Article Date: 11/1/2001

The Next Step in Contact Lens Care
How are lens solutions faring?
BY KAREN RODEMICH, Senior Associate Editor

What's the next step in development for lens care? Veteran contact lens practitioner, Frank Fontana, O.D., addressed this question and others to shed some light on this often-neglected topic. Dr. Fontana will give us an overview of the solution market, with his prediction of what's to come, and we'll also hear about some new products.

Way back when . . .

"The three basic things we knew when soft contact lenses came out is that you needed a disinfectant, a surfactant cleaner and a deposit resister (the enzyme)," said Dr. Fontana. "The biggest problem we had in the early days was people complying with their lens care."

He explained that the step people usually skipped was the digital rubbing. And because disposables weren't around at that time, some patients had reactions to their contact lenses. "So," he said, "we thought we'd combine the three basic steps to increase compliance." In the effort to accomplish this, manufacturers started having trouble with preservatives but then developed either better preservatives or no preservatives at all.

"Hydrogen peroxide was effective," he said, "but it had drawbacks. Patients experienced problems if the solution wasn't neutralized properly before it came in contact with their eyes." Along with that, "companies developed an enzyme and a surfactant cleaner," Dr. Fontana continued. "But, that system used a chemical disk that lost its effectiveness after 3 months and patients would forget to change it." He said that as chemical solutions started appearing again, the hydrogen peroxide systems sank in popularity.

Today's no-rub solutions

So what's the most common solution trend in the market today? Dr. Fontana said that now, Alcon and Allergan have one-step solutions (Alcon's Opti-Free Express Multi-Purpose Disinfecting Solution and Allergan's Complete Brand Multi-Purpose Solution).

"These are all good solutions; they're all doing the three basic steps, but now they've done something a little different with no-rub approval," he stated. As he said, and I'm sure you'll agree, no-rub solutions are much more convenient, because the most annoying factor for contact lens wearers has been cleaning their lenses digitally.

Now some of you may see no-rub contact lens solutions as double-edged swords. On one hand, they're convenient and offer protection for the many patients who don't digitally rub their lenses anyway. But on the other hand, approving the no-rub indication teaches all wearers to be lazy about contact lens care; we know rubbing really does make the lens cleaner.

Fortunately or unfortunately, what will be will be, so the best thing to do is watch the trend and continue to educate your patients about their lens care.

Dr. Fontana mentioned that there's something new from CIBA Vision, originally owned and developed by American Optical -- AoSept Clear Care -- a no-rub hydrogen peroxide solution that's been on the market for about 7 months now. It's one solution for cleaning, disinfecting and removing protein.

So why would you take patients back to a hydrogen peroxide solution? Dr. Fontana gave his own reasons: "Hydrogen peroxide doesn't have or need preservatives, so patients won't have reactions, and it's an effective cleaner." He can't say how well it works because he hasn't used it long enough yet, but he said that time will tell how effective this solution is.

Dr. Fontana did key in on one misunderstanding that practitioners may have with no-rub contact lens solutions -- that is, that they might not work with patients who deposit quickly. Fortunately, he pointed out, none of the packaging says that a patient should go against his doctor's orders, "so you can use your own professional judgment with each patient."

Another multi-purpose solution that was recently introduced for rigid gas permeable contact lenses (RGPs) is Alcon's Unique pH. Although not a no-rub solution, this product is a cleaning and soaking solution (no enzyme) that changes its own pH to match the pH of a patient's tears.

Another feature, Dr. Fontana remarked, is the way it's going to be used -- to presoak or precondition a lens. He explained that arrangements have been made with certain labs in the country so that, if a practitioner requests it when he orders lenses for a patient, the lab sends the lenses to the O.D. soaking in the solution ahead of time.

"Even though we clean lenses prior to dispensing them to a patient, something about a patient's eye chemistry might make initial wear uncomfortable," said Dr. Fontana. "So this is a good idea for bettering the initial comfort of lenses for patients. This way, if I have a participating lab send lenses to me, I know that they've been soaking in the mail for at least a day or two. Then, when I dispense the lenses to a patient, he should adapt to them quickly," he commented.

A bigger role for lubricating drops?

With the advent of contact lenses approved for 30 days of continuous wear, is it likely that in the future, contact lens solutions will become obsolete? Dr. Fontana doesn't think so. Here's what he had to say about it. "As long as we have contact lenses that are worn for 1 week and longer, the need for a solution will never be eliminated for most people."

Regarding continuous wear contact lenses, Dr. Fontana said that some people won't necessarily wear the lenses the entire 30 days and may take them off at some time within the 30-day period, so there will be much less solution use. "But if someone gets a sore or irritated eye, it's good to have these safe, formulated systems in which to store the contact lenses."

Thus, he says, "lubricating and rewetting drops will become more important with the 30-day lenses." But Dr. Fontana doesn't think that contact lens solutions will become obsolete, because not everyone may like continuous wear lenses.

One notable new lubricating drop is available from Allergan, Inc. Complete Blink-n-Clean Lens Drops help prevent protein film build-up and remove particulate material that can cause irritation and discomfort. Designed for use with soft contact lenses, the product is ideal for use with extended wear materials and is sold in 20-mL bottles for a 1-month supply.

Also, Alcon offers Clerz Plus Lens Drops for improved comfort during lens wear. More than a rewetting and refreshing drop, this product prevents protein buildup during lens wear.

For use with all kinds of lenses, Clerz Plus combines two proprietary ingredients -- Clens 100 and Tetronic. Clens 100 helps prevent protein from adhering to lenses. The other product, Tetronic, conditions and cleans the lens.

Evolving role

No doubt, as contact lens modalities change and evolve, so will the lens care products for them. In the future, we're likely to see continued growth of contact lens care products contained in a single bottle. One-step, no-rub solutions seem to be the wave of the future of lens care products.

Plus, with the advent of more contact lenses available for longer wear, we'll see enhanced eyedrop products for contact lens wearers.


Optometric Management, Issue: November 2001