Now more than ever, digital devices are an integral part of our daily lives. Many of your patients likely spend their workdays in front of a computer, supplemented by use of handheld devices such as smartphones or tablets throughout the day. As such, it is imperative for you to take the time to address this clinically. Dry eye and discomfort at the end of the day due to digital eye fatigue is a common and growing complaint, and especially so in contact lens wearers.

Affecting children to emerging presbyopes most acutely but also advanced presbyopes as well, device-related eye fatigue will soon become one of the most important factors we address in our practice. Our visual world is changing rapidly and we need to stay on top of it. In this column, we will address some of the ways to help your contact lens patients see the best and stay comfortable in their lenses.

How Many Hours?
Start by asking all your contact lens patients how many hours they sit in front of a computer. Mid-day discomfort is a symptom happening more frequently with decreasing blink rates and increasing meibomian gland dysfuntion.  Aside from just standard daily computer use, it is important to know how much time, on average, our patients (both children and adults) spend in front of smaller screens like those found on smartphones or handheld gaming systems. Contact lens comfort during such activities must be addressed at every visit. 

Asking about computer or digital device usage enables eye care professionals to discuss options like daily-replacement contact lenses, high-quality silicone hydrogel contact lenses and any prescription products or OTC drops that could help. It also gives us the opportunity to discuss computer and device usage best practices like taking visual breaks throughout the day and having a good pair of back-up glasses. Lastly but by no means insignificantly, these discussions often reveal near vision problems that can transition into a conversation about multifocal contact lens options.

Tailor the Process
Customize the contact lens fit by choosing a design, material, modality and solution (if needed) that provides ideal patient comfort. Although comfort is difficult to predict sometimes, choosing a lens that maintains its hydration will help mitigate digital eye fatigue. Many of the newer materials and designs have improved hydration, reducing end-of-day discomfort. 

Visual aids will help the patient understand complex processes like accommodation.  

Water content, important though it may be, is not the sole determinant of comfort, as contact lenses also vary in modulus, lubricity, oxygen permeability and edge design. All of those factors, along with the patient’s ocular health and environment, influence the patient’s perception of comfort with contact lens wear. 

Don’t forget to identify patients’ occupations, hobbies and daily visual requirements. This will also aid in properly identifying their visual needs and discussing proper expectations ahead of time. If you are fitting a multifocal lens for children or adults, you can also customize the multifocal lens design to the patient’s daily visual tasks. By successfully satisfying their visual needs, you will inevitably gain the respect of the patient and develop an ambassador for your practice.

Educate your Patients
Accommodation is a somewhat difficult scientific concept to discuss with your patients. Use visual aids to explain the usual process and how it functions as we look at our computers and other devices. This will especially help your patient understand if you need to fit them with multifocal contact lenses. 

Early Presbyopia May Fool You
Early presbyopia presents a challenge in that many patients may complain of distance blur or end-of-day eye discomfort. Accommodative fatigue is a major factor in these symptoms. It is important to educate the patient on the presbyopic process and the options available with contact lens wear. Many patients do not realize that multifocal contact lenses are even an option and that they will still be able to wear contact lenses for a long time into the future—as long as they want. Additionally, with the launch of many newer one-day multifocal lenses, patients can satisfy visual and comfort complaints at the same time, as the advantages of daily disposal help to reduce complaints of discomfort that might otherwise contribute to dissatisfaction. Put another way: don’t give the early presbyope any more reasons to be disenchanted.

Prepare your patients by educating them about the onset and progression of presbyopic vision symptoms and how your practice can handle future near vision problems. Many will return and even tell you they are ready to try this new multifocal technology. There is a wide array of multifocal choices for patients ranging from emerging presbyopes to even the most advanced patients, including the presbyopic astigmat. 

Case in Point
Kevin, a 41-year-old emerging presbyope, was complaining of discomfort and distance blur. He spends 10-12 hours per day using a computer or other digital device and has found himself taking his lenses out earlier and earlier in the day. He currently wears a -3.50D monthly disposable lens in both eyes and has worn it for years. 

Following a discussion of the visual effects of presbyopia and options to consider, he was fit in a one-day multifocal contact lens design. These lenses were not only more comfortable, but his vision was improved and he loved the convenience of daily disposability. 

Being confident and proficient in satisfying your patient’s needs in the ever-increasing digital world is critical to the success of your contact lens practice. Many newer lens designs provide good optics and address contributors to lens discomfort, and should be considered as a means to grow your practice.