Soft Contact Lenses in Dry Eye

Etty Bitton, OD, MSc, FAAO, FBCLA

Introduction

Dry eye disease (DED)[1] is a complex inflammatory condition that continues to challenge patients, eyecare practitioners and manufacturers alike. This became even more evident during the COVID pandemic with an increase in digital device use (resulting in less blinking) and mask-associated dry eye (M.A.D.E).[2] Contact lenses in the dry eye arena can be a friend and a foe. To start with the latter: symptoms of dryness and discomfort continue to be one of the main issues leading to contact lens dropouts.[3-4] Luckily, improvements in polymer technology and innovations in manufacturing continue to bring new contact lens options to market to address vision and ocular surface-related challenges such as dry eye. At the same time, contact lenses can be a friend to those with mild-to-severe dry eye symptoms therapeutic or bandage contact lenses are used to manage ocular discomfort, to support the cornea during healing after surgery or when the cornea is being treated for an underlying disease state, or to protect the cornea from the environment or from mechanical interaction with the lids. In addition, soft lenses can be ‘a friend’ in managing allergies, drug delivery to the ocular surface and UV protection.

A Fraction Too Much Friction

But first, let’s address the (dis-)comfort. To increase the wettability of contact lenses, surfactants or humectants such as polyvinyl alcohol (PVA) and hydroxypropyl methylcellulose (HPMC) can be added to blister pack solutions.[5] The purpose of these polymeric additives is to lubricate the surface of the contact lens to retain moisture or to prevent it from sticking. [6-8] During the interblink interval, a contact lens is exposed to environmental factors that promote the migration of hydrophobic groups toward the surface. Internal wetting agents can also be added to the contact lens matrix itself. These agents can be released throughout the day to improve comfortable wearing time.[9-12] Both of these strategies – wetting agents in the blister pack or in the lens matrix - are geared to address surface friction. Reducing lens surface friction, which has been found to be one of the main drivers of contact lens discomfort, [13-15] can improve on-eye wettability of the lens. These advances in polymer technology and manufacturing of soft lenses can provide additional options, especially for mild-to-moderate dry eye patients.

Controlled Delivery & Allergy Management

Soft contact lenses are well established for their ability to correct vision however, they are increasingly being considered as an emerging drug delivery tool.[16-20] Contact lenses can offer a sustained and controlled drug delivery, which can offer several advantages in the management of ocular pathologies such as infections, inflammation, glaucoma, allergies and dry eye.[20] Dry eye and allergies often cause similar symptoms of ocular discomfort, hyperemia, tearing and inability to wear contact lenses comfortably due to disturbances to the ocular surface. Eyecare practitioners have the challenge of differentiating between the two conditions, which may present concurrently. Topical antihistamines are effective, but they typically contain preservatives that can further disturb the tear film. It has been shown that modern daily disposable contact lenses, with enhanced lubricating agents, act as a barrier to airborne allergens and can assist with alleviating symptoms (burning and stinging) and with reducing hyperemia and corneal staining.[21] In that way, contact lenses are indeed a friend. To help maintain contact lens wear during allergy season, a slow-releasing ketotifen (antihistamine and mast cell stabilizer) lens is now available in some markets.[22-23] Each lens contains 0.019mg of ketotifen without any preservatives to provide up to 12 hours of comfort, allowing some patients to continue to wear their lenses during allergy season.

Blinded by the Light

Dry eye patients often complain of sensitivity to light as one of their main symptoms. [24-25] Many use sunglasses to alleviate this, especially for outdoor activities however, this requires the burden of always carrying them. For those dry eye patients who can maintain contact lens wear, a recent breakthrough in soft contact lens technology resulted in a light-adapting lens.[26] This 2-week replacement daily wear lens filters light in the visible (55% of blue light, 380-460nm) and invisible (99-100% of ultraviolet, <380nm) spectrum, allowing patients to alleviate light sensitivity issues during indoor (ie, digital device use) and outdoor (tennis, golf, hiking, etc) activities.

"Keeping abreast of these advances can differentiate our practices
and ultimately benefit our patients”​

Innovation Universally

Innovation in contact lens technology continues to evolve in the hopes of addressing numerous contact lens-related challenges faced by patients, including dry eye, all around the globe. International associations and specially devoted international groups are on top of the topic. Keeping abreast of these advances can differentiate our practices and ultimately benefit our patients. In addition, we should realize that soft lenses can be a good friend in contact lens practice, including for bandage contact lenses applications (as described in the CLEAR report),[27] managing allergies, drug delivery to the ocular surface and UV-protection. As an eyecare practitioner, it is an exciting time to manage patients, as we have additional tools in our armamentarium to address dry eye issues in contact lens practice.

References
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