Addressing common myths and misconceptions in soft contact lens practice

Figures & data

Table 1. Factors to consider outside of changing the contact lens when trying to improve suboptimal comfort; presented in the order they may likely be encountered in the ocular examination.

Factor	Evidence	Action
Vision	Association reported between visual clarity and ocular comfort^Citation124	Ensure CL prescription or CL optical design is optimised (e.g. toric, multifocal)^Citation125
Meibomian gland function	A proactive approach to dealing with mild and asymptomatic MGD in CL wearers has been recommended^Citation50	If signs of MGD or lid margin inflammation are noted, the use of warm compresses,^Citation113 in-office microexfoliation,^Citation115,Citation116 in-office thermal pulsation^Citation117 and lipid-containing drops^Citation118 may all help to improve CL comfort
Lid wiper epitheliopathy (LWE)	Although an association between LWE and CL discomfort has not been proven, this clinical sign is thought to occur due to increased friction between the lid wiper and anterior ocular surface (or CL)^Citation119	Use of lipid-containing drops improved signs and symptoms in one study^Citation123
Solution-induced corneal staining (SICS)	Equivocal evidence exists for an association between SICs and CL discomfort, but comfort scores do change with different combinations of material and MPS^Citation102	Consider changing the material–solution combination, switching to a preservative-free hydrogen peroxide system^Citation103 or removing the care system (necessitating a lens change) to refit with daily disposable

Table 2. Summary of whether 10 common beliefs related to contemporary contact lens fitting are supported by evidence.

Group	Belief	Addressed in the 1992 reviews of Efron and colleagues^Citation3,Citation4	Does current evidence enable the belief to be labelled as a ‘myth’ for contemporary CL practice?
Related to the contact lens and care system	Increasing oxygen transmissibility improves lens comfort	Comfort/‘dry eye’ was addressed but not directly in relation to oxygen.	Myth.
	Hydrogels should no longer be fitted	No.	Myth.
	Patients will be more successful wearing contact lens materials that demonstrate low levels of deposition	No.	Myth.
	When a patient reports discomfort, the first – and most appropriate – option is to change the lens	No.	Myth.
Patient-related concerns	Young children are less successful with contact lenses	No.	Myth.
	Multifocal fitting is not successful	Yes.	Myth.
	Concerns about contact lens-related complications, especially in non-compliant patients	Yes.	No. It is true that non-compliant behaviours increase the risk of CL-related complications; however, those risks are modifiable and there are many options related to the type of lens fit and patient education that the practitioner can employ to mitigate those risks.
	Patients with low astigmatism do fine with spherical lenses	Yes. Discussed as vision being better with glasses than CLs.	Myth.
Business-focused barriers	Focusing on growing my contact lens business is too time-consuming	Yes. Discussed the concern that CL practice is not profitable.	Myth.
	My contact lens business will not grow because as many patients as I fit end up dropping out		Myth.

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