100% Optical

The impact of patient behaviour on ocular surface and contact lens wear

The 100% Optical peer discussion was led by optometrist Marie-Therese Hall

A girl in a green jumper is applying a contact lens in front of a bathroom mirror
The impact of lifestyle on patients’ ocular surface and the effect on their contact lens wear was the focus of Johnson & Johnson MedTech’s peer discussion during 100% Optical 2024 (24–26 February).

The fully-booked session, entitled Peer review: The lifestyle choice, was held in the AOP Lounge and hosted by optometrist and Johnson & Johnson MedTech professional affairs consultant, Marie-Therese Hall.

Hall was assisted in facilitating the discussion by contact lens optician, Melanie McDowall, and optometrist Janki Shah-Speak.

The focus on the session was “how patient lifestyle and the behaviours that they have, the foods that they eat, and the environment that they are in, could potentially impact their ocular service, and then, subsequently, their contact lens wear,” Hall explained.

She began the discussion by referencing the Tear Film & Ocular Surface Society report, which was released in 2023.

Research in the area of ocular surface is constantly developing, she said.

The first case study up for discussion featured ‘Claire,’ a full-time contact lens wearer, whose needs had changed since her last visit to practice.

Practitioners considered what information might have been important at the initial contact lens fitting, why the patient’s experience of wear might have changed, and how best to establish the changes that the patient might be experiencing.

After the discussion, Hall showed attendees a video of the lens and of the patient’s eyelid, and encouraged them to consider the effect of cosmetics on the tear film and the subsequent contact lens experience.

“How can cosmetics influence patients’ tears, and how can that impact patients’ contact lens wear?” she asked.

Practitioners also discussed whether certain types of contact lenses deposit more material onto the ocular surface than others.

McDowall highlighted that the average UK adult uses screens for 13 hours per day, so wetting technology should be considered.

She also recommended checking for meibomian gland dysfunction.

Bespoke recommendations

The second case study featured a 23-year-old male patient, ‘Prakesh’, who liked the idea of wearing contact lenses socially, for sports, and for when working outside.

Hall urged attendees to think about how contact lens success could be measured and how lifestyle could influence this, based on the patient’s eye examination and his reported day-to-day activities.

She encouraged practitioners to consider which properties might be most important for first fit success, how they would explain this, and what advice they would give ahead of the contact lens trial.

Attendees also considered how success would be measured in the follow-up appointment.

Shah-Speak spoke about the importance of a bespoke recommendation in this case, while also matching need to realistic pricing as far as possible, due to the patient’s age.

Shah-Speak advised on the language that might be appropriate for the patient in this instance: “You may have an idea of what you want to spend, but we’re the clinicians and you’ve come to us for advice,” she said.

She added: “You want to wear them in these different situations and, looking at your eyes, this is what I think is going to work the best for you.”

Having a rethink may be appropriate if the patient makes it clear they can only afford an entry level lens, Shah-Speak said.

She also recommended that practitioners discuss blink rate, screen time, and the importance of wearing safety spectacles at work – especially if working on a dusty construction site, as the patient in this instance reported that he did.

Reflecting on the table discussion, “it was good to see that a lot of us were talking about safety specs, as well as thinking about having those more tailored recommendations or more frequently replaced contact lenses that will help keep his lens clean and comfortable,” Shah-Speak said.

Case study three featured a multifocal contact lens wearer, ‘Gillian,’ whose needs had changed since her last appointment.

Participants considered the elements that might affect vision in multifocal contact lens wearers, how they typically examine tear film, and whether any additional steps would be required in this specific case.

Dry eye and other health changes were also identified as important considerations.

Hall noted that there could be many external factors that had caused Gillian’s change in vision.

“How do we have that conversation?” she asked.

She recommended that practitioners consider the TFOS Impact of nutrition on the ocular surface report, which was released in 2023, in this case.

Hall also emphasised that this case might need more frequent follow-up than others.

She encouraged participants to discuss how they would explain their chosen management to the patient, what alternative lens they would suggest, and when they would follow up.