Why are soft contact lens wear discontinuation rates still too high?

ABSTRACT Introduction Notwithstanding continuing improvements in contact lens technology and increasing use of daily disposables, discontinuations from soft contact lens wear remain a significant problem with ‘drop-out’ too often occurring after patients have initially achieved successful routine use. Areas covered This review examines the possibility that the signs and symptoms of discontinuations might, for example be associated with corneal and/or lid wiper neuropathy and/or aqueous, mucin and lipid deficiencies and/or mental health disorders. In addition, this review examines how soft contact lens wear places high demands on tear functions. Expert opinion Limitations in clinically detecting evidence of some adverse responses to soft contact lens wear may explain how discontinuations can sometimes be described as unexplained. Similarly, limitations in clinically determining the significance of different forms of tear dysfunction and their exacerbation by soft contact lens wear may be a barrier to explaining why symptoms of dryness are most commonly associated with discontinuations. The wider experience obtained with cosmetic contact lens fittings that is discussed in this review may be relevant to problems encountered in therapeutic contact lens applications.