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 day out?"
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 techniques.
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 EFA's.
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.
1) Review 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.
3) Lid 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.
4) Drink 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.
5) Eat 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.
6) Two 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.
7) Bedtime 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:
8) Bedtime 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 tear evaporation.
9) Turn on a humidifier bedside. Adding moisture in the air at bedtime may help to keep the eyes from getting dry.
10) Use 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 function.
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".