It might seem plausible that contact lens wearers with a history of poor compliance are ill-suited to the responsibilities of the modality, a behavior pattern that eventually ends in dropout. Not so, says a new study presented this week at ARVO. Researchers surveyed recent contact lens (CL) dropouts to uncover the reasons behind their discontinuation and found meibomian gland dysfunction, not a history of noncompliance, was to blame.

The researchers asked 50 participants—25 current lens wearers and 25 recent dropouts—about general CL history and compliance and then tested noninvasive tear break-up time, tear meniscus height, blepharitis assessment and meibum quality and expression. Compliance issues such as exposing CLs to tap water, replacement schedules, sleeping in their lenses, or wearing the lenses longer than recommended had no effect on the dropout rate. In fact, the current lens wearers reported napping more frequently in their CLs than the discontinued wearers did when using the modality.

The only factor associated with contact lens dropout was upper eyelid meibum quality and expressibility.

“The contact lens market is flat primarily due to discontinuation of lens wear, often due to lens discomfort,” says Joseph P. Shovlin, OD, of Scranton, PA. “Along with past publications, this study suggests that meibomian gland function plays a vital role in the ability to continue to successfully wear lenses. Prevention with early intervention of meibomian gland dysfunction may be key to sustained lens comfort.”