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    How tear osmolarity affects lens wear

    Diagnosing, treating osmolarity efficiently may lead to less CL dropout


    If your patient is symptomatic with normal osmolarity, look for another source for his discomfort. Contributors might include hypersensitivities, allergies, blepharitis, partial blinks, lagophthalmos, conjunctival chalasis, ocular misalignment, or other visual disturbance.

    If your patient is asymptomatic with normal osmolarity, celebrate! Not only can osmolarity be useful in identifying problems in the tear film and ocular surface, but osmolarity can be a valuable marker in determining if changes made in solution or material are truly positively affecting the ocular surface.

    Once osmolarity returns to normal, you can offer the patient encouragement that symptomatic relief will likely follow. This translates to increased comfort and wear time for the patient and offers ODs peace of mind that we are being proactive to ensure long-term CL success and fewer dropouts.

    Related: Ocular surface disease limits surgical options


    Measurable markers key to success

    The message you are attempting to deliver to the patient will be better received and lead to better compliance when you use markers that are measurable. Along with osmolarity, I use the Crystal Tear Report on the Oculus 5M Keratograph to show the patient any debris floating in the tear film, tear meniscus height, tear break-up time, partial blinks, redness, and the presence or absence of oil.

    Tracking how patients’ CL wear impacts these markers helps to validate the conversation to initiate a treatment, change wearing habits, or upgrade the lens itself. By utilizing these markers, I can perform a repeat assessment at a later date to show positive or negative progression.

    Considering that many CL patients are desensitized, it is critical we not only monitor their tear film and ocular surface for change, but we demonstrate stability or instability through measurable means. This creates trust, validates our recommendations, induces compliance, and generates positive outcomes.



    1. Rumpakis J. New Data on Contact Lens Dropouts: An International Perspective. Rev Optom. 2010 Jan;147(1):37-42. 

    2. Bowling E, Bloomenstein M, Gaddle I, Clay G, Harrell M, Ward J, Brimer C. Prevalence of abnormal tear film quality and stability measured by abnormal tear osmolarity among contact lens wearers. Poster presented at: American Academy of Optometry; Anaheim, Calif.; Nov. 8-12, 2016.

     3. Craig JP, Willcox MD, Argüeso P, Maissa C, Stahl U, Tomlinson A, Wang J, Yokoi N, Stapleton F; members of TFOS International Workshop on Contact Lens Discomfort. The TFOS International Workshop on Contact Lens Discomfort: report of the contact lens interactions with the tear film subcommittee. Invest Ophthalmol Vis Sci. 2013 Oct 18;54(11):TFOS123-56.

    4. Glasson MJ, Stapleton F, Keay L, Sweeney D, Willcox MD. Differences in clinical parameters and tear film of tolerant and intolerant contact lens wearers. Invest Ophthalmol Vis Sci. 2003 Dec;44(12):5116-24.

    Read more from Dr. Brimer

    Crystal M. Brimer, OD, FAAO
    Dr. Brimer is a graduate of UNC-Chapel Hill and Southern College of Optometry. She is a fellow of the American Academy of Optometry and ...


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