Dry eyes with contact lenses useage

[mdy25]

Hello ,

I am new to this web site and seeking help to cure my dry right eye. It really bothers me when I wear contact lenses after having them in the right eye for about 5 hours. First I thought it was the kind of lenses I use.

My Dr. said that my right eye gets dry because of contact. I tried "Blink Contact Lubricant" and it works for 10 minutes and itchiness comes back. The strange thing is that only my right eye is bothering me when I wear contact.

I will very much appreciate any advice to this matter.

Thanks.
Mdy25

[holly]

Hi Mdy25! I know EXACTLY what you mean, but both my eyes are dry/irritated/scratchy/red/burning but my right eye is and always has been the worst! Wish I had some encouraging suggestions but I've tried Acuvue Advanced with Hydraclear and Focus Day & Night without any improvement at all. Try to get a free trial pair of lenses before you purchase a pair. Several folks have recommended Bausch & Lombe's Pure Vision contacts but I haven't tried them (due to my eye dr. not carrying them) Hang in there!

[dryeyes]

For dry eyes I have found Proclear non-toric and AC Definition lens the best. I have tried about every lens out there.

[rkralman]

Make sure you are using the newer silicone kind as they do not absorb the tears as quickly and don't get "glued" to the eye.. I use Focus Night and Day and have good luck but I want to try the new one, I think it is called Acuvue Oasys, but it may not be available yet. Also, when I do wear contacts, I cannot live without using Aquify saline sokution and Aquify drops . These two products are especially made for dry eyes and contact lens wear. You can find them both at Walmart. Good luck! Robin

[dryeyes]

It seems that the Acuvue Oasys contact lens does not come in powers above -6.

[dcampbeld]

The Proclear range are the only contact lenses to have FDA approval for dry eye usage. I do not have dry eye and don't wear lenses but have an interest in the dry eye condition through my work.

I have posted this information twice now and thought i should mention that I have no financial interest in these lenses or the company that supplies them (Coopervision) but my work leads me to believe in the product.

Darren

[Rebecca Petris]

Appreciate your posting about it. It seems like I used to hear about these more often but I just did a quick search and there are really very few comments about them on the BB. I am wondering why that is. Are they not being prescribed very often? DrG posted about them awhile back as being a useful option for dry eye patients who have lipid problems with the silicone hydrogels I think.

[DrG]

Well, the silicone hydrogel lenses have taken the limelight away from the Proclears. I still fit many Proclears, but not as many as before, primarily because of the advent of the silicone hydrogels -- particularly the Acuvue Oasys.

I have found that if I take 10 people who have dry eye symptoms, about half will do better with the silicone hydrogels, and the other half will do better in Proclears. The lens surface chemistry is what makes them different, and makes them react differently in different types of dry eye. It is easier to switch the contact lenses than it is to figure out what kind of dry eye a patient has.

The Acuvue Oasys seems to have a better surface chemistry than other silicone hydrogels...a slicker surface, which makes it feel like a Proclear. However, Cooper will eventually come out with a silicone hydrogel base on the Proclear phosphorycholine architecture, which should make it a superior product.

DrG

[khasler]

Just tried the Oasys lenses for a day and I still have mixed reviews. I liked that they were a little more durable than the Daily lenses I had been using before, but my eyes were still pretty dry, red, and irritated while wearing them. I can only wear contacts for a few hours at a stretch anyway, as my eyes are so dry, but I will be giving them another chance before making my final decision.

[dcampbeld]

DrG
Coopervision are indeed working on a hybrid proclear/silicone material lens and it may be released next year. One to watch out for.
Darren

[DrG]

DrG
Coopervision are indeed working on a hybrid proclear/silicone material lens and it may be released next year. One to watch out for.
Darren

Yes, that's what they've been telling me for over a year, now. Several years ago I happened to stumble onto a patent owned by Biocompatibles having to do with a novel contact lens which involved putting a PC coating on a silicone hydrogel material, and I've been waiting ever since.

Are you in the business?

DrG

[DrG]

I was asked to update this thread, and specifically to address several questions. The first is:

What are my experiences with Proclear and silicone-hydrogels?

Both continue to play a key role in my practice for dry eye patients. But, they seem to work with different types of dry eye. Some patients will do better with Proclear, while others seem to do better with silicone-hydrogels. Proclears are made of a high water, hydrogel type material, but has more water binding sites on the surface, which tends to repel deposits and make the surface very slick. On the other hand, silicone-hydrogels are very low water, which makes them less prone to evaporative loss.

What is my favorite silicone-hydrogel?

It is currently the Acuvue Oasys. Unlike other silicone-hydrogels, it does not depend on a surface treatment such as plasma for wettability. The wetting agent is admixed into the polymer matrix. This lens also seems to have a lower elastic modulus, which contributes to the mechanical comfort. Anecdotally, I hear some doctors complain about deposits, but I haven't really seen that problem and I use this lens quite alot.

How about an update on the Coopervision Proclear/silicone-hydrogel lens.

I got an update last weekend. In fact, the lens was officially announced today, with a national rollout in February. Unfortunately, it will not incorporate the phosphorylcholine material used in the Proclear lens. It appears as though there were some insurmountable technical issues with that particular formulation. Cooper has been losing out in the stampede to silicone-hydrogels, and so they are launching the Biofinity without phosphorylcholine. It will have a higher water content and lower modulus than competing products.

Any success stories with these lenses?

Well, all the time, actually. Silicone-hydrogels represent most of the soft lenses I dispense. The typical patient with dry eye in my practice will have subclinical dry eye which is made more symptomatic by contact lens wear. The newer lenses will reduce the dry eye symptomology, and increase the wearing time significantly, while reducing the amount of redness. However, sometimes something dramatic happens, as it did yesterday.


This female patient has a severe case of dry eye, with keratitis, that has been resistant to conventional treatment. She copes quite well, even though her vision is reduced by the roughened epithelial surface. At times, she has even presented with filamentary keratitis. Now that she is out of work, she has the time to focus on her eyes, and I put her on a round of prednisone, which made only a modest improvement. As a prelude to fitting her with a scleral lens, I decided to try Focus Night and Day, with a very low power (+0.25), as a bandage lens. This had the immediate result of improving her vision from 20/40 to 20/20 when worn with her spectacles. It will be interesting to see how well she tolerates this. Unfortunately, the lens is not available in her prescription, which includes high astigmatism, and so she must wear her spectacles along with the contact lenses. But, she was very, very happy with the improvement in her vision.

[DrG]

Just a quick update on the woman I treated with a Focus N&D bandage contact lens:

After one week her vision was correctable to 20/20 with glasses, and her punctate keratopathy improved by 50%. With the lenses she was not photophobic. She was very happy.

We have decided to push ahead with a scleral lens fitting so that she won't need her eyeglasses, but something tells me that the silicone hydrogel bandage lens is going to be difficult to beat. I call it the "poor man's scleral lens." ;)

[DrG]

Just a quick update on the woman I treated with a Focus N&D bandage contact lens:

After one week her vision was correctable to 20/20 with glasses, and her punctate keratopathy improved by 50%. With the lenses she was not photophobic. She was very happy.

I was so impressed by what I saw yesterday that I wanted to post an update. After several weeks of wearing a bandage soft lens during the day, along with instillation of rewetting drops every 2 hours, this patient exhibited virtually no corneal staining. She was noticeably happier as she had less distress/discomfort.

The RGP lenses fit very well (15.2 mm in diameter), but were not wetting properly, so I'm going to see about plasma treatment of the lenses.

[Niteyorkie]

I have been to two eye docs since being diagnosised with dry eye ( of unknown cause). I did wear contact without any problems for about 17 years. Then all of the sudden my eyes became red and swollen. My eye doc at that time started me on Tobradex and artificial tears and no contacts. After 6 months of treatment my eyes improved, but he told me I could no longer wear contacts because they were contraindicated in patient's with dry eyes. He said this would cause a corneal ulcer. I asked if I could wear them for a short time to go snorkeling. He said this would be especially dangerous because the water would get trapped between the eye and contact and cause an infection and ulcer.
I now go to another doctor (whose ad states it is the dry eye treatment center) and he has given me Proclear and Focus dailies. I have worn them for only a few hours and had no problems. I am just scared about using them because I know I don't want a corneal ulcer, but I am planning a trip and would really like to go snorkeling. With my high prescription, finding a mask is going to be expensive. Has anyone else ever been told this?

[Lucy]

I am just scared about using them because I know I don't want a corneal ulcer, but I am planning a trip and would really like to go snorkeling. With my high prescription, finding a mask is going to be expensive. Has anyone else ever been told this?

Hi Nitey--You have a whole bunch of questions all wrapped into one there.
1. You are scared (to use them) because they may cause a corneal ulcer.

2. You want to go snorkeling.

3. A mask with your high RX would be expensive.

Then you ask "has anyone else ever been told this? I'm not sure which question you are referring to.

First, I really hope your doc knows what they are doing with the lens and as of yet, you have no reason to think otherwise. If I were planning on a cool trip and going snorkeling......just to be on the safe side, I'd get some goggles in your RX. They are not as expensive as you think. It's been discussed here on DEZ just recently. They come in RX's up to -7 or so. Even if you are a -9 or -10, the -7 would get you by the snorkeling thing if you couldn't wear your contacts.

I'm going on a trip south this winter and would like to snorkel, but I'd have to have breathing lessons. I love to swim, live in the water, but can't master the art of breathing through a snorkel without drowning. Maybe I can find a little neighborhood kid to teach me.

Lucy

[Niteyorkie]

Sorry for the previous long post. The main question was has anyone been told contacts were contraindicated in DES?

[calli66]

...has anyone been told contacts were contraindicated in DES?
It's probably "self limiting" most of the time. If eyes are dry and irritated, wearing some types of contacts makes them worse.

But---I have very dry eyes, yet I can wear contacts (high Rx, too).

I don't know a thing about snorkeling, but don't you wear a face mask with that? Does the water get inside it? Can you wear glasses with face mask over that?

If you've only worn the Proclears and Focus for a few hours, that's not much to test them out. Contacts wear, plus seawater, plus snorkeling, plus sea air, plus dry eye--yeah, there's definitely the potential to have eye problems. That would ruin your trip for sure. Best to check out contact lens wear and snorkeling as SEPARATE experiences, in my opinion.

C66