Therapeutic use of silicone hydrogel lenses for the management of dry eye

[dcampbeld]

This article appears on the Silicone hydrogel website. As the title of the thread suggests it covers silicone hydrogel contact lenses used as therapeutic bandages in the treatment of dry eye. It is in fact a case study of the use of Night and Day as well as some general information on the topic. I am posting the link as there seems to be an interest in some threads in the use of silicone hydrogel contact lenses as a treatment for dry eye. It is not a publication but an article appearing on the Silicone Hydrogel website.

Title: Therapeutic use of silicone hydrogel lenses for the management of dry eye
Date of publication: March 2007
Source: http://www.siliconehydrogels.org/in_...tice/index.asp

Abstract
The therapeutic use of silicone hydrogel lenses for management of dry eye is the topic discussed by Richard Lindsay. A case report of a patient with bilateral corneal epitheliopathy (resulting from a severe chronic dry eye condition) is described. The outcome of successful treatment with high Dk Silicone hydrogel lenses is discussed, along with the other uses of these lenses in therapeutics

Darren

[calli66]

Hi Darren-
Dr G (Q&A doctors section) here discussed this topic a while back. He has had good results using the sil-hydrogel lenses for some of his patients with corneal damage. They have high oxygen transfer levels, and the advantage is that one can sleep in them. As a bandage, I believe ointments or drops are used at the same time.

For therapeutic use for dry eye, the sil-hydrogels may have less value (my own opinion, based on my experience). I have very dry eyes (but no other major problems) and the sil-hydrogels are very uncomfortable for me. Dr. G says the "wettability" of the lenses isn't so great, so there's more friction. But they work for some people. (see posts by Prattstar--I think he uses the bandage lens to heal recurrent corneal erosions).

I have good luck using other soft lenses (around 60% water--Biomedics XC and Extreme H2O). For me, they ARE therapeutic, up to a point. They keep my corneas from drying so much (I live in New Mexico USA--very low humidity, windy). They have their limitations--sometimes I can't wear them (pollen season), and some days my eyes are so dry that there's not enough tears to keep the lens hydrated (opaque spots develop on the lens, impairing vision). During theses dry days, lubricating with re-wetting drops doesn't seem to help much. Extra blinking sometimes solves it, but not always.

My eyes tend to be more comfortable with wearing lenses--I wear them 8-10 hours a day. I think it keeps my corneas more moist/ stable, and reduces the eyedrops I use during the day--I find that too many eyedrops mess up the balance of tears and cause more irritation.

C66

[painintheeye]

are these lens similar to scleral lens

c66, if you are wearing contact lens that would mean your dry eye condition isn't severe at all? i have moderate to severe dry eye and is looking into scleral as last resort. i have acqueous deficient dry eye and no other problem. does this lens represent another option for me or not? thanks, chris

[calli66]

I don't define my dry eye condition as "severe" at the present time, because it has stabilized through careful management. I have tested 2 in each eye on the Schirmer's scale pretty much for the last 4 years, regardless of whether I've worn contact lenses or glasses. I have had blepharitis (briefly) early on.

I CANNOT wear most contact lenses--having tried many, including all the newer silicon hydrogel lenses. The 2 brands of lenses I mentioned in my previous post are advertised as being an option for dry eyes (Extreme H2O, Biomedics XC ). These are high water content (60%) soft lenses. The first is made from a material that typically doesn't dry out and shrink much (Hioxifilcon A). The second is a soft lens with a special coating that I guess makes it more wettable (another lens of the kind is the ProClear Compatible).

I prefer contacts for vision correction reasons, because I am very nearsighted (-8.00). If it weren't for that, I would be OK wearing glasses--could get prescription Panoptyx, etc.

Whether you can wear contacts or not with dry eyes really depends on the reason you have dry eyes, whether you can find lenses that are comfortable and correct vision well enough, and your desire to "keep trying" while "listening" to what your eyes are telling you (not overwearing them, keeping them scrupulously clean with cleaners, protein-remover, etc.) Soaking/disinfecting solutions are known irritants for sensitive eye wearers---so there's lots to learn there.

Talk to your eye doctor, research some lens types if you want to, and give them a try. You will also need a really nice, fashionable, excellent quality pair of glasses for when you can't wear your lenses (which may be a lot).

I think soft lenses CAN be worn by dry eye sufferers--it's cheaper than going the route of scleral-type lenses. I too, view the scleral lenses as a "last resort" option, but more suited for people with permanent corneal damage.

Soft lenses aren't a short term solution for dry eye symptoms (foreign body sensation, redness, itching, discharge, etc.) You really have to have these under control, as well as night-time dryness, when considering contact lenses, I think. I went for more than a year wearing glasses, not contacts, when first diagnosed---and while trying Restasis for the first time, and ointments, gels, etc.

Find a patient eye doctor to help you with trial lenses. I choose optometrists instead of ophthalmologists (MD's) because they usually have more time and knowledge about contact lenses, and they aren't as expensive to visit (and for followups).

C66

[Guest]

Chris,

I wore a bandage lens constantly for 3 weeks, and I would say that I have moderate to severe dry eye in my right eye resulting in recurrent corneal erosions hence the trial of a bandage lens.

The trial went ok but by the end of 3 weeks my eye was quite inflammed. However, we then decided to take another approach as the bandage lens - whilst a zero prescription affected my vision (due to my laser reshaped corneas) during the day, I would apply a new lens every night and remove it of a morning.

This had a reasonable success the first week or so but but last week and again today, I woke with my right eye really inflammed and quite sore. I also had some discharge this morning (as I did last week) but the DR examined me last week and assured me that there was no infection.

I will be seeing DR again on Thursday so hopefully I can get to the bottom of this.

As for the bandage lenses (I think they are just zero prescription contacts) the ones I have are:
Ciba vision - Air Optix Night and Day (30 nights continuous wear) BC=8.4 and Dia=13.8
Bausch & Lomb Prevision (Haven't tried these yet) BC=8.6 and Dia=14.0.

Hope this helps
Ian

[dcampbeld]

Hi

I posted this link as the case study reported the successful use of silicone hydrogels (Focus Night and Day) in a dry eye patient. It just shows that lenses can be used in dry eye patients and give forum readers the opportunity to see a happy dry eye patient in lenses.

Chris I think that you need to ask for your doctors recommendation on what is right for you. Each patient is an individual and so there is going to be some trial and error about which lens if any can be used in your case. As Calli66 says he can not wear silicone hydrogel lenses but can wear conventional lenses such as Extreme H2O and Biomedics XC whereas this case study and DrG have shown the successful use of silicone hydrogels in dry eye patients.

Darren

[painintheeye]

thanks to all who replied

thanks guys, you've been great in answering my question. i am having a hard time dealing with dry eye symptoms. the reason i was asking about contact lens is not necessarily for corrective reason because i don't mind wearing glasses rather than i am looking for dry eye relief so i can live life again with my 6 year old. so with that in mind, would scleral lens still be the only lens that can meet my goal? thanks, chris c

[sazy123]

Hi painintheeye

i tested this theory the other week for theraputic use. And i have to say they did help with the burning in terms of protecting the cornea from the enviroment. If your main complaint is burning/stinging then they could be usefull. But my eyes were still to dry to handle them for more than an hour, they got dry and rewetting drops werent enough the drops soon dried up and they were still too dry. The worse thing was taking them out, it took me ages, If i didnt take me so long to take them out i would have given them more chance. and since i think the root cause of my dry eye in the first place was contacts i thought its not a good idea. Although these ones are better for dry eye than the ones i used to wear.

Scerals are good for dry eyes but some people do not like them either. i dont think you would get the dry problem as they dont sit on the cornea.