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Do contact lenses really cause dry eyes?
This is a common issue faced by many wearers as well. In the Asia Pacific Rim, 3 in 10 wearers drop out of contact lens wear(1). Tear Film & Ocular Surface Society Dry Eye Workshop, which is an international panel of experts in dry eyes conditions, report discomfort, dryness as the primary reason for contact lens intolerance(2),(3)
A contact lens can induce dry eyes and it is one of the key reasons for contact lens intolerance. Our tear film is the layer that provides the much-needed nutrients to our eyes and it is also the first optical surface required for clear vision. When we wear contact lenses, the lenses sit in between the tear layers. As the tears start to evaporate its water into the environment, the lens will also lose its water to the environment. If the eyes do not provide adequate tears to replace the loss of water, the dry feeling will be felt by the wearers. In air-conditioning, the air tends to be drier and the eyes lose its water faster to the cold air. It is similar to skin loses water faster in cold weather thereby require moisturizing cream to prevent skin from cracking. Therefore, in an air conditioning environment, wearers tend to feel the dry feeling of their lenses. Because of this dry eyes issue in contact lens wearers, there is a lens material that is designed for it.
Apart from feeling it in an air-conditioning environment, wearers may experience more incidents of dry eyes when they are focusing on their computer works. Every blink is a restoration of our tear layer. On average, we blink our eyes about 14,000 times a day. This works out to about 3-5 secs a blink. However, as we are focusing on our computer or mobile devices screen, our blink interval extended to 7-10 secs a blink. This is because when we get too engrossed in our near work, the eyes have the tentative to forget its blink. With the extended interval of our blink, the eyes lose more water without adequate restore of the tear layer, the eyes get the dry feeling again.
Lens materials that affect the oxygen flow to your eyes and dirty lens or overwore lens that compromise the performance of the lens in your eyes can affect the production of natural tears.
Contact lenses are categorized as medical devices by the Health Science Authority of Singapore. It has to be prescribed by a licensed optometrist, who is registered with Optometrists and Opticians Board of Singapore. They will be able to assess your suitability through the eye examination on your eye health. The optometrist will be based on your needs and recommend the right lenses for your visual activities and your wearing schedule. They will also educate you on the care for your lenses.
That’s why visiting your optometrists to assess your eye health can help you to alleviate the dry eye issue that arises from contact lens wear.
1. Rumpakis K. New data on contact lens dropouts: An international perspective. Rev Optom. 2010:147(1):37-42.
2. The Definition and Classification of Dry Eye Disease: Report of the Research Subcommittee of the International Dry Eye WorkShop (2007). Ocular Surf. 2007 Apr;5(2):179-93.
3. Contact Lens Industry Loses an Innovator Contact Lens Spectrum, Volume: 27 , Issue: April 2012, pages 3-7.
How do we identify Dry Eyes?
Sometimes your eyes may feel hot and burning and when you look into the mirror, it looks pretty red, or other times, you feels that there seem to be something sandy or gritty particles in your eyes that you keep rubbing or feels like rubbing your eyes. These are some commons symptoms patients experienced with dry eyes issue. You will be surprised to know that when you start tearing a lot, of course apart from crying, it is also a symptom of dry eyes. This usually happens more in older folks. Some days when you wake up, you realized that there are some yellow crusty particles at the corner of your eyes, these are the dead cells and dried up mucin. All these that I have mentioned: Burning sensation, Grittiness, Tearing, Redness, Stringing, and excessive mucus are some common symptoms of dry eyes(4). If these are what you experienced daily or very often, like 2-3 times a week, you may have some symptoms of dry eyes that you may want to visit your optometrists. Dry eyes may not be just induced by contact lens wear. Non-Contact Lens wearers can also have dry eyes condition. Females are more prone to dry eyes due to their lifestyle and biological. Seniors with age over 60 is also more prone to dry eyes issue. Some people may feel more symptoms, some people don’t. Usually, people with symptoms that affect their activities will seek help from the optometrists or go on self-medication.
4. GRUBBS 2014 – A Review of Quality of Life Measures in Dry Eye Questionnaires, Cornea 2014 February; 33(2): 215-218
What are the reasons that cause dry eyes?
Dry Eye is an eye condition characterized by the eyes not making enough natural tears or when the quality of the tears that are produced is bad. It can be due to environmental factors such as in an air-conditioning room, windy place or it can be due to your lifestyle, such as lack of sleep, prolong use of a computer, or mobile devices. Dry eyes can also be due to biological factors such as taking of anti-histamine, hormones pills, or underlying medical conditions like diabetes or after eye surgery such as LASIK or cataract surgery. It is important for people to recognize the symptoms for dry eyes and seeks professional help. A prolonged case of dry eye can affect the quality of life, impacting their vision, affecting the viability of the cornea cells, cornea is the transparent surface of our eyes, it relies on the tears for its nutrients(5).
A visit to your optometrists can help to assess the severity of your dry eye conditions and what could be the cause of it. Your optometrists will ask for the frequency of the symptoms, the associated cause factors, and check the eyes for signs of dry eyes and its severity. After ascertaining the causative factors, clinical sign, and severity, the optometrists will recommend the eye drops needed for your conditions.
In most of the cases, the first line of relief for dry eyes is an eye drop. Every eye drops have different ingredients and mechanics of actions to cater for different dry eye conditions. So consult a professional for the recommendation of eye drops for your condition.
5. https://www.aao.org/eye-health/diseases/what-is-dry-eye, accessed 04/08/2020
If I have an issue with dry eyes or more prone to having them, can I still wear contact lenses?
some contact lens wearers avoid asking this question because they worried that their optometrists may ask them to stop wearing contact lenses. Do you know that contact lenses have become the choice of vision correction for many people? Some people prefer to wear contact lenses even at home because of the convenience brought by the contact lens. Therefore, there are some wearers who rather suffer discomfort, dryness in silence than to stop wear lenses. But with today’s advancement in contact lens materials, even you have dry eye or prone to dry eye, the need to discontinue contact lens wear due to dryness is very unlikely. You can still wear a contact lens.
So, if you have a dry eye or more prone to having them, the first thing to do is to visit your optometrists to evaluate your dry eye condition. From the eye examination, we can determine the reason for your dry eye issue and recommend the best way to increase your contact lens wearing comfort.
As mentioned earlier, the eyes need a sufficient flow of oxygen to produce natural tears. Lens materials that allow more oxygen to pass through the lens giving the eyes better breathability will be a better choice(6). Daily disposable lenses are a great option for wearers with dry eyes. Because they are thrown away at the end of each day, it is more hygienic than scheduled replacement lenses such as biweekly or monthly lenses. This also minimizes the problem of lens drying out due to improper cleaning and build-up of protein and dirt deposits that can cause discomfort.
For some reason, such as costs, If you still want to use monthly lenses, then you have to make sure that you follow the replacement period of your lenses and not extend its wear. Most important, you have to make sure that the lenses are cleaned properly with the prescribed multi-purpose disinfecting solution. However, for dry eyes wearers, a hydrogen peroxide-based cleaning system is recommended. The hydrogen peroxide system has high efficiency in cleaning the lenses and is preservative-free after it has been neutralized.
6. Papas. E et al The significance of oxygen during contact lens wears, 2014 British Contact Lens Association
How is Dailies Total1 suitable for the wearer who is prone to dry eyes?
As mentioned previously, contact lens-induced dry eyes are due to the tears evaporated into the environment and follow by the moisture in the contact lens losing to the environment. As the lens loses the water, it hardened up and absorb the tears to maintain its softness. Therefore, the eye will have a dry feeling as the lens absorbs the tears. DT1 is a water gradient material, also known as a water lens, that is rich in its moisture on the outer surface that is in contact with the eyes and a silicone hydrogel core that allow oxygen to pass through. This provides an ideal condition for the eyes to enjoy the softness of the lens and the plentiful of oxygen passing through the lens. Its surface is covered with its surface technology that helps to stabilize the distribution of the tear and delay the evaporation of tears to the environment. This combination works well to maintain the moisture in your eyes. It is also a reason why you feel that the lens is slightly slippery as it’s surface technology increase the lubricity to reduce friction between the eye and the lens, thereby giving you a greater comfort(6).
Why Dailies Total1? How is it different from the contact lenses in the market?
In the past, most of the contact lenses are of hydrogel material that is a water-absorbing form(6). These lenses are soft and comfortable to wear on. However, it limits the oxygen flow from the tears to the eyes. This often causes the eyes to be lacked oxygen, resulting in other complications. With its water-absorbing characteristics, it tends to lose water faster to the environment and absorb the water from the tears. This results in the dry feeling for the wearer. As it is soft and gives initial comfort on wearing, the hydrogel was dominating the soft lens market.
Silicone Hydrogel was a breakthrough in contact lens in the early ’00s, it is a material that allows more oxygen to flow through, giving better breathability to the eyes. Materials scientists are able to merge these 2 materials, hydrogel and silicone together. A new homogenous silicone-hydrogel lens material is used(6).
In the current market, more new lenses are introduced with this silicone hydrogel materials. This new material allows more oxygen to flow through and does not dry up that fast. It is also soft enough for most wearers to be comfortable with it. Although there are some who said that it is still a bit uncomfortable as compared to the former hydrogel lens. Because it still has some rigidity of silicone across the lens. Silicone hydrogel is a material that is a combination of both silicone and hydrogel. Silicone is allowed more oxygen to pass but it is rigid in nature and tends to attract more deposits. The hydrogel is a soft and moisture-rich material. However, it limits the oxygen to transmit through(6). The combination gives the benefits of both and also the cons of both.
Our scientists in Alcon keep innovate and challenge ourselves in finding better lens materials for our wearers and in the most recent years, a new breakthrough in lens material was introduced by Alcon. Water Gradient lens or some refer it as a water lens. This is an ultra-soft lens that gives wearers a good comfort and provides high oxygen to pass through the lens.
Dailies Total 1 is the only water gradient material lens, also known as a water lens that provides the ideal wearing condition. It has an inner core that is silicone hydrogel that allows a high flow of oxygen to pass through. Its outer surface is hydrogel rich or moisture rich that is more than 80% water at its surface and close to 100% water at the end when in contact with the eyes. This moisture-rich gives an ultra-softness feeling to the wearer and there are times when the wearer feels like they are not wearing any lenses.
Dailies Total 1 has its silicone hydrogel in the core and a water-rich surface in contact with the eyes. This gives the ultra-soft feeling that is a comfort to the wearers yet gives a high flow of oxygen to the eyes. With adequate oxygen and the water-rich surface, the eyes feel more hydrated and breathable. Without a dry feeling, the eyes naturally feel more refreshing as well. Apart from this, you have also mentioned that it is slippery. This is due to its surface technology that increases the lubricity that reduces friction between the eyes and the lens7. With the reduced friction between the lens and eyes, wearing Dailies Total 1 feels like wearing nothing at all.
In general, Dailies Total 1 wearers can wear for longer hours as compared to traditional hydrogel lenses. However, the optometrist would still recommend you to wear your lenses not more than 8 hours a day. This is to allow your eyes to rest.
Non-contact lens-induced dry eyes due to allergies. How do we differentiate between dry eyes and allergies?
There some similarity symptoms for dry eyes and eye allergies. It can be a challenging task for professionals to differentiate when the patient is unable to relate the series of events or situation that leads to redness or itchiness that is the symptoms for both dry eyes and allergies. In some patients, they may have both dry eyes and allergies at the same time. Of course, the optometrists will be able to differentiate after the eye examination from the series of tests we have done.
For a layman, dry eyes and eye allergies may feel the same as the symptoms are pretty much the same, such as redness of the eyes or itchiness. If we were to think about what I have mentioned about dry eyes. It is due to inadequate production of tears or losing the tears faster to the environment causing a dry feeling eyes. Eye allergies, on the other side, are triggered by an allergen that is sensitive to the patient. It can be seasonal or temporary(7). The treatment for both is different as we are addressing different eye conditions. In most of the case, if it is a dry eye issue, we will prescribe a lubricating eye drops that are related to your type of dry eyes and advise you to reduce the activities or change the environment situation, such as avoid sitting directly under the air-con, to minimize your dry eyes. If it is of an allergy case, we will have to address to the allergen or triggers, such as pollen, dust, that causes the redness. To minimize the redness in allergy, we may prescribe OTC anti-allergy eye drops.
In both dry eyes and allergies, it is important for the patient to visit their optometrists if they think that they might have dry eyes or allergies. Leaving it untreated will cause more issues to the eye surface, which we know as the cornea. It is a highly sensitive and transparent tissue that allows light to pass so that we can see clearly and protect the eyes from microorganisms, such as bacteria or germs. If scarring or the surface is compromised, the infection may happen and our vision may permanently be impaired if scarring occurs on the cornea.
In general, it is recommended to visit your optometrists whenever you find that your eyes look red, you feel that your eyes are constantly itch or discomfort, you feel that your vision is not clear anymore. A regular eye examination is necessary for everyone, in particular, a C/L patient as the optometrist is able to assess not just its prescription but the health of the eyes and the current suitability of wearing lenses.
7. American College of Allergy, Asthma, and Immunology. Allergy Facts. http://acaai.org/news/facts-statistics/allergies (Accessed April 8 2019)
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