Ensuring our contact lens-wearing patients avoid complications is always one of our top priorities. A great number of factors can cause complications in these patients, ranging from dryness-related discomfort to toxicity reactions related to contact lens solutions.

While preventing adverse events in contact lens wearers may seem like a difficult task, a standardized approach to reinforcing compliant behavior can go a long way in keeping them complication-free.

1. Prescribe Gas Permeable Lenses for Easier Compliance.
I will typically recommend GP lenses to patients who are generally not good with handling or cleaning a soft lens. So, when dealing with your less-than-compliant patients, consider prescribing gas permeables. A rigid material is more amenable than a soft material to staying clean even with minimal patient effort.

Also, rigid lenses are much better for extended or continuous wear, as they are less susceptible to the tear film stagnation under the lens that allows any bioburden on the eye to remain, potentially causing an infection.

The wear characteristics of rigid lenses enable greater flushing of tears with the blink than soft materials, which is one reason why GPs have the lowest complication and infection rates.

Some practitioners are reluctant to fit gas permeable lenses, given their reputation for less comfort than soft lenses, but once you put a GP lens on a patient they’ll actually realize how little sensation there truly is. A little effort at patient education helps prepare patients for the adaptation experience.

I explain that rigid materials are sort of like a new watch or a new piece of jewelry—initially it will feel foreign, but after wearing it for a few days, you adapt to it and forget it’s there at all.

2. Choose Modalities that Prevent Build-up of Bioburden.
Naturally, daily disposal is the ideal way to avoid complications that involve bacterial bioburden. However, when fitting a patient who wants to wear reusable lenses, it’s actually safer to fit them in an extended wear lens that they can wear for a month straight and then dispose of, rather than daily wear.

Wearing the lens for a month straight without removing it actually helps to reduce bioburden by avoiding contact with the fingertips, as well as potentially poor patient cleaning habits.

Nevertheless, a shorter wear cycle is always the best choice. Daily disposable lenses have a complication or infection rate that is just as low as gas permeable modalities, making them an excellent option for avoiding complications.

The longer a lens remains in contact with the ocular flora, the more likely it will pick up debris, particularly if a patient is not cleaning properly.

3. Pair Materials with the Correct Contact Lens Solution.
Practitioners need to be aware of the differences between the many solutions on the market, as some lenses pair better with specific solutions than others.

A good of rule of thumb is to recommend a solution from the same manufacturer of the prescribed contact lens whenever possible, as they tend to work fairly well with one another.

Of course, some patients will have an allergic response to certain formulations, regardless of how well these products interact with each other. Sometimes, it’s simply a matter of experience—over time, you’ll learn which lenses work best with specific solutions.

Educating yourself and your patients on how solutions pair with certain lenses will help to prevent adverse events as a result of a “bad match.”

4. Avoid Generic, Store-brand Solutions.
Very often I will have patients come in complaining of irritation, which leads me to ask what lens solution they are using. They’ll often sheepishly tell me that they have made the switch to a generic, store-brand solution.

Many of these solutions are based on a formulation that is approximately 25 years old that was made for the old pHEMA lens materials. These solutions are not ideal for use with silicone hydrogel lenses. Sometimes, the preservatives in these solutions will be absorbed or adsorbed to the lens and cause a toxicity reaction, leading to increased redness and irritation.

To remedy this, I give the patient a sample of the original solution I recommended and have them return in about a week. This procedure usually clears the problem up.

This is why I stress educating the patient on the specific reasons I prescribed the original product, as most patients are unaware that generic solutions are inferior to the products we recommend.

5. Schedule Regular Follow-up Visits.
Patient follow-up visits are absolutely crucial when trying to eliminate adverse events. Allergic reactions in patients who have previously been exposed and sensitized to a particular preservative system will generally happen very quickly.

On the other hand, patients who are contact lens “newbies” will take several months to experience a reaction.

For this reason, we need to get patients back for multiple follow-up visits, so that we can assess their progress. We really cannot give patients their lenses and care systems and then say, “Okay, you’re all set—see you next year!”

It’s good to have patients come back after one week, one month and three months of wear, to see if there are any negative effects from either their lenses or solution.

If no problems manifest within that three-month span, you can then typically instruct your patients to come back for their routine annual visit. It is important to stress to patients that they should continue to come in for follow-up visits at least once per year.

Our ocular and systemic systems constantly change, so it is important to assess these in regard to contact lenses over time.

6. Know Who is a Good Fit for Daily Disposable Lenses vs. Extended Wear.
Generally, within the first month of wear, at the patient’s second follow-up visit you should be able to accurately assess whether they are a good fit for extended wear or short-cycle lenses.

Young people, especially teenage boys, should be fit in shorter cycle lenses right off the bat, as they are typically not our most compliant patients.

Personally, I like to fit younger patients into daily disposables right away to get them  into that habit as soon as possible. If patients are consistent with their wear schedules, the risk of developing adverse events is significantly lower.

By properly matching appropriate wear schedules to each of our patients, we can do our best to take non-compliance out of the equation all together, and avoid complications related to poor compliance.

7. Thoroughly Review Contact Lens Wear and Care Procedures with Your Patients.
As I’m sure you can imagine, many patients I see do not practice proper compliance. When I ask patients how they are cleaning their lenses, often I discover they are just taking them off and dunking them in solutions. 

I always go over proper wear and care schedules with each of my patients, and give them detailed, written instructions on compliant behavior. I give my patients a handout, we go over the instructions, demonstrate everything and then I have them show me exactly what they’re supposed to do.

When they come back for their first follow-up visit, I have them tell me how they are cleaning and caring for their lenses. If they aren’t able to explain it quickly, I know they’re not doing it right. In this scenario, we revisit how to properly care for the lenses and I give the patient another handout.

Patient education is crucial in preventing complications in lens wearers, so be sure to stress proper compliance with each patient.

8. Address External Ocular Health Before Fitting Patients in Contact Lenses.
During the initial visit, it’s important to look at the entirety of the health of the eye, including the lids and adnexa. Before fitting a patient in contact lenses, screen for meibomian gland issues or blepharitis.

Ensure that every patient has healthy lids, and that they are free of any tear film problems.

If your patients do in fact have pre-existing complications, be sure to give them any remediation they need, such as a lid scrub or warm compress, before fitting them at a later date.

Once you have ensured their external health is in order, it is then safe to begin fitting them into an appropriate contact lens.

9. Prescribe Daily Disposable Lenses for Patients with Dry Eye.
It’s generally a good idea for dry eye patients to avoid extended wear lenses. Daily wear and daily disposable lenses help to decrease the risk of having any problems, especially those related to bioburden under the lenses.

Because tear stagnation under the lens is such a problem with extended wear modalities, drier eyes are not very conducive to the practice of sleeping with contact lenses in place.

Build-up on lenses worn overnight with a drier tear film is typically higher. For these patients, it is best to avoid extended wear lenses entirely, and fit them into daily disposable modalities to prevent any potential complications.

10. Recommend Daily Disposables During Allergy Season.
When patients are experiencing irritation or discomfort as a result of allergies, very often patients can go into a daily disposable modality and then discard the lens very rapidly, so they don’t have to worry about any residual build-up of the allergen if they’re not cleaning properly.

This will help to reduce redness, dryness and any other irritation that can be caused by allergies.

Keep in mind that it’s also important for all contact lens wearers to have a good, serviceable pair of glasses. If they have an allergic event, get the flu or just don’t feel like wearing their lenses, they will not be wholly reliant on their contact lenses, potentially exacerbating any issue the lenses may be causing.

While complications in contact lens wearers can be caused by numerous factors, following these tips can help avoid many common problems. Educating yourself and your patients on these complications and their many causes will help ensure that your patients maintain safe and comfortable lens wear.

​Dr. Benoit is senior optometrist with The Eye Center of Concord, a multi-subspecialty ophthalmology group located in Concord, NH. He is a Diplomate of the Section on Cornea, Contact Lenses, and Refractive Technologies of the American Academy of Optometry.