The Stability of Dryness Symptoms After Refitting With Silicone Hydrogel Contact Lenses Over 3 Years Jeffrey Schafer, O.D., G. Lynn Mitchell, B.S., M.A.S., Robin L. Chalmers, O.D., Bill Long, B.S., M.B.A., Sally Dillehay, O.D., Ed.D., Joseph Barr, O.D., M.S., Peter Bergenske, O.D., Peter Donshik, M.D., Glenda Secor, O.D., and John Yoakum, O.D. Purpose. To assess the stability of dryness symptoms after refit- ting patients wearing low-Dk/t hydrogel contact lenses with high- Dk/t silicone hydrogel contact lenses and to determine whether early dryness symptoms were predictive of discontinuation in the 3-year study. Methods. Two hundred seventy-eight hydrogel lens wearers were refitted with lotrafilcon A silicone hydrogel contact lenses for continuous wear of up to 30 nights. Self-administered questionnaires at baseline, 1 week, and 3 years captured the frequency and intensity of dryness symptoms during the day and at the end of the day. One-week and 3-year responses were compared to baseline by a Bowker test of symmetry and median change in response with Wilcoxon signed rank test. Results. Frequency of during-the-day and end-of-day dryness decreased from baseline to 1 week and 3 years (during the day, frequency  “sometimes” 57.1% vs. 33.1% after 1 week and 58.5% vs. 28.8% after 3 years; end of day, 61.1% vs. 41.0% after 1 week and 64.0% vs. 35.9% after 3 years [P0.0001 for all comparisons]). After refitting, the proportion of subjects with dryness symptoms was stable. After 1 week, the presence of frequency of at least “sometimes” and severity of at least “moderate” during-the-day and end-of-day dryness were significantly associated with study discontinuation (during-the-day frequency [P=0.007] and severity [P=0.017]; end-of-day frequency [P=0.002] and severity [P=0.003]). Con- clusions. Dryness symptoms improved after 1 week of refitting with lotrafilcon A and remained stable through 3 years. The presence of dryness after 1 week was associated with discontinu- ation from contact lens wear. Refitting with silicone hydrogel lenses reduced the frequency and severity of dryness symptoms seen with hydrogel lens wear for many subjects. Key Words: Continuous wear—Dryness—Silicone hydrogel con- tact lenses—Symptoms. Many wearers of hydrogel or rigid gas-permeable contact lenses report symptoms of dryness while wearing their lenses. 1–3 When groups of contact lens wearers have been surveyed about the presence or intensity of various symptoms, dryness has usually been among the top two or three most common symptoms. 3,4 In addition, a high proportion of hydrogel contact lens wearers report moderate to severe intensity of dryness, especially late in the day. 4,5 Although they do not typically pose a problem with patient safety, dryness symptoms merit the clinicians’ attention because they are so often given among the main reasons to cease contact lens wear. 1,6,7 Contact lens wearers report dryness in a distinct pattern com- pared to patients who do not wear contact lenses in terms of the prevalence by sex and age. 8 This leads to the conclusion that the wearing of lenses themselves is related to the reports of dryness, rather than the lenses just exacerbating a condition that would be present without lenses in place. 9 –11 For example, in one recent cross-sectional study in patients who do not wear contact lenses, reports of dryness were much more common among women, with 58% higher proportion of women reporting moderate to intense dryness late in the day compared to men (14.2% vs. 9.0%, respectively). 8 In that study, among the lens wearers, only 20% more women reported that level of dryness compared to men (34.5% vs. 28.7%, respectively), and there was no significant correlation between sex and dryness for lens wearers. Although they tend to increase through the course of the waking day, 1,4 symptoms of dryness in contact lens wearers are valid, 12 repeatable, 13 and temporary if the stimulus (i.e., contact lens) is taken away. Begley et al. reported that 55.7% of patients with contact lens–related dryness simply removed their lenses to relieve symptoms and that half of them experienced complete relief with lens removal. 4,8 Although silicone hydrogel lenses were designed to address the corneal complications associated with hypoxia, 14 –18 numerous researchers have reported that patients wearing silicone hydrogel lenses also report fewer ocular symptoms of dryness while wearing them, at least in dispensing trials. 5 In one 7-hour nondispensing study using a contralateral study design with silicone hydrogel lenses in one eye and hydrogel lenses in the other, Fonn and Dumbleton 19 did not find any difference in the reports of dryness among previously asymptomatic or symptomatic patients. In a 2-month daily-wear dispensing study, reduction in end-of-day dryness was accompanied by significant decreases in bulbar and limbal redness. 20 It seems that by prescribing lens materials with the ability to transmit large amounts of oxygen, practitioners From The Ohio State University College of Optometry (J.S., G.L.M., J.B.), Columbus, OH; Atlanta, GA (R.C.); CIBA Vision Corp. (B.L., S.D., P.B.), Duluth, GA; Pacific University College of Optometry (P.B.), Forest Grove, OR; University of Connecticut Health Center (P.D.), Bloomfield, CT; private practice (G.S.), Huntington Beach, CA; and Groate Eyecare Associates (J.Y.), Greensboro, NC. Address correspondence and reprint requests to Dr. R.L. Chalmers, 2097 East Lake Road, Atlanta, GA 30307; e-mail: robinchalmers@mindspring. com Accepted March 7, 2007. DOI: 10.1097/ICL.0b013e3180587e21 Eye & Contact Lens 33(5): 247–252, 2007 © 2007 Contact Lens Association of Ophthalmologists, Inc. 247