Can Seasonal Allergies & Contact Lenses Coexist?

A topical antihistamine may be the answer.

BY JODI LUCHS, M.D., F.A.C.S.

They file into our offices every spring: patients whose seasonal allergies are causing contact lens intolerance. Their eyes are red, dry and itchy. They cannot wear their contact lenses for very long, and it’s impacting their work and leisure activities — even their social and emotional well being. The bottom line is that these people are quite unhappy.

Ocular allergies affect 54% of contact lens wearers, according to the Asthma and Allergy Foundation of America.¹ That’s about 15 million patients. When allergy season peaks, 73% of them cut their wearing time or use more rewetting drops than usual and 42% switch to glasses until their allergies subside.

Contact lenses actually increase the detrimental effects of ocular allergies. They can trap allergens against the eye for hours. And by doubling the level of the inflammatory chemokine eotaxin on the eye, contact lenses can indirectly cause tissue damage, eosinophilia and more severe papillae for patients with giant papillary conjunctivitis.² It is no wonder that so many patients remove their contact lenses during allergy season.

We can get a head start on this problem by identifying allergies when patients first get their contact lenses and by educating them about avoidance and other preventive measures. But relief is close at hand for our uncomfortable, redeyed allergy sufferers as well. A combination of topical antihistamine and rewetting drops will bring the symptoms under control in a few days, and patients can return to the lifestyle they enjoy with contact lenses.

Figure 1. Patients who were in the group that used the combination therapy demonstrated almost seven times greater improvement in overall eye comfort than those who used only the rewetting drops.

Topical Epinastine Study

Because allergies can cause contact lens intolerance or, when they are at their worst, a frank inability to wear contact lenses, fast and effective treatment is paramount. The treatment options are topical antihistamine, rewetting drops or both.

Last spring, I participated in a multicenter, randomized, open-label study of this combination vs. rewetting drops alone. Members of the study group all had contact lens intolerance related to allergic conjunctivitis. Patients needed to have spent at least 1 month in daily-wear contact lenses that we found to have an adequate fit. We put them on rewetting drops b.i.d. (Equate, Wal-Mart) for a 5- to 7-day run-in period.

Figure 2. Patients who used the combination of epinastine and rewetting drops reported a 40% decrease in ocular itching. Those who used only the drops reported little change in itching.

Patients who still met all the criteria after 1 week (146 total) were randomized to use rewetting drops b.i.d. and as needed or epinastine HCI ophthalmic solution 0.05% (Elestat, Allergan/Inspire Pharmaceuticals) b.i.d. with rewetting drops as needed. We evaluated patients at the start, middle and end of their week-long treatment period and asked them to rate their overall comfort, itching, wear time and use of rewetting drops.

The Antihistamine Prevails

Patients using epinastine and drops reported that overall comfort improved after 1 day.³ On a scale of 0 to 4, with 4 being complete comfort, these patients showed significant improvement at all points during treatment. At 7 days, comfort ratings had increased 0.48 points for epinastine and drops, compared to an 0.07-point increase with rewetting drops alone (Figure 1). Itching improved 40% with epinastine, compared to a statistically insignificant change with rewetting drops (Figure 2).

Predictably, better comfort meant longer contact lens wear time. Patients treated with epinastine averaged nearly 2 hours more daily wear than patients who used rewetting drops (Figure 3). Those 2 hours can make a meaningful and welcome change in a patient’s ability to get through the workday or spend a Saturday in the garden.

Finally, I think that the most revealing data about comfort relates to patients’ use of as-needed rewetting drops. As we all know, it is quite hard to change patients’ self-medicating behaviors. With epinastine, patients changed their rewetting habits quickly and significantly. Over 7 days, they averaged 0.55 fewer uses of rewetting drops, while a change in asneeded use was insignificant for patients using rewetting drops alone. Patients felt that their comfort and contact lens tolerance had improved noticeably and quickly with epinastine.

Figure 3. Patients who used a combination of epinastine and rewetting drops achieved almost 2 more hours per day of comfortable contact lens wear.

Epinastine’s Impact

In all four study parameters, epinastine performed significantly better than rewetting drops, including a difference of nearly 2 hours in wear time. The efficacy of this drug stems from the potent antihistamine’s action H1 and H2 receptors. It inhibits many aspects of the allergic cascade, so its effects are both fast and long lasting.

This means patients get a true b.i.d. effect. The drops go in before contact lenses, provide complete relief without breakthrough symptoms until evening, and then go in again after lens removal. The lens-wearing experience improves dramatically. The drops even have less drying effect on the ocular surface than other antihistamines, and their pH is similar to natural tears, so they’re well tolerated. In short, epinastine allows patients to get through allergy season in comfort, wearing their contact lenses, while performing their regular activities. OM

References

1. Asthma and Allergy Foundation of America. Eye on Allergies Survey. July 2006.

2. Moschos MM, Eperon S, Guex-Crosier Y. Increased eotaxin in tears of patients wearing contact lenses. Cornea. 2004;23:771-775.

3. Data on file. Inspire Pharmaceuticals.

Jodi Luchs, M.D., F.A.C.S., is in private practice at South Shore Eye Care in Wantagh, N.Y. He is also Director of the Division of Refractive Surgery at North Shore-Long Island Jewish Health System, Long Island, N.Y., and assistant clinical professor of Ophthalmology at Albert Einstein College of Medicine, Yeshiva University, Bronx, N.Y. Dr. Luchs is a consultant for Allergan, and on the speakers bureau for Inspire Pharmaceuticals.