Contact lenses have long been an alternative to glasses for vision correction. When I was young in the 1970s, “hard” contacts were the only option. Soft contacts came about in the 1980s, but they were expensive and non-disposable. The price came down, and they became so cheap that they were made to be thrown away after a day of wearing them. “Cheap” is relative, however, with a year’s supply can be $600-$1200, which doesn’t include the exam. The benefits are that they offer convenience and flexibility. However, emerging evidence suggests that they may pose greater risks to ocular health compared to surgical alternatives like LASIK, PRK, or EVO ICL. This article delves into the comparative risks associated with contact lens wear, highlighting concerns such as increased susceptibility to infections, damage to corneal nerves and meibomian glands, and the resultant ocular surface diseases.

1. Elevated Risk of Corneal Infections with Contact Lenses

One of the most significant concerns with contact lens use is the increased risk of a corneal ulcer, also called bacterial keratitis, which can and does blind many people each year- a fact the industry doesn’t advertise. A meta-analysis (a study compiling many related studies) revealed that over a five-year period, daily soft contact lens wearers experienced approximately 11 more cases of microbial keratitis per 10,000 individuals compared to those who underwent LASIK surgery. This risk escalates with extended-wear lenses, leading to 81 additional cases per 10,000 over the same timeframe. There is a risk of infection with LASIK/PRK and EVO ICL, but with contacts, you’re constantly exposing yourself to the “sponge” for bacteria that is the porous contact lens.

The incidence of microbial keratitis post-LASIK is remarkably low, estimated at 0.0046% (1 in 21,697 procedures), and slightly higher for PRK at 0.013% (1 in 7,434 procedures). These findings underscore the comparatively higher infection risks associated with prolonged contact lens use. Not to mention that you’re not spending time each day inserting, removing, and caring (hopefully very fastidiously) for your contact lenses.

2. Impact on Meibomian Glands and Ocular Surface Health

The meibomian glands, located along the eyelid margins, secrete oils essential for a stable tear film. There are about 25 of these glands in each upper and lower eyelid, and they are essential for a healthy ocular surface, which is essential for clear consistent vision. Contact lens wear has been linked to meibomian gland dysfunction (MGD), leading to evaporative dry eye. A review of studies found that 15 out of 22 articles reported significant morphological and functional changes in the meibomian glands of contact lens wearers. These changes include gland dropout, reduced expressibility, and altered secretion quality.  In short, these eyelid glands atrophy over time due to the effects of the contact lenses. It makes LASIK/PRK or EVO ICL a more appealing choice, and in my opinion, a healthier long-term choice for your eyes. Not to mention your pocketbook, as once you’ve paid for your vision correction, it pays dividends by not spending $800-$1500 per year on contacts and glasses.

Another study involving 87 soft contact lens wearers demonstrated that prolonged lens use correlates with increased gland loss and morphological alterations, contributing to dry eye symptoms. These structural changes can persist even after discontinuing lens wear, indicating potential long-term damage.

I’ve seen the end results of chronic contact lens wear as severe ocular surface disease that needs to be treated the rest of your life.

3. Corneal Nerve Damage and Sensory Impairment

Chronic contact lens wear can adversely affect corneal nerves, leading to decreased corneal sensitivity contributing to dry eye disease. The mechanical interaction between lenses and the ocular surface may result in nerve fiber loss and reduced nerve density. This nerve damage impairs the eye’s ability to detect dryness, potentially delaying symptom recognition and treatment. Your corneal nerves deliver essential growth factors for your corneal tissue, they alert you to foreign objects in your eyes, and they serve as a feedback loop to your eyes to produce more tears. Without corneal nerves, your vision would be significantly decreased, and the health of your eyes impaired.

In contrast, while refractive surgeries like LASIK and PRK do involve corneal nerve disruption (EVO ICL does not), studies indicate that nerve regeneration occurs over time, with a gradual restoration of corneal sensitivity. This regenerative capacity reduces the long-term impact on ocular surface health compared to the persistent effects observed with contact lens wear.

4. Misattribution of Symptoms and Delayed Diagnosis

Symptoms arising from contact lens-induced ocular surface disease, such as dryness, irritation, and blurred vision, are often misattributed to allergies or environmental factors. Conversely, any sort of eye irritation is often misdiagnosed as dry eye. This is why it’s so important to see an experienced ophthalmologist or optometrist to make the diagnosis and treatment plan. This misdiagnosis can lead to inappropriate treatments and prolonged discomfort. Recognizing the role of contact lenses in these symptoms is crucial for effective management and prevention of further ocular surface damage.

5. Advantages of Surgical Alternatives

Refractive surgeries like LASIK, PRK, and EVO ICL offer several benefits over contact lenses:

• Reduced Infection Risk: As previously discussed, the incidence of microbial keratitis is significantly lower post-surgery compared to long-term contact lens use.
•  Improved Ocular Surface Health: By eliminating the need for daily lens wear, these procedures reduce mechanical stress on the cornea and eyelids, promoting better meibomian gland function and tear film stability.
• Enhanced Quality of Life: Patients often report greater satisfaction and convenience post-surgery, with freedom from the maintenance and potential complications associated with contact lenses.
• Better Vision: Better vision is the result of better ocular surface also
• Better for your Finances: Contacts and glasses are an ongoing cost. An investment of $5000 for LASIK may save you at least $1000 per year, which is a 20% return on an investment that you enjoy at the same time. A true “no-brainer”. Try our cost calculator on our pricing page to see your savings.

Conclusion

Although soft contact lenses provide a non-surgical option for vision correction, they carry definite vision-threatening risks, including increased susceptibility to potentially blinding corneal infections, meibomian gland dysfunction, and corneal nerve damage. Sadly very few people really take into account these very real potential risks. These complications can lead to chronic ocular surface disease, referred to as “dry eyes” and diminished quality of life. In contrast, surgical alternatives like LASIK, PRK, and EVO ICL offer safer, long-term solutions with fewer associated risks. Individuals considering vision correction should book their consultation online at SHARPEVISION to evaluate the most suitable, lowest risk:highest reward options to get you out of glasses and contacts in a 6 minute (3 minutes per eye average) procedure!

1.    Microbial Keratitis Risk with Contact Lenses vs LASIK:
•    Shorter E, Golan S, Fine H, et al. A comparative analysis of the safety and efficacy of contact lenses and laser refractive surgery. Eye Contact Lens. 2017 May;43(3):201–207.
https://pubmed.ncbi.nlm.nih.gov/28317680
2.    Post-Refractive Surgery Infection Rates:
•    Golan S, Seitz B, Oellerich S, et al. Incidence and management of infectious keratitis after LASIK, PRK and LASEK: review of the literature. Ophthalmologe. 2017 Jun;114(6):501–506.
https://pubmed.ncbi.nlm.nih.gov/28532931
3.    Meibomian Gland Dysfunction in Contact Lens Wearers – Review Article:
•    Srinivasan S, Muthumanickam G, et al. Effect of contact lens wear on meibomian gland morphology and function: a systematic review. Cont Lens Anterior Eye. 2022 Sep;45(5):101570.
https://pubmed.ncbi.nlm.nih.gov/35351398
4.    Contact Lens-Induced Gland Dropout:
•    Arita R, Shirakawa R, et al. The influence of contact lens wear on meibomian gland morphology and function. Ocul Surf. 2019 Jan;17(1):104–110.
https://pubmed.ncbi.nlm.nih.gov/30608243