Nothing will make a cornea/contact lens doctor break out in a cold sweat more than the patient mention of concurrent retinal disease. We have become quite adept at masking, managing, and mitigating a wide variety of corneal conditions. But if the retina is not functioning correctly then all we’ve done during the last 30-minute visit is entertain or annoy the patient with our assortment of fancy contact lenses. So, what are some tips that can lead to contact lens wear success in patients who have retinal disease? Here, I share the strategies that have worked for me.
Confirm Retinal Stability
Before initiating any contact lens fitting, confirm retinal stability. This is important because many retinal diseases—including diabetic macular edema, retinal vein occlusion, and postoperative scarring following retinal detachment—can fluctuate over time. Reviewing recent OCT scans, visual acuity trends, and retinal specialist notes enables you to confirm retinal stability. I have found that in most cases, several months of documented stability provides the data needed for a successful or lasting contact lens fit. I typically wait for clearance from the retina specialist; in most instances 2 to 3 months is acceptable, but certain conditions may require 6 months or longer.
Assess Subjective Visual Experience
Patients who have retinal disease often experience functional visual deficits, such as reduced contrast sensitivity, metamorphopsia, and scotomas, all of which impact lens selection. Therefore, understanding the patient’s subjective visual experience helps in choosing the “right” lens. As an example, individuals who have peripheral retinal disease may achieve optimal vision in standard soft lenses. The reason: These lenses optimize central vision. Peripheral retinal disease spares central retinal function.
Consider Ocular Surface Health
It is not a matter of whether you will encounter dry eye disease in patients who have retinal conditions, but how bad it is. It’s imperative to consider ocular surface health when selecting a lens material and design for these patients. High-DK silicone hydrogel, daily disposable, or lens materials that enhance moisture retention are ideal for these patients, as they improve comfort and wear time. Regarding lens design, patients who have irregular astigmatism related to scleral buckle procedures or who have corneal distortion or long-standing pathology such as chronic diabetic retinopathy achieve comfortable wear in rigid gas permeable (RGP) or scleral lenses. Rigid gas permeable lenses provide a stable tear reservoir, whereas scleral lenses vault over the cornea resting on the sclera, creating a fluid-filled reservoir between the lens and the corneal surface. One example is a patient with neurotrophic keratitis (NK)—common in patients receiving monthly intravitreal injections causing cumulative iatrogenic ocular surface disease (OSD) and/or those who have previous barrier laser treatment/retinal disease affecting the neural feedback loop. For NK or OSD, I err on the side of a scleral lens to avoid direct contact with the ocular surface. Those without OSD would likely do well with a traditional corneal RGP design.
Managing Patient Expectations
Many individuals recovering from retinal disease have heightened concerns about their visual future. Those of a more advanced age may have concerns relating to their dexterity or the proper handling of lenses. Expect insertion and removal training to be a longer process than you anticipate. Assign staff member(s) with the most patience to the task. Candid discussions about expected outcomes, contact lens-adaptation timelines, and realistic improvements to vision and comfort reduce anxiety and increase satisfaction. A structured, supportive approach enhances clinical outcomes and the patient’s experience. OM
