When Nick Howard started out as a contact lens optician more than three decades ago, he would ask his patients whether they use a computer.
“Nowadays it is a given,” he said.
“You see two-year-olds in prams using digital devices,” Mr Howard added.
From teenagers who play computer games into the small hours of the morning to office workers who spend large chunks of the day in front of a computer, modern lifestyles involve more tasks that prompt reduced or incomplete blink patterns.
Working in practice, Mr Howard has noticed symptoms of dry eye often associated with retirees in teenagers.
“Long screen times are an inevitable trigger of low-grade dry eye and, in the fullness of time, that can develop into moderate to high level dry eye disease,” he highlighted.
"We can only speculate about what the symptoms of today’s young people will be like in 20, 30 or 40 years,” Mr Howard said.
The contact lens optician estimates that he now spends around half of his working week dealing with dry eye.
Asked what steps he takes to prevent dry eye developing in contact lens wearers, Mr Howard highlighted the importance of using corneal topography to assess tear film quality and consistency.
“It is my go-to for an initial and ongoing assessment,” he said.
Mr Howard added that the pictorial nature of corneal topography makes it patient-friendly, providing a clear illustration of how different treatments and contact lens materials affect the tear film.
Measuring tear film osmolarity and monitoring any related lid issues is also key, Mr Howard emphasised.
“Long screen times are an inevitable trigger of low-grade dry eye and, in the fullness of time, that can develop into moderate to high level dry eye disease”
He shared that it is unrealistic to fit a patient with contact lenses and expect the tear film to continue as it did before.
“If you put a contact lens on eye, you will inevitably disrupt the tear film to an extent. In order to balance the books, we’ve got to take some sort of balancing action to maintain the status quo – whether that is dietary change, lid management, the use of lubricant drops or habitual changes at work,” Mr Howard said.
As well as paying attention to anterior segment issues, practitioners should consider the type of contact lens material that they fit patients with.
Although silicone is beneficial for oxygen permeability, Mr Howard noted that it is also hydrophobic and can generate a moderate amount of friction.
Dry eye sufferers may benefit from contact lenses with reduced silicone content or comprised of ‘smart silicone’ with a longer molecular chain that reduces the level of raw silicone, while maintaining oxygen permeability.
“There are also lenses with a very high oxygen transfer but the molecular structure of the lens changes at surface so it becomes silicone-free,” he said.
“We can only speculate about what the symptoms of today’s young people will be like in 20, 30 or 40 years”
Signs of dry eye
Asked what dry eye symptoms he looks out for among contact lens wearers, Mr Howard highlighted that patients may wear their contact lenses for shorter lengths of time than they did previously.
“You are looking out for a reduced level of comfort and possibly reduced quality of vision,” he said.
He said that a strange paradox of dry eye is that patients will often complain of watery eyes.
“If a patient comes into the consulting room dabbing tears away from their cheek on a cold, windy day that is an absolute classic symptom of dry eye,” Mr Howard shared.
He concluded that eye care professionals across the globe are becoming increasingly aware of dry eye disease.
“They are developing advanced skills in early detection, whilst highlighting the importance of effective treatment plans and options for dry eye disease,” Mr Howard highlighted.
Image credit: John Holcroft