A typical practice sees 109 patients each week (Nichols et al.). One-third of these are contact lens-wearing patients. In 2018, 69% of contact lens wearers (including both soft and gas permeable) were using silicone hydrogels. Growth in the daily disposable market translated to 35% of wearers in this healthier modality.
While this study reported important findings in the first 3 months of soft contact lens wear, results from longitudinal studies will be valuable to ascertain possible progressive insult to the ocular surface. For instance, meibomian gland expressibility and atrophy were shown to worsen for the first 2 years of soft contact lens wear in young individuals but not worsen much beyond that time point (Alghamdi et al.).
It is widely understood now that a reusable lens with chemically based multipurpose solutions creates a low-grade inflammatory environment that logically worsens deeper into the wear cycle. To be fair, the choice of lens for group 3 (PureVision 2, Bausch + Lomb) had a high modulus, thick edge and earlier generation of surface wetting technology. Surprisingly, Willcox and colleagues found no relationship between ocular comfort and tear cytokine levels.
Ocular surface changes in the environment of soft contact lens wear tend to happen in the early stages but are often subclinical. It is up to the clinician to risk stratify for each patient to promote the healthiest ocular surface long term while achieving the best possible vision and comfort in a low modulus, daily disposable lens whenever possible.
Alghamdi WM, et al. Ophthalmic Physiol Opt. 2016;doi:10.1111/opo.12278.
Nichols J, Fisher D. Contact Lens Spectrum. January 2019.
Willcox MD, et al. Mol Vis. 2015;21:293-305.
Justin Kwan, OD, FAAO
Associate, Professional Eye Care Center, Niles, Ill.
Disclosures: Kwan reports he is on the speakers bureau for Visioneering Technologies Inc.