by Carmen Abesamis-Dichoso, OD, MAT, FIACLE, FPCO, FAAO
A good opportunity to recommend daily disposables for patient peace of mind.
The COVID-19 crisis has radically changed the practice landscape for optometrists. Safety, more than affordability and convenience, is now the principal consideration for both patients and their eye care providers. Against this backdrop, contact lens use and maintenance have come under greater scrutiny. In particular, patients are questioning whether contact lens wear during the pandemic is safe. The consensus, from both practitioners and academics, is that it is safe to wear contact lenses during the pandemic. 1-5
NO CAUSE FOR CONCERN
There is no evidence to suggest that contact lens wearers are at increased risk of contracting COVID-19. As long as patients follow standard care and hygiene practices, it is safe to wear contact lenses amid the ongoing health crisis. Many organizations, such as the American Academy of Optometry, the American Optometric Association, and the International Association of Contact Lens Educators, have published updated guidelines to address concerns related to contact lens wear during the pandemic. 1-5 These guidelines cite more or less the same basic recommendations:
Patients should wash their hands thoroughly before handling contact lenses;
Those wearing monthly and 2-week lenses should regularly disinfect their lenses according to manufacturer recommendations;
Those wearing daily disposable lenses should dispose of lenses each evening; and
Patients who have any cold or flu symptoms should temporarily stop wearing their lenses.
PROMOTING DAILY WEAR LENSES
In my opinion, optometrists should focus on promoting daily disposable contact lenses at this time. This modality is not only the safest option for patients; it also offers additional benefits over other wearing modalities. These include enhanced comfort, comparable cost, greater convenience, fewer complications, better tear film compatibility, and less lens dehydration.
It has been well documented and reported that most common complaints and concerns of contact lens wearers have to do with discomfort as a result of end-of-day dryness. 6,7
Comparable or Lower Cost
When worn 5 days per week or less, daily disposable lenses are less expensive than longer-wear modalities (eg, monthly, biweekly). 8 When worn 7 days a week, daily wear contact lenses cost a bit more than other contact lens modalities. For patients wearing monthly, biweekly, or frequent replacement contact lenses, in addition to the cost of their lenses, there are the added expenses of also regularly purchasing contact lens cases and lens care solutions.
Because daily disposable contact lenses don’t require cleaning or soaking, no contact lens case is needed, and compliance is very high. Practitioners don’t have to worry about whether patients are replacing their cases every 3 months or whether they are properly employing the ruband-rinse cleaning technique.
Daily disposable contact lenses have a lower incidence of corneal infiltrative events than other wearing modalities. 9 Additionally, because these lenses are disposed of each day, there is no protein buildup that causes decreased comfort and blurred vision in lenses with longer wearing schedules.
As long as our patients follow proper contact lens handling and hygiene guidelines, they are at no increased risk of COVID-19 infection compared with nonwearers.
Better Tear Film Compatibility
The tear film is a complex structure with a complex function. Silicone hydrogel daily disposable lenses are less prone to dehydration than traditional hydrogel lenses due to their lower water content, which means greater tolerance for lens wear.
Traditional hydrogel lenses that are worn for an extended period of time tend to build up deposits from tears, which contain proteins that attach to the lens and are not totally eliminated by the use of cleaning solutions. Gellatly et al found that both high and low contrast acuity decreases as a contact lens ages. Therefore, it is safe to assume that the sooner a lens is disposed of, the less chance it has to build up deposits, thereby maximizing the visual acuity of its wearer. 10
HELP KEEP PATIENTS SAFE AND HEALTHY
As long as our patients follow proper contact lens handling and hygiene guidelines, they are at no increased risk of COVID-19 infection compared with nonwearers. The benefits of daily wear contact lenses predate the pandemic, but they now take on increased importance because of the fear engendered by the crisis. Promoting the use of this modality as a safer alternative for contact lens wearers is an opportunity for eye care practitioners to show our patients that we have their best interests at heart.
Author’s note: I wrote this article while sheltering in place in Manila. With time aplenty, I have been scouring the internet and reading about the struggles of many optometrists. I join the universal fraternity of our profession in wishing that everyone will come out of this well.
COVID-19 and contact lenses: the facts you need to know. Centre for Ocular Research and Education. https://core.uwaterloo.ca/covid-19/. Accessed May 4, 2020.
Contact lens wear and coronavirus (COVID-19) guidance. British Contact Lens Association. www.bcla.org.uk/Public/Public/Consumer/Contact-Lens-Wear-andCoronavirus-guidance.aspx. Accessed May 4, 2020.
Contact lens wear during COVID-19. American Academy of Optometry. www.aoa.org/covid-19-patient-resources/contact-lens-wear-during-covid-19. Accessed May 4, 2020.
Industry informer position statement COVID-19. International Association of Contact Lens Educators. https://iacle.org/industry-informer-position-statementcovid-19/. Accessed May 5, 2020.
Contact lens wear during COVID-19. American Optometric Association. www. aoa.org/covid-19-patient-resources/contact-lens-wear-during-covid-19. Accessed May 5, 2020.
Kojima T. Contact lens-associated dry eye disease: recent advances worldwide and in Japan. Invest Ophthalmol Vis Sci. 2018;59(14):DES102-DES108.
Dumbleton K, Richter D, Woods C, et al. Compliance with contact lens replacement in Canada and the United States. Optom Vis Sci. 2010;87(2):131-139.
Efron N, Efron SE, Morgan PB, et al. A ‘cost per wear’ model based on contact lens replacement frequency. Clin Exp Optom. 2010;93(4):253-260.
Chalmers RL, Keay L, McNally J, Kern J. Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates. Optom Vis Sci. 2012;89(3):316-325.
Gellatly KW, Brennan NA, Efron N. Visual decrement with deposit accumulation on HEMA contact lenses. Am J Optom Physiol Opt. 1988;65(12):937-941.