Wearing contact lenses during standard working hours negatively affects ocular health
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Peer-reviewed literature demonstrates that wearing contact lenses can lead to adverse ocular complications, including corneal microinjuries, hypoxia, tear film disruption, and dry eye symptoms.
Allergy is the fifth leading chronic condition in industrialized countries among all ages, and the third most common chronic disease among children under 18 years old. Many of allergic patients also have problems with vision and want to improve their quality of life by wearing contact lenses. They are most frequently young and active individuals, for whom contact lenses provide greater convenience and more satisfying vision correction than spectacles. However, application of high quality and immunologically neutral products do not protect from allergic side reactions. Nowadays, eye-related allergy and contact lens wear concern larger and larger populations worldwide. The purpose of this review is to summarize the studies on ocular complications associated with wearing contact lenses. The article presents indications for allergic patients especially on the care system and wear schedule.
The purpose of this review is to summarize the studies on ocular complications associated with wearing contact lenses. The article presents indications for allergic patients especially on the care system and wear schedule. Keywords: allergic patients, lenses, ocular allergy status released display-pdf yes is-olf no is-manuscript no is-preprint no is-journal-matter no is-scanned no is-retracted no Received 2014 Jul 3; Revised 2014 Sep 20; Accepted 2014 Nov 27; Issue date 2015 Jun. Nowadays we are witnesses of significant development of contactology and an increase in the number of patients wearing contact lenses.
Approximately 15–20% of the world population is affected by some form of allergy, and ocular symptoms are present in 40–60% of allergic patients [ 1 , 2 ]. Therefore, eye-related allergy and contact lens wear concern larger and larger populations worldwide. The problem aggravates during spring, which is the time of increased exposure to allergens and hence intensified allergic reactions. The common problem is the use of contacts by atopic individuals. It has been found that the risk of experiencing various external eye symptoms during the use of contact lenses increased 5-fold in patients with a history of an atopic condition [ 3 ].
Silicone hydrogel contact lenses exhibit better oxygen permeability but are more rigid. The other category is rigid gas permeable contact lenses fabricated from inflexible “organic glass” ( polymethyl methacrylate – PMMA). There are two types of schedules for wearing contact lenses. Daily wear contact lenses can be worn up to 14 h a day and need to be removed prior to sleeping. Some brands of extended wear contact lenses can be worn continuously for up to seven days while others can be worn for up to 30 days and nights without removal.
Despite its undeniable benefits, a contact lens is a foreign material residing on the cornea and, as such, it may lead to numerous adverse events which decrease lens-wearing comfort. As an irritant, a contact lens may cause damage to the structures of the eyeball. The most common problems are corneal hypoxia, hyperemia, microinjuries, depressed corneal metabolism rate, alterations in the level of the mitotic index and disruption in the integrity of the corneal epithelium [ 4 ]. Contact lenses also have a negative effect on the tear film, the basic mechanism for eye surface protection.
In the case of an adequate volume and composition of the tear film, contact lenses-related effects on the anterior eye are negligible. However, patients with lacrimal gland dysfunction may develop a dry eye syndrome and severe discomfort, which have been observed in approximately 80% of those wearing rigid contact lenses and 20–30% of soft contact lenses wearers [ 5 ]. The discomfort becomes even worse in allergy sufferers who take antihistamine preparations [ 6 ]. First and second-generation antihistamines block histamine receptors and thus also decrease the secretion of mucous and aqueous layers of the tear film.
According to epidemiological studies, the disease occurs in 5–15% and 2–5% of soft and rigid contact lens users, respectively [ 10 ]. Age and gender do not seem to affect the likelihood of developing GPC while a history of atopic conditions may be of importance. Figure 2 Giant papillary conjunctivitis (GPC) Giant papillary conjunctivitis represents an immune reaction to mechanical injury caused by the surface of contact lenses. Irritation of upper tarsal conjunctiva brings about changes in conjunctival histology resulting in tissue remodeling and formation of characteristic giant papillae.
Because it is absorbed by the soft contact lenses it is recommended to avoid use of drops containing BAK in patients wearing contact lenses. At present, a preferred soft contact lens type is silicone hydrogel contact lenses. The material's physical properties, i.e. high oxygen permeability and low water content, ensure high comfort and safety of use. Hence, the most common adverse effect, i.e. corneal hypoxia, has been eliminated.
An alarming sign that requires specialist examination is the so called red eye ( Figure 4 ). The patient may complain of discomfort, pain, blurred vision and lacrimation. Contact lenses should be removed and kept available in case bacterial culture would be necessary. The patient should be referred to an ophthalmologist on an emergency basis. Figure 4 Red eye Contact lens wearers who develop allergic reactions are frequently forced to discontinue lens use. Also, older forms of anti-allergic eye drops must be instilled several times during the day which leads to cessation of contact lens wear. Eye drop preservatives (e.g.
Table 1 Practical guidelines to avoid contact lens wear problems in allergic patients The best choice of lenses for allergic patients are daily disposables The extended wear contact lenses are strictly contraindicated The regular lubrication of the ocular surface with preservative free eye drops is very important (min. 3 times a day) Allergen avoidance Topical newer-generation antihistamines e.g.
<h4>Background</h4>Contact lens discomfort is a symptom-based clinical diagnosis that affects 13% to 75% of contact lens wearers. The Tear Film and Ocular Surface Society defines contact lens discomfort as "a condition characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibility between the lens and ocular environment, which can lead to decreased wearing time and discontinuation from lens wear." Signs of the condition include conjunctival hyperemia, corneal and conjunctival staining, altered blinking patterns, lid wiper epitheliopathy, and meibomian gland dysfunction. Eye care specialists often treat contact lens discomfort with lubricating drops, including saline, although there is no clear evidence showing this treatment is effective and safe.<h4>Objectives</h4>To evaluate the efficacy and safety of lubricating drops for ocular discomfort associated with contact lens wear in adults.<h4>Search methods</h4>We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE, Embase.com, two other databases, and two trials registries to May 2024, without date or language restrictions.<h4>Selection criteria</h4>We included parallel-group randomized controlled trials (RCTs) that evaluated lubricating drops, including saline, versus no treatment, or that evaluated lubricating drops versus saline, in adult contact lens wearers. We included studies regardless of publication status, language, or year of publication.<h4>Data collection and analysis</h4>We applied standard Cochrane methodology. The critical outcome was contact lens discomfort. Important outcomes were corneal fluorescein staining and conjunctival redness. Adverse outcomes were incident microbial keratitis, inflammatory corneal infiltrates, and participant discontinuation. We assessed risk of bias for outcomes reported in the summary of findings table using the Cochrane risk of bias t
Study characteristics Methods Study design: parallel‐group RCT Study year: NR Unit of randomization: person Masking of participants: yes Masking of outcome assessor(s): yes Masking of other trial personnel: no; ophthalmic assistants over‐labeled then dispensed study drops to patients Was CL discomfort measured with an instrument: no, only 1 out of 6 questions a answered on a Likert scale Duration of intervention: 1 month Duration of follow‐up: 28 days b How did the study authors handle missing data?: NR Did the study authors describe power/sample size consideration?: NR a Symptom questionnaire: This drop makes my contact lenses more comfortable upon insertion This drop makes my contact lenses more comfortable all day long This drop makes my contact lenses feel more comfortable at the end of the day This drop makes my contact lenses less dry all day long My eyes feel less dry at the end of the day when I use this drop I can wear my contact lenses longer when I use this drop b Symptom questionnaires and report of drop use frequency completed on days 3, 7, 10, 14, 17, 21, 24, 28; bulbar conjunctival redness at baseline, 2 weeks, and 4 weeks Participants Inclusion criteria Current use of reusable disposable soft contact lenses (≥ 8 hours per day, five days per week) Ocular dryness symptoms resulting in discomfort when wearing lenses Comfortable lens wearing time at least 2 hours less than total wearing time Need to use rewetting drops at least some of the time during a typical day of contact lens wear Exclusion criteria Ocular disease or any clinically significant ocular signs that would contraindicate contact lens wear Baseline characteristics Saline Age, mean (SD) or median (IQR): 26.3 (6.4) Female (%): 70 Total no.
Study characteristics Methods Study design: parallel‐group RCT Study year: November 2014 to July 2015 Unit of randomization: person Masking of participants: yes Masking of outcome assessor(s): yes Masking of other trial personnel: cannot tell Was CL discomfort measured with an instrument: yes, VAS(0‐10); "the participant rated both eyes together by providing one single rating." Duration of intervention: 14 days Duration of follow‐up: 14 days How did the study authors handle missing data?: complete case analysis; "analysis of comfort was done with "Intention to treat participants with non‐missing observations." Did the study authors describe power/sample size consideration?: no Participants Inclusion criteria Informed consent Stable, tear lipid layer thickness ≤ 75 nm without contact lenses Successful use of biweekly or monthly replacement soft contact lenses in both eyes for ≥ 5
drops, frequency): "one drop directly before CL use, two drops while wearing the CLs (spaced by at least two hours), and one drop directly after CL use; no other time of day restrictions were placed on drop usage." Intervention duration: 2 weeks CL materials: NR CL replacement frequency (daily, weekly, biweekly, monthly, other): daily disposable Outcomes Primary study outcome Difference in ocular surface damage as measured by the Brien Holden Vision Institute (BHVI) Grading Scale Secondary study outcome Dry eye disease, as measured by the CLDEQ‐4 Time points: baseline and 2 weeks Notes Sponsorship source: industry; "Alcon Research, LLC supported this investigator‐initiated study" Country: USA Setting: hospital and clinic based (university hospital and private practice) Contact author: Andrew Pucker Institution: University of Alabama at Birmingham, Birmingham, AL, USA Clinical trial registry no.: NCT03848221 Open in a new tab BID: twice daily; BUT: break‐up time; CL: contact lens; CLDEQ: Contact Lens Dry Eye Questionnaire; IQR: interquartile range; NA: not applicable; NaCl: sodium chloride; NR: not reported; PVP: polyvinylpyrrolidone; RCT: randomized controlled trial; SD: standard deviation; SiHy: silicone hydrogel; SPEED: Standardized Patient Evaluation of Eye Dryness questionnaire; VAS: visual analog scale.
Liability for extended-wear contact lenses.
Because of the risk of serious complication that accompanies the extended wear of contact lenses, clinical management should emphasize adequate communication with the patient and a systematic program of examination and follow-up. Management should be in compliance with informed consent requirements, which obligate practitioners to document instructions, findings, warnings, and recall examinations. The most likely legal claim is one of negligence, and the most common causes of liability are inappropriate patient selection, improper wearing schedules, improper management of contact lens-related complications (especially corneal abrasions), and inadequate monitoring of ocular health. In determining the liability of optometrists, a medical standard of care may be applied.
Published in Optometry clinics : the official publication of the Prentice Society (1991)
Tear plasmin activity with contact lens wear.
Plasmin, a proteolytic enzyme, has been detected in the tears of patients experiencing anterior ocular disease, and during contact lens wear. Using a radial caseinolysis procedure, we examined tear plasmin levels in 66 patients who were wearing soft and rigid lenses for daily and extended wear. Compared to non-contact lens wearers, patients wearing soft and rigid lenses for extended wear were significantly more likely to exhibit tear plasmin activity. Eight hours of open-eye thick HEMA lens wear did not induce tear plasmin activity in a group of 10 subjects. However, significant increases in tear plasmin activity were recorded after short-term (1 hour) eye closure with and without lens wear, and following overnight (8 hours) eye closure without lens wear. Overnight eye closure also resulted in significantly increased numbers of epithelial cells and leucocytes in the tear fluid. Our results suggest that increased tear plasmin activity during extended contact lens wear may be attributable to the effects of eye closure rather than hypoxia or the presence of the contact lens per se.
Published in Current eye research (1992)
Disposable vs. non-disposable contact lenses-the relative risk of ocular infection.
The wearing of contact lenses is not without some risk. When prescribing contact lenses, several decisions must be made regarding the type of lens; for example, daily wear vs. extended wear and disposable or frequent replacement lenses vs. non-disposable or traditional (reusable) lenses. Often the decisions are based on issues of comfort, cost and/or the ability to fit the patient with one type or another. Consideration of a possible increase in the risk of ocular infection from contact lens wear is not necessarily a variable in the selection process, but maybe it should be. From the aspect of provider liability and as a public health issue, this paper will attempt to explore the relative risk of ocular infection associated with the wearing of disposable and traditional contact lenses.
Published in Journal of the American Optometric Association (1992)
Topicality. In recent years, dry eye syndrome has become increasingly important in clinical practice. Disturbance of the wettability of the eye surface occurs due to external factors influence, one of which are contact lenses. The review presents the literature data analysis covering possible impact of contact lenses made of different materials (hydrogel, silicone hydrogel, soft and rigid gas permeable) on the development of dry eye symptoms, as well as the role of tear substitutes use when wearing contact lenses. Due to agreat variety of different studies on this topic, the literature review on the tear substitutes instillation when wearing contact lenses in patients with dry eye syndrome is relevant and crucial for doctors in outpatient departments. Conclusion. The research has shown that, it is possible to identify unmodifiable and modifiable risk factors for dry eye syndrome with reliable and probable factors. In addition, the therapeutic use of HYLO-COMOD and PARIN-POS is accompanied by minimum possible negative side effects and their use can increase the amount of tear film, as well as reduce the severity of eye discomfort.
Evaluating the effects of wearing contact lenses: morning and afternoon testing.
Corneal steepening and myopic increases are characteristic of diurnal variations which affect habitual wearers of contact lenses. Testing before insertion of lenses and after wearing lenses for 8 hours provided a good indication of the magnitude of diurnal changes in 35 individuals.
Published in Journal of the American Optometric Association (1978)
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