as practitioners are re-evaluating at regular pinch-points. Keeping our door open and adding our professional value to that contact lens experience is what keeps patients satisfied with their contact lenses in the long term.
The Existing Contact Lens Wearer
When that lens-wearer returns, we need to assess whether their current lenses are still meeting their expectations and serving their individual needs. What has their day-to-day wearing experience been like? How has their lifestyle changed since first fitting? Are any newer lifestyle factors having a significant impact?
A full understanding allows the opportunity not only to assess whether the patient’s contact lenses continue to meet all their needs, but also to counsel on the significance of any behaviour and lifestyle shifts.
When it comes to lifestyle shifts, practitioners are encouraged to think outside the box. Changes can range from a new occupation or environment, a medication that affects ocular health,5 or they could be as simple as a small adjustment in makeup and cosmetics.
For example, heavy mascara and false lashes can influence lens wear, with 46% of women reporting itching as the most common side effect of eyelash extensions,6 and a periocular Botox injection can have the effect of reducing tear production and increasing evaporation7 – something most patients won’t be aware of. A lot of readily available anti-wrinkle and anti-ageing creams contain ingredients that are potentially toxic to the ocular surface.8
It’s not second nature to ask patients about their make-up or skincare regime, so consider rephrasing: could any changes to their contact lens wearing experience can be linked to any recent changes in cosmetics? The key here is to begin with the patient’s discomfort and then consider the driver of that discomfort. If it’s not immediately obvious, think a bit deeper and ask when it started and when they noticed things begin to change.
Shifts in diet and nutrition can also be a factor. We know high alcohol consumption can affect tear film function,9 and smoking, whether directly or passive, can cause an increase in tear film evaporation and damage to the ocular surface.10 Be ready to communicate that information sensitively and effectively. Help the patient understand the changes that they could implement, whether it be diet, screen time or lubricants.
Let them know that although many modern contact lenses are designed to withstand the challenges of modern lifestyles, their overall experience is still beholden to some other factors that influence how the lens performs.
The takeaway is that there are some things we can change and some things we can’t. Diet and cosmetics might be changeable. Screen time is more difficult to change because it is so central to the modern lifestyle, but even so practitioners can provide practical advice, such as taking regular breaks, ensuring their working environment is well ventilated and that they drink plenty of water.
This counsel can be done in tandem with a patient-friendly explanation on why you’re recommending an alternative contact lens, describing the material and its beneficial attributes. For example, an explanation of the wetting technology, and why you feel it will perform better or specifically benefit them.
This way, the patient is cognisant of the holistic, collaborative approach between themselves and their practitioner, together assessing lifestyle and contact lens simultaneously for the most successful outcome.
The Presbyopic Contact Lens Wearer
When things begin to change for the presbyopic patient, it’s more crucial than ever to expand that holistic lifestyle overview, taking into consideration all manner of general health concerns and their potential impact on eye health. For example, the patient might have developed a systemic health condition which they don’t immediately link to eye health, like rheumatoid arthritis which can cause less tear production and lead to dry eye.11
The quality and quantity of tears does change as we get older, whether we have general health changes or not, and this is only exacerbated by our digital lifestyles, where looking at a screen can reduce the amount of blinks per minute.12
The patient may be naturally looking to alleviate this discomfort with lubricating eye drops, but not all drops are the same. Some target different layers of the tear film; therefore, the best course of action is a comprehensive tear film assessment, along with direct advice in terms of management strategy to help pinpoint the most effective eye drop for the patient.
Many over-the-counter eye drops also contain preservatives,13 so we would naturally always recommend opting for an unpreserved lubricant,14 but many patients might not pay due attention and would require guidance to discern.
To support patients as they become presbyopic and as their tear film evolves, practitioners must ensure to carry out a full tear film assessment, examining lids and lashes, tear prism height, fluorescein assessment, a lid eversion to allow assessment of the palpebral conjunctiva; and specular reflection to assess the quality of the tears, both with the contact lens on eye and without.
As patients become presbyopic, their visual needs change too. Practitioners need to be able to communicate the features and benefits of multifocal contact lenses in a manner which allows the patient to best understand how they will work for them in their everyday life.
When fitting a patient with multifocal contact lenses for the first time, practitioners should ensure they’re using the right fit guide for the multifocal lens they’re using, and that the patient’s prescription is accurate.
Consider the contact lens material and how the material properties might interact with that patient’s change in tear film. Having knowledge of current soft contact lens information, as well as the latest clinical contact lens and ocular surface research to assist them in planning contact lens use around the needs of the patient.
As ocular surface research, patient lifestyles and lens technology all constantly evolve, and it is up to us practitioners to assess what these new developments are telling us and how we can integrate these learnings into our current care.
Think Outside the Box
Consider patient behaviour and lifestyle choice, and how modifiable behaviours can improve contact lens success. Consider how research is constantly evolving and think about how manufacturers are always researching and developing new contact lens materials in line with evolving patient lifestyle needs.
This trifecta of knowledge on research, lens properties and patient lifestyle has its biggest impact through close communication and collaboration with the patient, ensuring they understand clearly not just the options available to them, but also the knowledge that they are fully involved in the decisions made about their care.
- Marie-Therese Hall is professional affairs consultant from the vision team at Johnson & Johnson.
Disclosures
Acuvue Contact Lenses are indicated for vision correction. For detailed product description and safety information, please consult the Instructions for Use or on the Johnson & Johnson website www.e-IFU.com.
References
- TFOS Lifestyle Report Executive Summary: A Lifestyle Epidemic ¬ Ocular Surface Disease. Available at: https://www.sciencedirect.com/science/article/pii/S1542012423001179 Last accessed: Apr 2024
- Prevalence and risk factors of pterygium: a systematic review and meta-analysis. Available at: https://pubmed.ncbi.nlm.nih.gov/29551597 Last accessed: Apr 2024
- Epidemiology of allergic conjunctivitis: clinical appearance and treatment patterns in a population-based study. Availableat: https://pubmed.ncbi.nlm.nih.gov/26258920/ Last accessed: Apr 2024
- Personal hygiene risk factors for contact lens-related microbial keratitis. Available at: https://bmjophth.bmj.com/content/5/1/e000476.full Last accessed: Apr 2024
- The ocular adverse effects of oral drugs. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8377292/ Last accessed: Apr 2024
- Eyelash extension use among female students in a Tertiary Institution in Nigeria: A study of kaduna polytechnic, Kaduna. Available at: https://pubmed.ncbi.nlm.nih.gov/29379000/ Last accessed: Apr 2024
- A Review of Periocular Botulinum Neurotoxin on the Tear Film Homeostasis and the Ocular Surface Change. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6409927/ Last accessed: Apr 2024
- TFOS Lifestyle: Impact of cosmetics on the ocular surface. Available at: https://www.sciencedirect.com/science/article/pii/S1542012423000319 Last accessed: Apr 2024
- Oral alcohol administration disturbs tear film and ocular surface. Available at: https://pubmed.ncbi.nlm.nih.gov/22330961/ Last accessed: Apr 2024
- The effect of smoking on the ocular surface and the precorneal tear film. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395277/ Last accessed: Apr 2024
- Ocular Involvement in Rheumatoid Arthritis. Available at: https://www.aao.org/eyenet/article/ocular-involvement-inrheumatoid-arthritis Last accessed: Apr 2024
- The Relationship Between Dry Eye Disease and Digital Screen Use. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC8439964/ Last accessed: Apr 2024
- Preservatives from the eye drops and the ocular surface. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5729814/ Last accessed: Apr 2024
- TFOS DEWS II Management and Therapy Report. 14 Available at: https://www.sciencedirect.com/science/article/pii/S1542012417301143?via%3Dihub Last accessed: Apr 2024
