Comfort conversations

Over time, I’ve realised that most patients appreciate being given the additional choice of contact lenses, even if they don’t take up the option straight away.

As my knowledge of lens materials and designs has grown, so has my confidence in matching patient lifestyle needs with suitable options. I have also become more comfortable framing the recommendation in a positive, patient-centred way, such as linking it to something they had mentioned in their history. Now I see raising contact lenses as a natural part of the consultation, not as an additional add-on.

Over time, I’ve realised that most patients appreciate being given the additional choice of contact lenses, even if they don’t take up the option straight away

Comfort concerns

In practice, the most common comfort concerns I hear from patients are usually related to dryness, lens awareness towards the end of the day, or lenses feeling gritty after several hours of wear.

I find that the way I respond to comfort concerns is just as important as the clinical solution I offer. Patients often feel reassured when I normalise what they’re experiencing. For example, I’ll explain that it’s common to notice lenses more at the end of the day, especially after long hours at a screen. Suggesting small practical tips like the 20-20-20 rule for screen breaks can often make a big difference. I also find that some patients are very sensitive to the initial sensation of a lens on the eye, and they can mistake this normal awareness for discomfort. Using analogies can often help in these instances, for example by comparing lens awareness to wearing new shoes, I advise patients that at first, the lenses may be noticed more, but over time they will feel more natural. Most importantly, I remind patients that comfort issues are solvable and that they don’t have to tolerate discomfort. I explain that a wide range of contact lenses are available and with each contact lens utilising a different technology, it’s simply a case of finding the right lens to match the patient’s lifestyle and needs.

It's important to strike a balance between using positive language to keep patients motivated about using lenses without over-promising. I’ve learned that language makes a huge difference when managing comfort expectations. Rather than telling patients that they won’t feel a thing when inserting lenses, I tell patients that they may feel a drop of cold water going on the eye during insertion and that it’s normal to be aware of the lenses at first, especially during the settling-in period, but that this awareness should quickly lessen with regular wear. I also find it helpful to mention that lens wear should be expected to feel comfortable for most of the day, but there may be times, such as towards the evening of a day after long screen use, when they may be noticed a little more. This sets a balanced expectation and avoids disappointment. I find that using straightforward, honest language helps to build trust with patients whilst also allowing them to enjoy their contact lens experience with confidence.

By linking lifestyle factors directly to comfort, patients understand that small adjustments can make a big difference in their experience with lenses

Lifestyle learnings

Integrating questions around lifestyle factors into the initial conversation is far more beneficial than treating them as a separate checklist. During the initial history taking I’ll start by asking about daily routines, such as work, hobbies, and screen use, and then explore how these might impact comfort with lenses. For example, I will ask about how many hours in a day are typically spent in front of a digital device and how much time is spent in air-conditioned environments. Similarly, I’ll enquire about allergies or seasonal symptoms that could affect lens wear.

Once these factors have been highlighted, I frame them in terms of practical strategies by advising what types of contact lens visual correction and modality would be best suited for the patient’s lifestyle. I also use this opportunity to talk about how certain lifestyle changes can be made to maximise success in contact lens wear. For example, for allergy sufferers, I explain how lubricating eye drops or lens replacement schedules can also help. By linking lifestyle factors directly to comfort, patients understand that small adjustments can make a big difference in their experience with lenses.

It’s vital to consider lens material, modality, and wearing schedule as key factors in contact lens related comfort whilst tailoring the discussion to the patient’s history and priorities

Materials matter

It’s vital to consider lens material, modality, and wearing schedule as key factors in contact lens related comfort whilst tailoring the discussion to the patient’s history and priorities. For instance, if there is a known history of dryness or sensitive eyes, then it’s important to explain how different materials and the likes of daily disposables can help reduce irritation and improve comfort. It’s also important to discuss realistic wearing times because extended hours of wear will also play a role in contact lens related comfort. When having this conversation with patients it’s important to avoid overloading them with technical details and instead focus on what’s relevant to them. Framing the discussion around daily routines, activities, and previous experiences allows me to recommend the lens type that best fits their lifestyle whilst setting realistic expectations for comfort.

When patients attend for follow up appointments it’s imperative to listen out for any cues that may suggest a change in comfort. This can sometimes be as simple as patients mentioning that they are wearing their lenses less than previously. Using open ended questions can help establish any potential cases of discomfort experienced in lens wear. I often ask patients during history taking, ‘When you take your lenses out, is it because you want to or because you feel as if they need to?’ Similarly, I ask patients to grade the comfort of lens wear on a scale of one to 10 and will then cross reference this to answers given during previous visits. If there is a drop in the subjective rating, then I will try to establish what the cause may be. I also use follow up appointments as an opportunity to remind patients that contact lens technologies are ever evolving and will offer patients with an alternative lens to trial particularly if the appointment has revealed concerns around the comfort of the current lens wear where an alternative lens may offer a solution to this.