Joseph P. Shovlin, O.D.
Associate Clinical Editor

In most cases, contact lens wear is a safe and effective way to correct refractive error. Sometimes, however, things go wrong. The patient may present with acute red eye response, infiltrative keratitis, ulcerative keratitis, severe dry eye symptoms, contact lens-induced abrasions or other forms of epitheliopathy.

As we continue to expand our role in primary care, we must be able to respond to these problems. Otherwise, your patientís ocular health, success with contact lens wear and overall satisfaction with your practice may be in jeopardy.

The right approach isn't always so clear, though. When a patient presents with ulcerative keratitis, do you use one or more agents? Do you use silicone plugs on contact lens wearers who present with marginal dry eye symptoms? Do you treat corneal pathology with a bandage contact lens? Or, does the risk of infection preclude you from using this option with today's management techniques? Will you take a fresh look at the overnight wear of contact lenses? In our 23rd Annual Contact Lens Report, we'll look at these three "Great Contact Lens Debates":

 Fluoroquinolone vs. Fortified Antibiotics for Ulcerative Keratitis. When a patient presents with a presumed infection, are you comfortable enough with fluoroquinolones as a single-agent therapy? Or, do you look to using two fortified antibiotics for a slightly broader spectrum coverage? Optometrists Ron Melton and Randall Thomas debate the appropriateness of using these agents for coverage in severe infections.

 To Plug or Not to Plug. We can appreciate the view of those who avoid using plugs in contact lens patients for a red, dry eye. Their concern: The plugs create a "cesspool" effect that causes tears to dam up and increase pro-inflammatory mediators, thereby enhancing ocular surface disease. However, you can also make a strong case for inserting plugs in contact lens patients with marginal dryness in mild aqueous-deficient eyes. Specifically, the plugs allow you to maintain a reservoir of tears on the front surface of the eyes, particularly when application of artificial tears is not enough. Optometrists Albert Morier and Milton Hom discuss the pros and cons of punctal occlusion in your contact lens patients.

 Is the Time Right for Extended Wear? You'll recall that in the 1980s, there were frequent reports of complications associated with extended wear. Amidst the growing public concern, contact lens manufacturers voluntarily reduced the wearing schedule from 30-day extended wear to seven days. With Bausch & Lomb and Ciba Vision introducing new materials with improved Dk/L values, expect manufacturers and the FDA to revisit the issue of 30-day extended wear. Expect patients who want more convenience to ask about this option. Barry Weissman, O.D., argues against extended-wear contact lenses because of their less-than-glowing history. Colleague Burt Dubow discusses why we should take a fresh look at this option.

Finally, though the concept of bandage contact lenses is not new, recent advances and research are expanding their therapeutic potential. Bandage lenses provide a way to manage conditions such as dry eye, epithelial disorders and bullous keratopathy, while offering relief to patients. While bandage lenses are relatively safe with judicious use, infection remains a major risk of this modality. Optometrist Robert A. Ryan discusses when to use a bandage lens and when to use prophylactic antibiotics.

As you can see, we each vary in our approaches to treating contact lens-related problems. However, you must deal with these issues in a timely and appropriate fashion. Your patient's ocular health may depend on it. Hopefully this report will help you manage those rare and not so rare complications that youíll encounter in your contact lens practice.

Nonetheless, the Great Contact Lens Debates will go on.