Silicone Hydrogels are the latest craze

Silicone Hydrogels (SiHys) are the latest craze, and it seems every single contact lens company is coming out with the next best SiHy on the market. No doubt silicone has transformed the contact lens industry by allowing more oxygen to the eye, but at a cost of decreased wettability, increased hydrophobicity, more potential for deposits, and some contact lens intolerance/reactions to the material.

Should we be putting every single patient into SiHys?

I have a few patients who have actually developed an allergic reaction or contact lens intolerance to silicone hydrogel material. After switching these patients to hydrogels or gas permeable lens material, their symptoms have abated.

Case in point: A 17 yo WF was fit into a SiHy dailies brand last year with no issues. I refit her this year, keeping the material the same, and just altering her power. She returned a few weeks later complaining that her eyes were red and irritated with the contact lenses. She had some mild injection and some papillae, so I started her on a steroid. Everything cleared up, and she resumed contact lens wear. Shortly after, the symptoms returned. I again started her on the steroid, and a few days later, I switched her to a hydrogel daily lens. She has been successful in the lenses for 4 months. 

They won’t be going away anytime soon

Hydrogel materials definitely have their place in the contact lens world, and they won’t be going away anytime soon. There are many reasons I still reach for a hydrogel as my first lens option, and I think many of my colleagues do the same.

Silicone hydrogels are amazing and have a huge place in my practice, but they are not for every patient. Hydrogels and gas permeable lenses can sometimes help patients who have failed in SiHys. The prices of hydrogels are usually less, so it can encourage contact lens wearers to continue with lens wear if price is a concern.

The ocular health response is great in many patients with hydrogels. We must not think of increased oxygen as the only important factor when reaching for a contact lens (which is probably what I did fresh out of residency). Hydrogels can work well for many patients!