Clinical characterisation of contact lens discomfort progression

Laura Valencia-Nieto; Alberto López-de la Rosa; Alberto López-Miguel; María J González-García

doi:10.1016/j.clae.2023.102096

Clinical characterisation of contact lens discomfort progression

Cont Lens Anterior Eye. 2024 Feb;47(1):102096. doi: 10.1016/j.clae.2023.102096. Epub 2023 Dec 14.

Authors

Laura Valencia-Nieto¹, Alberto López-de la Rosa¹, Alberto López-Miguel², María J González-García³

Affiliations

¹ Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain; Departamento de Física Teórica, Atómica y Óptica, Facultad de Ciencias, University of Valladolid, Valladolid, Spain.
² Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain; Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, University of Valladolid, Valladolid, Spain. Electronic address: alopezm@ioba.med.uva.es.
³ Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain; Departamento de Física Teórica, Atómica y Óptica, Facultad de Ciencias, University of Valladolid, Valladolid, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain.

PMID: 38097423
DOI: 10.1016/j.clae.2023.102096

Abstract

Purpose: This study aimed to assess the subjective and objective differences among the steps of the contact lens discomfort (CLD) progression classification established by the Tear Film & Ocular Surface Society (TFOS) using questionnaires and clinical signs, and to propose a simplified classification.

Methods: Contact lens (CL) wearers were evaluated in a single visit. The Contact Lens Dry Eye Questionnaire (CLDEQ)-8, the Contact Lens Discomfort Index, and Visual Analog Scales for discomfort and dryness were administered. The non-invasive break-up time, the tear film lipid layer thickness, conjunctival hyperaemia and papillae, lid-parallel conjunctival folds, the fluorescein tear film break-up time, corneal and conjunctival staining, lid wiper epitheliopathy, and the Schirmer test were assessed. Sign and symptom scores were compared among TFOS CLD progression steps using analysis of variance or the Kruskal-Wallis H test. Steps 1 and 2 (reduced comfort), and steps 3 and 4 (reduced wearing time) of the TFOS classification were combined to obtain a simplified classification, and the same comparison was performed. A p-value ≤ 0.05 was considered statistically significant.

Results: One hundred-fifty CL wearers (97 women and 53 men) aged 34.4 ± 12.6 years were included. In the TFOS classification, there were significant differences between step 0 (no CLD) and the rest of the severity steps for the scores obtained in all questionnaires (p ≤ 0.015). All steps were differentiated (p ≤ 0.032) based on the simplified classification for all questionnaires, except steps 1 and 2 for the CLDEQ-8 and dryness VAS (p = 0.089 and p = 0.051, respectively). There were no differences (all p ≥ 0.06) between the sign scores among the steps of either classification.

Conclusion: CLD management is encouraged from its first appearance. Simplifying the phases of CLD severity may allow a more accurate classification and a better awareness of the problem by clinicians and CL wearers by using more straightforward simple messages.

Keywords: Classification; Contact lens; Discomfort; Questionnaires.

MeSH terms

Conjunctiva
Contact Lenses, Hydrophilic* / adverse effects
Cornea
Dry Eye Syndromes* / diagnosis
Dry Eye Syndromes* / etiology
Female
Humans
Male
Tears