A Crackly Issue

Which is better for DED, eyeglasses or contact lenses?

by Joanna Lee

You hear this from your patients too often these days: They’re driving along a highway and they’re suddenly hit with a sensation of their eyes drying up with a sharp stab that feels like their eye balls are going to crack. They pull over to the side of the busy road, desperately trying to pat their eyes to induce tears or use eye drops to soothe the painful episode before attempting to drive home safely.

The cracking sensation can be attributed to how dry eyes affect the cornea’s natural ability to heal itself, as a recent discovery at the Washington University School of Medicine in St. Louis explained.1 This finding adds impetus towards finding ways to treat dry eye disease (DED), which is usually associated with meibomian gland dysfunction (MGD).

What’s more, this condition which was previously prevalent among the aging population or those experiencing hormonal changes is now spreading to different age groups.

“We are noticing DED among younger people, even in their mid-30s and younger kids. The pandemic has resulted in longer use of monitor screens and mobile phones, and working and studying from home — all contributing to the prevalence of dry eyes,” shared Mr. Ryan Ho, an optometrist from Malaya Optical in Malaysia.

On a daily, practical level, how can those who need to wear prescription lenses deal with the discomforts of dreadful dry eyes? Would glasses or contact lenses impact wearers for the better?

A few optometrists who have also experienced dry eye symptoms themselves share their thoughts.

Go for glasses?

Those who are already sensitive to the painful sensations and effects of dry eyes would eschew wearing contact lenses and choose to wear prescription glasses instead.

“Generally speaking, glasses are better for dry eyes as contact lenses absorb more of your natural tears and can increase the signs and awareness of dry eye symptoms,” shared Dr. Jason Teh, In2Eyes’s owner, as well as founder and director of the Dry Eye Group in Melbourne, Australia — comprising three practices that focus on dry eyes.

“One of the main reasons contact lens wearers drop out of wearing contact lenses is due to dry eyes,” he continued.

Ms. Nur Marsya Sabrina Mohamad Sahrizal, a junior optometrist at Hava Optique in Cyberjaya, Malaysia, also concurs. “As we all know, contact lenses cover the front part of the cornea. So, this prevents the cornea from getting direct oxygen and worsens the dry condition,” said Ms. Nur Marsya Sabrina.

Ms. Nur Marsya Sabrina's deep interest in dry eyes began when she suffered from the condition herself during her optometry undergraduate days. And today, in her practice, she often comes across dry eye sufferers.

“For our patients with 0.25 or zero power, we would still suggest that they wear glasses as they help reduce the rate of moisture evaporation from the eyes and help protect the eyes,” she added.

Moisture chamber glasses

Dr. Teh said moisture chamber glasses could be prescribed for dry eyes. Currently available in certain markets, these dry eye glasses — like the ones produced by Ziena — have silicone gaskets or cups surrounding the eye area, which create a sealed pocket of protection from dust particles, wind, and other environmental factors that could lead to dry eyes.

These moisture chamber glasses have given patients relief from dry eye symptoms and reduced reliance on eye drops. They also help protect the eyes from pollutants and reduce risks of infections that may induce dry eye episodes.

An interesting debate comes with the use of blue light filter glasses in association with dry eyes. While the American Academy of Ophthalmology (AAO) says blue light does not contribute to digital eye strain2 (rendering blue light filtering glasses unnecessary), some emerging studies are showing concerns about blue light having an impact on dry eyes.3,4

According to Mr. Ho, “There are certain studies which show that blue light filters can help dry eyes. It enables the patient to slightly prolong their wear time.”

Choose contact lenses?

For those who prefer to wear contact lenses, it is still a viable choice for eyesight correction despite the setbacks of dry eyes while wearing them. The key is in understanding the choices.

“As we know, contact lenses are directly touching our eyes, so they offer us a clearer vision when we wear them,” Ms. Nur Marsya Sabrina explained. However, she recommends that dry eye patients wear daily disposable contact lenses.

There is, however, something to take note of, contrary to popular belief. “Conventional soft contact lenses with higher equilibrium water content (EWC) may not be that comfortable for dry eyes because the water content from the lens tends to evaporate. And to compensate, they absorb moisture from the eyes’ natural tear film, increasing the discomfort for dry eyes,” continued Ms. Nur Marsya Sabrina.

Silicon hydrogel contact lenses

Here is where silicone hydrogel contact lenses could be a good alternative. These types of contact lenses carry from five up to seven times more water content than hydrogel contact lenses and are more oxygen permeable — enabling more oxygen to be carried to the eye via the water content in the lens. Thus, patients with dry eyes might prefer wearing these types of lenses.

Scleral lenses

Alternatively, dry eye sufferers with refractory issues could consider the use of scleral lenses.5 Conventionally reserved for therapeutic use, these lenses which have a larger area of coverage over the cornea have been showing efficacy ever since Kok and Visser's pivotal 1992 study6 first highlighted dry eye patients who reported longer wear time with the lens with substantial improvement in their visual acuity.

In another study7 by Alipour et. al in 2012, mini scleral lenses were used on patients with moderate to severe dry eyes due to a variety of causes.

Four out of seven patients reported relief from dry eye symptoms, decreased artificial tear usage, and improved visual acuity over their 18-month follow-up period.

“Under extreme dry eye conditions, a bandage contact lens can also be used to help heal the cornea so that normal vision and comfort can be achieved,” Dr. Teh shared.

For him, educating patients is key to mitigating this crackly issue. “Dry eye is such a silent problem initially. We can see the early signs of dry eyes, but most of the patients won’t feel it until it’s progressed to a point where they get the symptoms,” he said. “By then, the dysfunction is a lot worse. So, we’re trying to tap into that early treatment and prevention, along with education instead of waiting for a patient to be really in pain first.”

Contributing Doctors

Mr. Ryan Ho first undertook a Bachelor of Science in Microbiological Sciences at the University of Kansas, USA, in 1996 before studying Optometry at the International University College of Technology Twintech, Malaysia, in 2008. He is a skilled optometrist with over 15 years of experience. He obtained his first degree in B.Sc. at the University of Kansas, USA, and continued to pursue his passion for his Bachelor of Optometry (Hons) in Malaysia. His opinions on the treatment of Ortho-k, monovision, progressive lens fitting, and myopia in children have been well sought after on national television stations, such as RTM, TV3, and national newswires, as well as publications such as Bernama, The Star, and more. He has helped build Malaya Optical from a family-owned business of three generations to become a twotime award winner of the prestigious Brand Laureate Award. While he is busy running his retail practices, online store, and building an eyewear brand, Mr. Ho makes sure to spend

Finding the most suitable options for your patients

Dr. Teh’s practice focuses on thorough eye examinations, and at In2Eyes, they utilize the Lipiflow and the relatively novel IPL (intense pulse light) treatments. Meanwhile, at Malaya Optical, Mr. Ho runs the Oculus K5 to examine the meibomian glands and test tear break-up times.

With a choice of the most suitable lens

References

— be it glasses or contact lenses, while getting proper diagnoses and treatment, dry eye sufferers can continue battling the excruciating symptoms that often disrupt their daily routines.

“While the use of these digital lenses is very much important, patients should still be reminded of the 20-20-20 factor in managing their daily routines,” Mr. Ho concluded. “Don’t stare at the computer for over 20 minutes. Every 20 minutes, look away 20 feet for 20 seconds.” quality time with his family as they are the inspiration behind this brand. During his leisure time, Mr. Ho enjoys riding his road bike on numerous road adventures. ryan@malayaoptical.com

1. Dry eye disease alters how the eye’s cornea heals itself after injury. Available at: https://medicine.wustl. edu/news/dry-eye-disease-alters-how-the-eyes-cornea-heals-itself-after-injury/. Accessed on January 8, 2023.

2. Are Blue Light-Blocking Glasses Worth It? Available at: https://www.aao.org/eye-health/tips-prevention/ are-computer-glasses-worth-it. Accessed on January 8, 2023.

3. Zhao ZC, Zhou Y, Tan G, Li J. Research progress about the effect and prevention of blue light on eyes. Int J Ophthalmol. 2018;11(12):1999-2003.

4. Niwano Y, Iwasawa A, Tsubota K, Ayaki M, Negishi K. Protective effects of blue light-blocking shades on phototoxicity in human ocular surface cells. BMJ Open Ophthalmol. 2019;4(1):e000217.

5. Bavinger JC, DeLoss K, Mian SI. Scleral lens use in dry eye syndrome. Curr Opin Ophthalmol. 2015;26(4):319-324.

6. Kok JH, Visser R. Treatment of ocular surface disorders and dry eyes with high gas-permeable scleral lenses. Cornea. 1992;11(6):518-522.

7. Alipour F, Kheirkhah A, Behrouz MJ. Use of mini scleral contact lenses in moderate to severe dry eye. Cont Lens Anterior Eye. 2012;35(6):272-276.

Dr. Jason Teh is a dedicated practicing optometrist. He is the founder and director of the Dry Eye Group in Melbourne, Australia, a comprehensive diagnostic eye clinic with a vision and commitment towards a variety of advanced treatment options in dry eye disease (DED). A long-standing member of the Optometry Australia Association, Dr. Teh was also a graduate of the University of Melbourne with a B.S. in Pharmacology (Hons) in 1998 and a Bachelor of Optometry in 2001. Having lived with DED himself for more than 25 years, Dr. Teh specializes in its management. Passionate about improving lives through better vision and eye health, he is also committed to educating his patients on the causes of their dry eyes and helping them manage their symptoms through preventative and modifying lifestyle measures. He is proud and most fulfilled by his contribution to the growth of the optometry industry by running dry eye workshops, lecturing on DED at various conferences, performing clinical research trials of new dry eye products, and assisting his colleagues to establish their own dry eye clinics. jason@dryeyegroup.com.au marsyaams@gmail.com

Ms. Nur Marsya Sabrina Mohamad Sahrizal is currently an optometrist at the Hava Optique eyewear company in Cyberjaya, Malaysia. She graduated in optometry from the National University of Malaysia (UKM). She has conducted research studies on dry eye diseases, and her passion lies in issues concerning contact lenses. She has conducted several community services for eye health screening offline as well as online. During her leisure time, she enjoys dancing on her own and watching horror movies.