Not a day goes by without a patient complaining that they cannot wear their contact lenses due to some vague reason. Usually, the story goes like this: “I used to wear contacts fine until I had my baby. So, I went to the doctor and she put me in a new lens. Later, I couldn’t wear that pair, so I went to a different doctor, and he put me in a different lens. Now, I can only wear lenses once in a while for just a short period of time. I have all the lenses in this lunch bag and want to know which ones are right for me.”
The Problem Isn’t Your Lenses – It’s Your Eyes
When I encounter that scenario, I start thinking that the only thing in common with all of the fine lenses and fine doctors is the patient. Usually, it has to do with dry eye or meibomian gland dysfunction. Unless compliance with a lens wear regimen is the main issue, or a solution sensitivity is present, we will have to restore the tolerance of the lenses by first fixing your dry eye problem.
We Look at Your Tear film, Blink Pattern & Eyelid Seal
Doing a Tear Lab tear osmolarity test will uncover the amount of inflammation that exists on the ocular surface. The greater the osmolarity score, the greater the inflammation and the more difficult it will be to restore the ocular surface to normalcy. A higher osmolarity score means that there is proportionately more salt in the tears from the evaporation of the aqueous (watery layer) of the tear film. The water evaporates due to insufficient oil being expressed from the meibomian glands due to blocked or atrophic glands or due to an incomplete blink pattern or a poor eyelid seal.
These properties of the tear film and the blink pattern and eyelid function are determined in the advanced testing we do during our dry eye workup. The gland structures are analyzed using infrared dynamic meibomian gland imaging mammography with the LipiView2 instrumentation from Tear Science, the makers of LipiFlow.
A Stable Tear film Will Allow Comfortable Contact Lens Wear
If diagnosed properly, the correct treatment should yield a successful contact lens wearing experience. That treatment needs to be able to reduce inflammation and get the oil glands working again. Many times, it involves using LipiFlow Thermal Pulsation Treatment, a 12-minute procedure that evacuates the constipated oil glands so that the aqueous layer can be protected. Just like it is necessary to have a firm foundation for a building, a stable tear film is a prerequisite for healthy contact lens wear to exist. With the plethora of one-day healthy options for contact lens wear and new gas permeable materials on the market today, it would be rare for a patient to not succeed with contact lenses.