Millions of people struggle with discomfort and vision problems without realizing the true cause.
If you have “dropped out” of using your contact lenses, you’re far from alone. More than 25% of contact lens wearers stop wearing them — with discomfort and vision problems being the main reasons cited — and it’s likely many of them are among the 15% of contact lens wearers who are dealing with a condition known as contact lens intolerance (CLI).
“Contact lens intolerance is when patients have an inability to wear contact lenses for various reasons,” explained Sonny Goel, M.D., a board-certified ophthalmologist and laser eye surgeon. “Usually, it’s just discomfort — even with a good fit on your contact lenses, you’re still putting a prosthetic in the eye, and the cornea is very sensitive.”
CLI causes and symptoms
CLI has several possible causes. “Allergies can be a factor,” Dr. Goel said, “or you can have dry eye either due to aqueous deficiency or meibomian gland dysfunction — but I would say the mechanical friction of the lens rubbing the eye is one of the main causes of CLI. Very often, once you take out your contact lenses, a lot of the symptoms go away.”
Those symptoms include not just dryness and irritation, but also persistent feelings of “grittiness,” burning, watering, soreness, and eye fatigue.
While some patients seek out over-the-counter remedies like artificial tears or allergy medications, Dr. Goel notes he has had mixed results with this options. “My experience is that very few of those things will work,” he said.
Ignoring CLI can be dangerous. Eye irritation can lead to inflammation and the introduction of bacteria, breaking down the surface barrier protections of the eye. “That’s when patients start to have infections,” Dr. Goel noted. “And those infections can create scars, which can lead to loss of vision.”
Treatments
If you’re suffering from CLI, the obvious non-surgical solution is to stop wearing contact lenses and switch to glasses. Dr. Goel also suggests that taking a “vacation” from your contacts from time to time to give your eyes a rest can also help alleviate symptoms.
But for many, persistent CLI eventually leads them to contemplate surgery to correct their vision. There are several options, though Dr. Goel doesn’t recommend the one you may have heard of, laser-assisted in situ keratomileusis (LASIK), which can often cause increased dry eye as a side effect.
“Since one of the setups for CLI is having dry eye,” Dr. Goel noted, “we don’t want to make their dry eye situation worse by doing LASIK.”
Dr. Goel believes small incision lenticule extraction (SMILE) laser eye surgery is one of the best solutions for CLI. “SMILE uses a small incision, so you don’t have a large corneal flap like you have with LASIK; you’re cutting less of the corneal nerves and leaving more of the cornea intact, and in my practice, I’m seeing less dry eye issues as a result.”
But some patients don’t qualify for SMILE, so Dr. Goel may also recommend another surgical option: The EVO Implantable Collamer Lens (ICL). “With the EVO ICL, we put a lens implant inside the eye,” he explained. “Now, that’s a great technology because you’re not doing any corneal surgery. You’re just going through the cornea to get the lens in the eye.”
EVO ICL is more invasive, however, with a higher risk profile. And it’s more expensive, costing about twice as much as SMILE surgery.
Dr. Goel believes patients need more education about CLI from their doctors. “The biggest issue I find is that patients don’t know what normal is,” he noted. “Their doctors need to set expectations about what is normal, what patients need to see as abnormal, so they can raise their hand and say, ‘Hey, this is not working for me.’”
For more information about contact lens intolerance, go to https://zeiss.com/vision-care/us/home.html.