As we know, contact lens discomfort is the number one reason for contact lens dropout (followed by vision not being as clear and then cost). When patients come into my office and complain about discomfort, here are some questions I ask them:

  • Do you notice discomfort right away or only toward the end of the day?
  • When the weather is excessively hot or cold or windy, do you notice a difference?
  • Are you using any eye drops with or without lenses?
  • What solutions are you using?
  • How often are you disposing of your lenses?
  • Is this a new problem or have you noticed this for a while?

If the patient has any issues with new contact lenses or has changed solution, sometimes a simple change of contact lens material or solution will solve the issue. The more difficult cases are the patients who have worn contacts for many years.

If nothing has changed with the material or solution or replacement cycle, a thorough evaluation of the ocular surface is necessary. I am finding more and more contact lens patients are suffering from dry eye, and that is the main reason for the dropout. I like to tell patients, “ok you have been wearing the same lens for 10 years and discarding them at the same interval, and you’ve been using the same care system. The contact lenses and solutions have not changed. That tells me it is a problem with your eye.”

After describing this, practitioners usually fall into one of two camps. One camp will refit the patient into a new contact lens material, while the other camp will treat the underlying cause of dry eye. I used to fall into the first camp. In a world where patients demand instant results, I would dispense a new type of contact lens to them, so they could go about their life. However, as the years go by, I am finding myself falling in the camp of treating the underlying condition, which is usually some sort of dry eye. When we treat the underlying issue, the patients start to understand that it is their eye that is the problem, not the contact lens. When treating the root of the problem, the results can be longer lasting, yielding better lens comfort year after year.

I am curious what all of you do in the case where patients complain of contact lens discomfort? Do you change their contact lens material? Their solution? Add in artificial tears? Treat dry eye?