12 things you can do to improve
your contact lens wear
By Marc Herwitz, O.D. Lieutenant,
Medical Service Corps United States Navy
We all know that not every day
is golden for contact lens wear. It is a fact that complications such as
poorly cleansed lenses, allergies and dry eyes will interfere with significant
wearing time. So what is it that doctors answer when their patients ask: "Is
there anything that I can do to make my contact lens wear better day in
The question has traditionally
been tackled by focusing on re-education of the patient on proper lens
cleaning techniques and evaluation of the brands of cleaners, disinfectants
as well as enzymatic products. That is usually followed with advice on
the use of rewetting drops needed. Pretty basic stuff really that is very
important, but often not enough for most contact lens wearers let alone
someone with keratoconus. My emphasis here is not to forget the aforementioned
but to talk about the role that proper lid hygiene and nutrition plays
in successful contact lens wear. Although there might not be concrete scientific
support from research sources on the effects of nutrition and how it relates
to tear function, I can tell you that I have received overwhelming subjective
support and affirmation toward improved contact lens wear from my patients
who have followed a guideline of nutritional supplementation with lid hygiene
To understand this, it is important
to know a little bit about the surface of the eye as well as the eyelids.
Our tear film, which is situated between the ocular surface and the contact
lens, is comprised of a three-part structure that changes as the day progresses
on. It is composed of a thin inner mucin layer that attaches the thick
aqueous or watery layer to the ocular surface. On the outside is a thin
lipid-like layer responsible for conservation of the evaporation of the
watery middle layer. Different glands are responsible for these layers.
Namely, the meibomian glands along the lid's margin contribute to the lipid
portion; the lacrimal glands produce the aqueous layer, while the goblet
cells produce the mucin layer. There is a lot that we don't know about
our tear film, or what causes us to have problems with it, so treatment
is variable. Some experts believe in adding supplements for the thinning
watery layer and others advocate artificially replacing a depleted lipid
layer. Yet others are talking about mucin layer fortification.
When we are talking about the
eyelids, we are often talking about Blepharitis, a catchword for various
types of eyelid inflammation. However, it is important to note that even
for those who do not have blepharitis, a ritual of lid hygiene to remove
excessive oils and loose dead skin that is sitting on the eyelid margins
may greatly enhance contact lens comfort. The presence of oils or loose
skin on the lids can greatly restrict the meibomian glands from producing
a proper lipid tear layer.
The nutrition value of maintaining
a level of natural oils in the body might be helpful toward improving contact
lens wear. We are talking about essential fatty acids or EFA's, specifically
the omega 3 and omega 6 fatty acids. These are introduced into our system
through our diet. Omega 3's can be found in fish products like salmon,
sardines and herring. Additionally, flaxseed and canola oils contain omega
3's. Almonds, walnuts, and sunflower seeds are great sources of omega 6
So let's talk about a routine
to follow that involves supplementation, conservation, lid hygiene as well
as nutrition and some common sense. The following is a plausible routine
of what you can do to enhance your contact lens wear and make your eyes
feel better. I will include other ideas that patients
have tried and commented to me that seemingly worked for them. I guess
the important thing to say here is that much of this is trial and error
and might work out better for some than for others.
proper cleaning techniques based on manufacturer guidelines.
2) Use rewetting
drops whenever necessary...not all rewetting drops are the same. Similisan
Corporation for instance makes three different drops that can be used with
or without the contact lenses in. The Similisan eye drop#1 help to "stimulate
the body to heal itself" the manufacture suggests, by triggering its
immune system. It is a wonderful product that I have used in practice for
many years. Patients swear by its effects. The Similisan #2 drop is their
allergy drop and can be used if there is an underlying allergy complication
to the dryness of the eyes. Both of these products are homeopathic in genesis.
There are other drops available such as Viva Eyedrops that is an antioxidant
eyedrop. I prefer the non-preservative drop varieties since there is really
nothing in them to irritate the surface of the eye. These drops are broken
down into three degrees of thickness. The thinnest are low viscosity drops.
It is a subjective issue in selecting a low viscosity drop over say, a high
viscosity drop. Again, trial and error.
hygiene is an important element that is often initiated but then dropped
by patients. Doctors often recommend lid scrubs, or the use of a clean
washcloth saturated with warm water and a little Johnson and Johnson shampoo
diluted into the cloth and then gently moved across the eyelid margins
with the eyes closed to remove debris and cleans the lids. Prepared lid
scrub pads in single foil packages are also available for the same effect.
I have found no differences in using either one. As long as one of these
are used the effect is usually positive.
8 to 10 cups of water. Keeping hydrated will help to keep fluid levels
high. At the same time, avoiding beverages that contain caffeine such as
coffee and caffeinated sodas as well as the consumption of alcohol, which
deplete water from the system.
a dozen almonds, pecans or Walnuts per day to get in your omega 6 EFA's.
Peanuts, or peanut butter will provide a proper substitute.
tablespoons of flaxseed oil, 1 to 2 times a day. An easy way to introduce
omega 3 and 6 EFA's. Keeping this oil refrigerated in order to keep its
potency from fading. It has been said that flaxseed oil contains a higher
level of omega 3 EFA's than that contained in Norwegian Cod Liver Oil.
preparation #1:Consider the use of a high viscosity gel or lubricant gels
at night after the lenses are removed from the eye, such as GenTeal Gel
or Tears Again lubricant gel. OR:
preparation #2: instead of a thick gel or ointment, use a non-preserve
low-viscosity artificial tear like GenTeal drops, Refresh Plus, Tears Naturale
Free or the like with the Tears Again Liposome Lid Spray which is applied
6 inches away from the eye when your eyes are closed and without contact lenses
in. This spray application is made up of phospholipids that help to seal
your tears in adding to your own lipid tear portion therefore reducing
on a humidifier bedside. Adding moisture in the air at bedtime may help
to keep the eyes from getting dry.
sunglasses that are large enough to prevent wind from drying out the eyes
and eliminating any foreign body from entering the eye as well. 11) Avoid
smoking or a smoky environment. 12) Consider taking multivitamins. We believe
that deficiencies in vitamins A and C, riboflavin and B6 can effect tear
Little research has been performed
to support much of what has been said to date. I would expect that that
should change as homeopathy has been gaining ground these last few years
and as dry eye complaints continue to rise as our population continues
to age. Again, this plan might not be for everyone but certainly a trial
of this routine might just be "what the doctor should have ordered".