Abstract
PurposeTo investigate whether carrying out various interventions part way through the day influences comfort in symptomatic daily disposable (DD) contact lens wearers.MethodsA subject-masked, randomized, controlled clinical trial was conducted in thirty symptomatic soft lens wearers who wore their habitual DD contact lenses bilaterally for 12 h on two separate days. Five hours after lens application, one of the following three interventions or a control was performed on each eye: replacing the existing lens with a new lens; removing and reapplying the same lens; performing a ‘scleral swish’; and no action (control). Comfort scores were recorded using SMS text messages every hour following lens application using a 0 (causes pain) to 100 (excellent comfort) scale. Comfort scores before lens application, at 6 mins post-application, and at 6 mins post-intervention were also recorded.ResultsThere was a significant reduction in comfort from pre-lens application to 6 mins post-application for all groups (all p<0.05). Comfort gradually decreased from 6 mins to 5 h after lens application for each group (p<0.0001) with no significant difference between groups over the 5-h period (p = 0.09). There was no significant difference in comfort 6 mins post-intervention for any group (all p>0.05). After the intervention, comfort continued to decline (p<0.0001) with slightly lower mean scores for the control group compared to the new lens group (p = 0.003). Change in comfort relative to pre-intervention (5 h) was similar for all groups (p = 0.81). There was no difference in comfort at 12 h between groups (p = 0.83).ConclusionThis work has confirmed that comfort shows a continual and significant decline over a 12-h wearing period in symptomatic DD contact lens wearers. None of the interventions investigated had any significant impact on end-of-day comfort. These data suggest discomfort in lens wearers is more heavily influenced by changes to the ocular environment rather than to the lens itself.Trial RegistrationControlled-Trials.com ISRCTN10419752 http://www.controlled-trials.com/ISRCTN10419752
Highlights
The growth of the contact lens industry has been severely limited by the number of discontinuations from lens wear which occur each year
This work has confirmed that comfort shows a continual and significant decline over a 12-h wearing period in symptomatic daily disposable (DD) contact lens wearers
The stagnation of the post-lens tear film may in turn lead to an increased accumulation of debris, inflammatory cells and other tear film components behind the lens [21,22,23] resulting in increased adverse inflammatory events [24]
Summary
The growth of the contact lens industry has been severely limited by the number of discontinuations from lens wear which occur each year. Contact lens discomfort (CLD) has been consistently reported as the leading cause of lens drop out [2,3] Wearers experiencing CLD usually experience fewer comfortable wearing hours [2,3,4] and they may feel compelled to alter their wearing habits in order to relieve discomfort [5]. Alterations to the ocular surface caused by the lens such as lid parallel conjunctival folds (LIPCOF) [14], lid wiper epitheliopathy (LWE) [15,16], and meibomian gland dysfunction (MGD) [17,18] have been associated with symptoms of discomfort It is unclear whether or not CLD is driven by an underlying inflammatory response. Morgan et al [32] reported an increase in potential inflammatory cells at the lid margin after contact lens wear which was greater in subjects wearing high-friction contact lenses
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