Article Date: 4/1/2009

Solutions for Improving Contact Lens Hygiene

Solutions for Improving Contact Lens Hygiene

Doctors provide recommendations to help increase compliance among patients.

BY LESLIE GOLDBERG, Associate editor

We are all aware of the American Optometric Association's recommendations for contact lens wearers (see and that exercising good hygiene with contact lenses will keep eyes healthy and improve visual performance. The question remains, how many of your patients follow these recommendations and how do you help them to ensure compliance?

Communication is vital

Troy Bedinghaus, O.D., of Lakewood Family Eye Care, in Lakewood Ranch, Fla., and contributor to the Web site, says that his first attempt at getting his patients to comply to good hygiene is a verbal explanation of proper care. His second step is a written one-page handout that includes what they should do and where they should call if they encounter a problem. "Lastly," he says, "I find it best to share what will happen if they don't clean their lenses correctly. I employ a kind of scare tactic by showing patients pictures of serious eye infections. With multi-purpose solutions (MPS) in particular, although it says ‘No Rub’ on the bottle, the patient should digitally rub the lens with his or her fingers because research has shown that this knocks off 90% of the bacteria." He does say that his patients are becoming more compliant because the recalled solutions have made them more aware of what could happen to them.

Susan Kovacich, O.D., assistant clinical professor at Indiana University School of Optometry prescribes a lens care regimen to her patients — sometimes going as far as writing the name of the MPS on a prescription pad. "Our contact lens prescription form has an area to write in the recommended solution. I educate the patients that all MPS solutions are not created equal, and that contact lens problems may result from using non-recommended solutions," adds Dr. Kovacich.

Andrea M. Janoff, O.D., F.A.A.O., assistant professor of optometry at Nova Southeastern University in Ft. Lauderdale, Fla., verbally explains to her patients why it's important to use a certain product according to the manufacturer's instructions, emphasizing that patients who adhere to a care regimen enjoy healthier and more comfortable lens wear with better visual performance.

"I explain the ‘how’ using my hands and an imaginary lens and bottle of solution as a visual aid (demonstrating a person rubbing and rinsing lenses, emptying cases and allowing the case to air dry the next morning and putting in fresh solution the next night)," she says. She explains the "why" and provides a written sheet similar to one recommended by the AOA. At each follow-up visit, she asks patients to explain in detail what they do to care for their lenses. "It takes all of 30 seconds at each visit. I correct any errors in the procedure as necessary," she concludes.

The biggest abusers

Knowing your patients' contact lens wearing habits is critical. Shelley I. Cutler, O.D., F.A.A.O., a consultant and practitioner located in Springhouse, Pa., is an advocate for daily wear lenses for the teen population. "Many teens have horrible hygiene habits," says Dr. Cutler. She says girls take their black eyeliner pencils and tend to apply it on the inner lid margins where the meibomian glands are. "Most likely they don't replace their make up products with the frequency they should. Many apply their products by a bathroom sink. The sink may not be ideally clean and be a breeding ground for bacteria, fungi, etc.," says Dr. Cutler. "Combine the material/solution issues with contaminated make up products and any resultant keratitis can be the portal of entry for an infection."

For compliance, Dr. Cutler recommends that all girls use eyeliner under their eyelashes and she has patients clean their cases a couple of times a week, allowing the case to dry and to use a multi-purpose solution. "If we teach them how to take out the lens and to throw them out at the end of the day, we are helping them to combat infection. We must go for the best option in a poor situation," says Dr. Cutler.

Proper hygiene and case care

"I emphasize hygiene, making sure the patient knows that their hands should be clean whenever they handle the lenses, and to never use tap water to rinse or store contact lenses," says Dr. Kovacich. "At each visit, I reinforce the importance of digitally cleaning the lenses before storing them. The patient should understand that this action removes surface deposits and can help keep their lenses more comfortable." Dr. Kovacich also makes sure the patient knows not to "top off" the solution, but to refill the empty, clean case with new solution each night after rubbing the lenses.

Dr. Bedinghaus says the biggest thing patients neglect is not disposing of the case. "I am always saying keep the case dry, while the contact is in your eye," he says.

Dr. Cutler recommends patients empty lens cases, clean, rinse and dry them. "You break up the biofilm by drying the case," she says. "There is then nothing left to breed. Soap breaks up the biofilm where the pathogens house themselves."

She says that if patients are really diligent, they can use boiled water once or twice a week as nothing can live in boiled water. For those less diligent, she finds it effective to wash the case out with a soap that does not contain moisturizers. Dr. Cutler prefers a saline rinse, but will accept a quick water rinse followed by a quick saline rinse then drying of the case.

Dr. Bedinghaus says that patients should replace cases at regular intervals — at a minimum of every three months.

Specific solutions?

Many formulation differences exist among the contact lens care products on the market. "I do not believe that all patients are the same, so I tailor the disinfection solution to each situation," says Dr. Kovacich. "As the doctor, it is my responsibility to make the best recommendation to the patient, especially since there are so many solutions on the market. If a patient is happy with his current solution, has no comfort complaints and I find no problems during the exam, I usually do not recommend a change, unless the patient is using a generic [solution]." Dr. Kovacich does not recommend using generic solutions and also recommends peroxide solutions for many of her patients.

"I recommend multi-purpose solutions for twoweek lenses. If patients can handle a multi-purpose solution and clean the case, I go that route," says Dr. Cutler. "but if I see [corneal] staining, I recommend peroxide solutions." She does not recommend generics. "I stay with named brand solutions because with generics, you may be using an older generation of the product and not the current formulation."

"I make recommendations based on the material I'm using, the patient's condition and the approved care system, as indicated by a manufacturer and prior history of solution reactions," says Dr. Janoff. "I change systems if I see significant hyperemia and/or superficial staining that manifests within a few hours of lens insertion."

All the doctors interviewed agreed that the most important steps to follow for good lens hygiene include rubbing the lenses, changing the case on a regular basis and following the manufacturer's recommended care regimen. OM

Optometric Management, Issue: April 2009