One in three eye health problems in contact lens wearers is a result of inappropriate lens care and cleaning, and the primary reason patients stop wearing contact lenses is comfort.
There will always be a human component to contact lens infection risks and comfort. As optometrists, we need to manage the risks and try to prevent both. The ideal solution should provide health, biocompatibility and comfort. Here are some of my evidence-based ideas for lens care.
1 Do your ground work
Be proactive and read manufacturer and independent data for a good overall view of current lens and solution technology, plus any positive or negative interactions. Look at your individual patients and ensure you are making good product recommendations based on their refraction, general health, lifestyle and individual ocular surface. These should cover:
- Lens fit/modulus
- Ocular surface condition—pre-existing dry eye, meibomian gland dysfunction, lid wiper epitheliopathy, incomplete blinking, anterior blepharitis and papillary conjunctivitis
- Lifestyle and general health—have they changed? Life changes (diet, exercise, work, hormones, illness and medications) so sometimes our lens care recommendations should, too.
2 Use new generation MPS
Many multipurpose solutions in common use today were developed before silicone hydrogel materials, so assuming compatibility between lenses and lens care products is potentially naïve.
Older formulations can have weaknesses that newer formulations may have overcome and we need to convey this to our patients. Staying informed about the unique attributes of available products helps us choose those best suited to each patient.
Dual disinfection means activity against a broader range of pathogens and this is particularly important as bacteria adhere to silicone hydrogel lenses in greater numbers than they do to hydrogel lenses. Newer multipurpose solutions also have better efficacy, pH, biocompatibility and lens wettability.
3 Focus on comfort
Poor comfort with contact lenses is the primary reason for contact lens drop-outs, so comfort should be something we consider when making solution recommendations. Ocular comfort and symptoms in symptomatic contact lens wearers can be improved by switching to an alternative contact lens care product combination.
Gently massaging each side of the contact lens while rinsing is essential for proper care. Rubbing improves health, comfort and vision, rubbing removes significantly more microbes, including the gram negative bacteria and Acanthamoeba, and rubbing reduces corneal staining.
5 Know your environment
Where are your patients wearing their lenses? Drier environments lead to drier lenses. Where are your patients storing their lenses? The bathroom and humid environments lead to greater lens case contamination.
6 Keep it clean
One hundred per cent of patients know they should wash their hands before touching their lenses but no age group is completely compliant with this step. Good hand hygiene is an important factor in limiting corneal infections. The lens case is the most frequently contaminated item, yielding the widest range of bacterial isolate, fungi and Acanthamoeba. Case contamination is a known risk factor for ocular infection and inflammation.
7 Review changes
Review your patients’ current lens and solution compatibility and reassess symptoms and signs when you make changes. Ineffective cleaning is visible on the lens but solution sensitivity can present in a few ways. It may result from toxicity to any part of the chemical make-up of the solutions, it may be a patient’s allergic reaction to the solution ingredients, the patient may be using a solution inappropriately or the solution may be incompatible with a particular contact lens material.
Looking for signs of ineffective cleaning and solution sensitivity enhances your understanding of compatibility within your patients.
8 Remember peroxide
It is often ideal to keep things simple with peroxide solutions due to their proven effectiveness in sensitive eyes with both hydrogel and silicone hydrogel lenses. Peroxide is great for patients with allergies, meibomian gland dysfunction, a history of solution-induced corneal staining or multipurpose solution toxicity, a history of corneal inflammatory events or eyelid papillae.
Hydrogen peroxide has the lowest incidence of corneal inflammatory events and solution-induced corneal staining.
9 Avoid solutions, use dailies
Some patients need monthly, two-weekly and conventional lenses for various reasons, but if we can get patients wearing daily disposables we should fit them. Daily disposables are easier for patient compliance, can improve comfort, have a reduced risk of infiltrative complications and result in fewer severe infections.
10 Communication is key
Compliance is better when communication is good. Remember to praise patients for good behaviour and to educate them about their poor behaviour. Prescribe a solution and ensure the patient and practice staff know which solution it is. Explain reasoning behind each step and mention patient benefits including reduced risk of infections and improved comfort.
Communication is key to understanding if a patient is happy with their lens and lens care. If happy with those things, they will be happy with you and are more likely to recommend you.