If a patient is interested in contacts, it may be tempting to provide the lenses same day.

However, it’s important to fit the contacts and evaluate after a period of time as changes in the ocular surface that result in comfort or vision problems may develop.  

It’s important to evaluate the ocular surface prior to contact lens wear and if a patient has dry eyes, meibomian gland dysfunction, blepharitis or allergic eye disease, treat these conditions first prior to contact lens fitting.

If contact lenses are finalized right away, the ocular surface does not somehow “get better” or “improve” over time and may cause significant problems to develop over the ensuing weeks of wear.

Contact lens dropout

Statistics on contact lens dropout, the discontinuation of contact lenses, has not varied much over time. According to published studies, contact lens dropout ranges from 15-23% of wearers. [1-7]

These rates are extremely high, especially with the advancements in contact lens materials and designs currently available.

In a study that evaluated the impact of contemporary contact lens materials and designs on contact lens discontinuation, the primary reasons for discontinuation were discomfort and dryness; the secondary reasons were red eyes and expense. [7]

Prior to fitting contact lenses, it is helpful to ask about patients previous contact lens experience. What were the positive and negative aspects of contact lens wear?

If contact lenses were discontinued, why? Was it specifically due to trouble with vision, comfort, limited wearing time, or all three?

What to treat before a contact lens fitting

If necessary, consider treating an ocular surface disease prior to contact lens fitting to help extend the comfortable wearing time each day and improve the overall comfort over the life of the lens.

Address the ocular surface to improve vision in general. This is especially important for multifocal contact lens wearers and digital device users.  

Managing the ocular surface speeds up the time to achieve a successful contact lens fit and reduces chair time, saving time for both the practitioner and patient.

The next time a patient with dry eye disease is interested in contact lenses, the temptation may be to fit same day, hoping with time contact lens wear may become more comfortable or the eyes will get better and become less dry.

Pause, educate and manage ocular surface disease, and then proceed with the contact lens fitting.  

References

  1. Schlanger J. A study of contact lens failure. J Am Optom Assoc. 1993;64(3):220-224.  
  2. Weed K, Fonn D, Potvin R. Discontinuation of contact lens wear. Optom Vis Sci. 1993;70(12s):140.  
  3. Pritchard N, Fonn D, Brazeau D. Discontinuation of contact lens wear: A survey. ICLC. 1999;26:157-162.  
  4. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. Nov 2002;22(6):516-527.  
  5. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. Feb 2007;26(2):168-174.  
  6. Rumpakis J. New Data on Contact Lens Dropouts: An International Perspective. Review Optom. 2010;147(11):37-42.  
  7. Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. Jan 2013;39(1):92-98