Published in Ocular Surface

The Latest in Therapeutic Eyewear and Lenses for Dry Eye Disease

This is editorially independent content
7 min read
Dry eye disease is a multifactorial condition that may require concurrent therapies. Discover how optometrists can improve treatments for dry eye patients with therapeutic eyewear and lenses.
The Latest in Therapeutic Eyewear and Lenses for Dry Eye Disease
Worldwide, dry eye disease (DED) affects between 5% to 50% of adults, and the prevalence rises with age and is greater in women than in men.1 The TFOS DEWS II study describes dry eye disease as a multifactorial ocular surface illness characterized by a loss of tear film homeostasis and ocular discomfort.
DED harms the corneal epithelium and can be caused by persistent ocular surface irritation and inflammation, tear film instability and hyperosmolarity, corneal nerve damage, and adverse environmental conditions that result in worsening dry eye signs and symptoms over time.2
Patients with severe dry eye and decreased pain thresholds frequently require more than regular pharmacological therapy to improve their symptoms. Which brings us to the question: what adjunctive therapies can be considered along with pharmacological therapies in DED management for these patients?

Moisture chamber glasses

Moisture chamber glasses are a commonly underutilized treatment for DED. They can help patients cope with dry eye symptoms, including epiphora and foreign body sensation, by reducing the impact of wind and environmental stressors on the ocular surface.

This specialized eyewear can contain a multi-layer eyecup that gently surrounds the eyes and fills the gap between the face and the front frame of the glasses, producing a seal around the eye and efficiently blocking light, wind, and other irritants.

Many moisture chamber glasses are sports wrap-around sunglasses with foam on the frame that protect the eyes from wind, dust, pollen, and air conditioning. Overall, these glasses prevent tears from evaporating from the ocular surface.3 Moisture chamber glasses are created with a discrete, soft, and latex-free silicone eyecup that can be routinely worn without drawing attention to the frame. They include a variety of lens choices, such as photochromic lenses, and come in a variety of styles.
Every pair of glasses can have the lens type, frame color, and eyecup color adjusted because the eyecup is held in place magnetically. Furthermore, each lens choice provides complete protection against UVA and UVB radiation.4

Moisture chamber eyeglasses are a great choice for everyday wear since they seem like a typical pair of glasses with clear lenses.

The mild silicone eyecups make them comfortable to wear, even during outdoor sports such as cycling, hiking, and other high-velocity activities.4,5 Lastly, moisture chamber glasses are commonly claimed to a health savings account or flexible spending account when purchased.

Tinted and blue light filter glasses

While the relationship between blue light and ocular health is somewhat controversial, research has shown that blue light exposure reduces the survival rate of corneal epithelial cells in animal models and cell culture experiments.6 Blue light has been demonstrated to enhance the generation of reactive oxygen species (ROS) in corneal epithelial cells, which eventually causes inflammation. Ocular inflammation can be exacerbated by oxidative damage and apoptosis.6
Niwano et al. used an in vitro cell culture experiment to determine the phototoxicity of blue light on corneal epithelial cells. According to the findings, blue light appears to alter the mitotic phase of corneal epithelial cells in a dose- and time-dependent way. The microvilli on the epithelial layer of the corneal epithelium lose their support and stability, resulting in dry eye.
However, blue light's effects on the cornea are not restricted to corneal epithelial cells, as it may also have a considerable inhibitory influence on corneal stromal cell activity.7 Furthermore, it was shown that blue light-induced oxidative damage was decreased by efficient antioxidant extracts, alleviating clinical symptoms of the ocular surface in a dry eye mouse model and further indicating that blue light is involved in the establishment of dry eye.7
Tinted and blue light filter glasses are becoming popular care tools for people with dry eye who spend a lot of time in front of a computer screen. Still, research has not yet verified this approach for reducing dry eye and improving ocular surface morbidity.

Although some studies have demonstrated that blue light exposure might cause increased inflammation and oxidative damage in epithelial corneal cells, this has not yet been fully verified in human clinical research.

This is also the case with the claim that blue light has a dose-dependent and time-dependent impact on epithelial cells, resulting in the loss of microvilli and tear film support, which can deteriorate with prolonged screen time.
Therefore, the use of blue filter glasses is not yet evidentially indicated for use in dry eye therapy. As this area is investigated further, the use of blue filter glasses may be a future consideration as a viable supplementary treatment option for people suffering from dry eye disease.6,7

Scleral lenses

Therapeutic contact lenses have been known to improve tear film stability on the ocular surface in patients with chronic lid exposure or irregular corneal surfaces leading to tear film instability.

Scleral contact lenses are a form of rigid contact lenses that vault the entire cornea and limbus with a fluid reservoir that helps to hydrate the cornea, regenerate the corneal surface, maintain epithelial stability, and protect the ocular surface against the mechanical shearing forces of the eyelids.

These features make scleral lenses an ideal option for treating ocular surface diseases, and hence, is the reason why they are more widely used today for severe dry eyes patients or patients with severe ocular inflammatory conditions, such as ocular graft versus host disease (GVHD), Stevens-Johnson syndrome (SJS), and Sjogren's disease.8
Scleral lenses are a great example of an available technology that allows for modification of the ocular surface ecosystem that helps in providing better management for severe dry eye cases.
Scleral lens innovations include:
  • Utilizing scleral and corneo-scleral topographers to custom-fit lenses.9
  • Simplifying fits over anatomical obstacles and reducing suction.9
  • Alleviating effects of higher-order aberrations and improving visual acuity.9

Final thoughts

Dry eyes can be significantly disruptive to many people’s daily routines, and these therapeutic eyewear and lens options can provide patients relief within minutes. These treatment options can easily be added to a patient’s current dry eye treatment/management plan, so that vision and overall quality of life and comfort can be improved.
It is important for eyecare professionals to be aware of all the different DED treatment options and research being discussed to set up their dry eye patients for success.

References

  1. Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, Na KS, Schaumberg D, Uchino M, Vehof J, Viso E, Vitale S, Jones L. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017 Jul;15(3):334-365.
  2. Craig JP, Nelson JD, Azar DT, Belmonte C, Bron AJ, Chauhan SK, de Paiva CS, Gomes JAP, Hammitt KM, Jones L, Nichols JJ, Nichols KK, Novack GD, Stapleton FJ, Willcox MDP, Wolffsohn JS, Sullivan DA. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017.
  3. Waduthantri S, Tan CH, Fong YW, Tong L. Specialized moisture retention eyewear for evaporative dry eye. Curr Eye Res. 2015 May;40(5):490-5.
  4. https://www.zienaeyewear.com/products/kai
  5. https://7eye.com
  6. Zhao ZC, Zhou Y, Tan G, Li J. Research progress about the effect and prevention of blue light on eyes. Int J Ophthalmol. 2018 Dec 18;11(12):1999-2003.
  7. Niwano Y, Iwasawa A, Tsubota K, et al Protective effects of blue light-blocking shades on phototoxicity in human ocular surface cells BMJ Open Ophthalmology 2019.
  8. Jedlicka, J., Johns, L.K., Byrnes, S.P. Scleral Contact Lens Fitting Guide. Contact Lens Spectrum. 2010.
  9. https://www.bostonsight.org/practitioners/prose-treatment
Deepon Kar, OD
About Deepon Kar, OD

Dr. Kar is from Calgary, Alberta. She started her healthcare career in academic research by successfully completing a Master’s degree in Neuroscience at the Cumming School of Medicine in Calgary in 2012. She then graduated from the Illinois College of Optometry in 2019 with a special interest in dry eye disease management and specialty contact lenses.

Dr. Kar moved to Lethbridge, Alberta to provide optometric care to the rural community. When she’s not looking after her patient’s eye care needs or joining her co-hosts on the Four Eyes Podcast, you can find her exploring the local trails and eateries in Lethbridge, and searching for a rescue dog to add to her family!

Deepon Kar, OD
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