Soothing Dryness in Lens Wearers
Looking to make lens wear more tolerable for patients?
Contact lens-related dryness is a major problem for contact lens fitters and for patients. It has been described as the number-one cause of contact lens dropouts. While experts have written about many strategies to conquer this prevalent dilemma, we're still always looking for better ways to treat it.
Allergan's Restasis (cyclosporine A) has been so successful in treating dry eyes in my practice, that I decided to undertake a pilot study. (I'll present the results of this study at the December meeting of the American Academy of Optometry.)
Testing a theory
I looked at 16 patients and divided them into a test group and a control group. I gave the test group Restasis b.i.d. before and after lens wear and the control group a carboxymethylcelluose rewetter (Refresh Contacts, Allergan) b.i.d. before and after lens wear. Both groups also used carboxymethylcelluose rewetting drops p.r.n. (up to q.i.d.) during the lens-wearing period.
To eliminate possible lens material variables, I refit them all with new frequent replacement soft contact lenses. I designed the study to add Restasis to the patient's regimen, just as we normally do in practice.
The results are in
I followed both groups for five weeks and performed a battery of dry eye tests. At the end of the period, the test group showed statistically better results than the control in temporal bulbar conjunctival fluorescein staining, use of rewettting drops during contact lens wear and subjective evaluation of dryness measured with severity score.
The results that impressed me the most were the subjective and objective improvements that the test group experienced compared to those of the control. The control group had an increase in temporal bulbar conjunctival staining and rewetting drop use. Temporal staining increased about a half a grade and rewetting drop use increased by about one drop each day.
On the other hand, the test group showed a decrease in both measures. The temporal staining decreased about a half a grade and rewetting drop use decreased about one drop each day.
Interestingly, several patients from the test group demanded to continue the treatment after the study ended. One patient claimed that she couldn't wear her contact lenses for any measure of time without using Restasis.
To each his own
After conducting this study, I'm convinced that cyclosporine A is a great treatment for contact lens-related dryness. While some eyecare practitioners advocate treating contact lens dryness by redesigning the lens (materials, etc.), my first choice is now to redesign the lacrimal gland and the eye -- with pharmaceutical treatment.
References available on request
|Pictured are examples of severe bulbar conjunctival staining that can sometimes accompany contact lens dryness.|
DR. HOM RECENTLY COMPLETED OCULAR DISEASE CONSULT (ISBN 0323024475) TO BE PUBLISHED BY ELSEVIER HEALTH IN 2005. DR. HOM RECEIVES RESEARCH GRANT MONIES FROM ALLERGAN.