Pain directly related to lens wear.

[Hari Navarro]

Hi everyone,
With the countless reports of pain related directly to lens wear (even if this is due to poor fitting) could it not be the case that these thing are just plain 'not' in our corneal healths best interest?

I feel the arguement that we all need them to allow us to function within society holds little water unless we are giving little to no weight to the long term damage.

When even the contact lens industry is propossing a 'cascade hypothesis for the development of keratoconus in which chronic ocular trauma plays a significant role. Atopy, eye rubbing and RGP contact lens fitting were all implicated and require the practitioner to minimise insult to the cornea '... shouldn't WE then call for a concerted re-examination of contact lens wear for KC??

Hari

[GarethB]

Follwoing from Hari, feedback to the optomotrist is very important especially if the pain is during a certain activity such as walking in the wind etc.

When my eyes are examnined or new lenses tried I always try to go beyond the lens hurts, is the pain in one specfic area, top/bottom eye lid, when my eye move from side to side.

I am sure this is why when I first got my lenses it took so long to find my optom and I were happy with and which is why they have lasted so long.

Pain is usually a sign something is wrong.

Some lens pain is not due to the lens damaging the cornea, but the eye lids too.

This is why I make a big thing about getting tear production/quality checked out too and ensure adequate hydration which can help reduce the friction between cornea and lens.

[piper]

My last RGPs, before the transplant, were the best I'd ever had. I'll still wear the left one of course. They are comfortable, no feeling of even having lenses. They are that good...EXCEPT when I walk into a WalMart store Then, within five minutes they are dry and sticky. No other store does this to me. Must be their air handling or dust from the clothing or something.

Piper

[Sweet]

As Gareth has said hydration is very important. Since i started using Systane and piggy backing touchwood things have never been better. I now get fifteen hours of wear without pain instead of five, though i rarely wear them as long as that only when working. I also make sure that i have one day without them every week.

Sweet X x X

[Hari Navarro]

Hi Gareth, Piper and Sweet... And so do any of you believe that the wearing of lenses in any way causes your cornea lasting damage? I know you have found ways to sooth your problems but is there a chance damage is still being done?

This is not scare-mongering its just that I have a real concern that lenses have cemented a place in our treatment regimes and for the most part they are bulletproof to criticism.

And even if there have been products developed to trick our eyes into thinking that a foreign body is not pressed against it on a daily basis... does this mean that the trauma is reduced or eliminated?

This is why I again cannot understand why it is that more are not demanding that a full review is undertaken to examine exactly what extent of chronic ocular trauma it is that the president of the British Contact Lens Assoc. is talking about.

Maybe his words have been taken out of context and maybe it has no effect on our future ocular health to wear contacts... but I for one would like a definitive answer.

The KC community generates millions in revenue via lens sales... the very least we can expect is that we are totally informed as to their effect.
But then why would anyone who benefits from this enormous sum jump up and offer data that gives lenses anything other than a glowing report?

This is why when the president of the BCLA mentions 'chronic ocular trauma' and 'insult to the cornea' in the same speech my interest was spiked. There has to be something to this.

Hari

[Hari Navarro]

I just had a quick surf and found this (somewhat dated) report. Although this is a lab report based on animal results the last paragraph highlights, for me at least, that when dealing with unstable corneal tissue (as in the case of KC) deep corneal abrasions (even if not scar forming) are probably something to be avoided.

Contact lens-induced corneal epithelial injury.

* Bergmanson JP,
* Chu LW.

Rigid contact lenses were fitted on primates to study the subsequent corneal epithelial injury. This trauma was compared to corneal abrasions produced by a blunt object. The traumatic abrasion caused a rupture of the basal cells, which were identified as the most vulnerable part of the corneal epithelium for such an injury. The internal plasmalemma of the basal cell remained adherent to the epithelial basement membrane due to the strong hemidesmosomes along the cell membrane. Contact lenses were capable of producing similar injuries which did not penetrate the basement membrane and therefore did not involve the anterior limiting lamina (Bowman's membrane).

We concluded that contact lenses produce a self-limiting trauma and even a severe case of contact lens overwear, although it causes deep corneal abrasions, seldom results in permanent scar formation.

Hari

[John Smith]

Thanks for posting that, Hari.

It's useful to see their suggestion that the use of lenses does not cause scarring.

[GarethB]

Hari,

I beleive certainly in my case over the last two years where my KC is completly unchanged that if you wear lenses sensibly then there is no damage.

When I was having problems between June - December 2004 I was concerned and as soon as my lenses started to hurt they were removed and I soon learn what the early warning signs were so I could remove them 90% of the time before things became painful. There is a difference between discomfort and pain.

Due to the time optoms and nurses can spend with patients (certainly in the UK and it differs between eye units) that patients should be given a good practice guide to lens wear, especially in conditions where lenses are use as part of treating a damaged cornea.

I personally beleive that if lens wear was so damaging that we would be see far higher cases of corneal transplants regardless of people having KC as we form only a small minority of the overall lens wearing population.

The next leaflet the group produces could well be a Lens Wearing Good Practice Guide if such a thing is feasable. If this is the type of thing people would find helpful, let the commitee know so that it can be discussed.

[jayuk]

Hari

Do you think the lens issues are more to do with incorrect fitting than anything else? Bearing in mind the lens technology advances?

I think its fair to assume that a Keratoconic cornea will be less forgiving to an incorrectly fitted contact lens due to a) the sensitivity of the cornea b) the hybrid surface distortion. This may be why KC affected people have more issues with rgp lenses than other areas.....

J

[GarethB]

One of the issues is that sometimes the best vision is not the ideal lens fit from a comfort perspective. Then with good comfort, the vision is not so good so we accept a compromise between the two.

Could it be that as us aptients are demanding too much from lenses so go for best vision while compromising comfort?

Are we also guilty of becoming blazee about lens/eye care?

I know initially I wanted 6/6 pretty much at all cost, now I am happy to settle for 6/12 with comfortable lenses.

It is just that I am fortunate that with changing a few things regarding life style and using eye drops that I get extremely comfortable lens wear and 6/6.

If the drops were masking a problem, then it would be detected on the eye examinations I have on a regular basis.