We believe that this is still an important topic, and we ask patient to bring in their contact lens case, solutions, and any other products they may be using to care for their eyes or contact lenses.
An increasing number of our contact lens wearers are wearing daily disposable lenses.1 Even with this increasing number, a majority of the contact lens wearers in the United States wear contact lenses that are not daily disposable and require contact lens solutions to help them care and maintain their lenses.
Although we typically think of those wearing either weekly, two-week, or monthly disposable lenses, there are a number of patients wearing specialty soft lenses and gas permeable who also require contact lens solutions.
We believe that this is still an important topic, and we ask patient to bring in their contact lens case, solutions, and any other products they may be using to care for their eyes or contact lenses. By asking patients to bring in their lens supplies, you will have a greater understanding how patients really take care of-or don’t care of-their contact lenses.
We’ve seen enough poor compliers to understand that appropriate compliance will create a successful lens wearer.
Here we will discuss the three points to keep in mind about the importance of lens care to comfortable, healthy contact lens wear.
Although most patients will view multipurpose solutions as simply different labels on bottles containing the same solution, there are significant differences that exist among these solutions.
But, if patients do not understand the differences, they will be more likely to be influenced by lower cost and will often switch from the solution that was recommended to them during their initial contact lens fitting. Simply put, if patients are not well educated why you prescribed a certain lens care solution, they will tend to purchase the one that costs the least.
So what are the differences, and how do we educate our patients about those differences?
The majority of multipurpose solutions were created in an era of hydrogel lens technology. As such, they were specifically formulated to optimize disinfection and comfort with hydrogel materials. Three new multipurpose solutions were brought to market about a decade ago.
Of those three, one was voluntarily recalled in 2006 because it was associated with increased risk of Fusarium keratitis, and a second was voluntarily recalled in 2007 because of its association with increased risk of Acanthamoeba keratitis.2,3
This was certainly an era of caution in which clinicians became much more cognizant of the solution-contact lens interaction. As a result, a new era of solutions was created to help meet the needs of patients wearing contemporary contact lenses, such as silicone hydrogel lenses.
More on lens care: Patient awareness: Assumptions, expectations, and reality
These new solutions are truly revolutionary in terms of the benefits that they provide. Lens care manufacturers looked at either maintaining or improving disinfection efficacy in addition to improving comfort in an era of silicone hydrogel lenses. Interestingly, none of the three contemporary solutions are approved as a “no-rub” solution, which is a move by the FDA and industry to increase levels of patient compliance.
The three new contact lens solutions are:
• Biotrue (Bausch + Lomb) is unique in that it contains hyaluronan. This is a known moisturizing agent that that has been shown to retain itself to the surface of various hydrogel and silicone hydrogel lenses.4 Additionally, polyquaternium has been added to the solution to optimize disinfection efficacy.5
• OptiFree PureMoist (Alcon) differs from its predecessor OptiFree Replenish by its major surfactant polyoxyethylene-polyoxybutylene (HydraGlyde).6 This surfactant improves surface wettability and end-of-day comfort.7
• Revitalens OcuTec (Abbot Medical Optics) is a complete reformulation of its predecessor Complete Easy Rub. It contains polyquaternium-1 and alexidine as its major disinfecting agents. Wetting agent Tetronic 904 provides an enhanced wearing experience for patients.8
Peroxide systems have been the mainstay for those individuals who have any type of hypersensitivity with any multipurpose solutions. Additionally, peroxide is a great way to keep contact lenses clean because the lenses are initially submerged in 3% hydrogen peroxide. A platinum disc in the lens case then neutralizes the peroxide into a neutral saline solution over the FDA-approved soaking time.
The mainstay for years has been Alcon’s ClearCare. It has been in the market for almost two decades. It contains a cage that holds the lenses, and the platinum disc is attached to the cage so the peroxide doesn’t begin to be neutralized until the lens-disc cage combination has been submerged in the peroxide.
Earlier this year, Alcon introduced Clear Care Plus, which added wetting technology to help aid in lubricating the surfaces of the lenses.
Bausch + Lomb has recently brought to market PeroxiClear. This peroxide system requires a four-hour soak as opposed to a six-hour soak required by most other peroxide systems-this may be a more convenient neutralization schedule for patients with irregular schedules.
One cautionary word about peroxide systems: be leery of store-brand or generic products. All of the peroxide systems mentioned above have the platinum discs attached to the plastic cages that are simultaneously submerged into the peroxide soaking solution. This is the ideal situation because high concentrations of peroxide are in contact with the lenses for substantial time to provide adequate disinfection.
Many store-brand peroxide systems include the platinum discs at the bottom of the lens storage case, not attached to the cage, which means that a patient who fills the case with peroxide needs to place the lenses in the solution immediately after filling the container with peroxide. Otherwise, the peroxide will sit in the container neutralizing before the lenses soak in peroxide. Consider this: your patient is removing her lenses, then she gets a phone call.
She may have already filled the container with peroxide and, because the presence of a platinum disc in the container, it will begin neutralizing the hydrogen peroxide immediately. Ninety percent of neutralization will typically occur in the first 30 minutes of the peroxide being in the presence of the platinum disc.9
So if the patient isn’t immediately placing the lenses into the solution, they are not receiving the full benefit of the disinfection efficacy of the peroxide system.
Because peroxide is neutralized to pure saline, it is a neutral environment that has the potential to allow organisms that would normally be killed to survive the soak. Although we discourage patients from utilizing store-brand or generic products, if patients continue to use them, we make sure that they are aware of the nuance that exists.
There are significant multipurpose disinfecting solution options for our patients who wear gas permeable (GP) contact lenses. These involve two-step systems that require both a cleaning and rinsing/soak regimen with cleaning portion requiring a different solution than rinsing and soaking.
These include Boston Original and Boston Advanced (Bausch + Lomb) and Optimum (Lobob). Additionally, there are two single-bottle systems with cleaning and conditioning using the same solution: Boston Simplus (Bausch + Lomb) and Unique pH (Menicon).
But for those individuals for whom you suspect a sensitivity to multipurpose solutions, hydrogen peroxide systems work remarkably well. Clear Care, Clear Care Plus, and PeroxiClear are all approved to be used with GP lenses. They provide an option for patients who may have hypersensitivities to solutions, those with seasonal allergies, and some who deposit more heavily on GP lenses.
The traditional cage systems works well with traditional small diameter GPs and with smaller diameter scleral lenses. Larger scleral lenses may present logistical challenges due to cage size.
Boston Foundation for Sight has partnered with The Dry Eye Shop to produce an oversized case for peroxide disinfection to fit its PROSE (prosthetic replacement of the ocular surface ecosystem) scleral lenses. The case will work for any large diameter GP lenses.
Alternatively, patients may snap the disc off the stem, then place disc and loose lenses into the container without the cage (dot OD lenses with a Sharpie marker to distinguish OD from OS)-the cage isn’t necessary for the disinfection process, only to keep the lenses separate and provide structure for soft lenses.
Contact lens solutions still play a significant role in the contemporary optometric practice. The differences between them are important to understand, and it’s critical to stay abreast of new research in the area of lens care.
By understanding these differences, you can tailor the specific solution to your particular patient and optimize his wearing experience.
Make sure you educate your patient why you are recommending a specific solution-he is more likely to remain compliant with your recommendation. Better yet, consider retailing solutions out of your practice to continue to solidify your recommendations. It will ultimately lead to a happier, more compliant patient.
1. Morgan PB, Woods CA, Tranoudis IG, et al. International contact lens prescribing. Cont Lens Spectrum. 2014 Jan;30(1):28-33.
2. Chang DC, Grant GB, Wannemuehler KA, et al. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA. 2006 Aug 23;296(8):953-63.
3. Joslin CE, Tu EY, Shoff ME, et al. The association of contact lens solution use and Acanthamoeba keratitis. Am J Ophthalmol. 2007 Aug;144(2):169-80.
4. Scheuer CA, Fridman KM, Barniak VL, et al. Retention of conditioning agent hyaluronan on hydrogel contact lenses. Cont Lens Anterior Eye. 2010 Dec;33 Suppl 1:S2-6.
5. Kilvington S, Powell CH, Lam A, Lonnen J. Antimicrobial efficacy of multi-purpose contact lens disinfectant solutions following evaporation. Cont Lens Anterior Eye. 2011 Aug;34(4):183-7.
6. Senchyna M, Stauffer P, Davis J, Ketelson HA, Meadows DA. Characterization of a multi-purpose lens solution designed for silicone hydrogel materials. IOVS. 2010 Apr;51(13):3426
7. Napier L, Garofalo R, Lemp J, Ketelson HA, Lally J. Clinical evaluation of an investigational multi-purpose disinfecting solution. Poster presented at: Contact Lens Association of Ophthalmologists meeting, Sept. 2010, Las Vegas.
8. GonzÃ¡lez-MÃ©ijome JM, da Silva AC, Faria-Ribeiro M, Lopes-Ferreira D, Peixoto-de-Matos SC. Multi-site clinical assessment of Complete Revitalens MPDS in 2981 contact lens wearers across Europe and USA. Cont Lens Anterior Eye. 2013 Dec;36(6):289-93.
9. Christie CL, Meyler JG. Contemporary contact lens care products. Cont Lens Anterior Eye. 1997;20 Suppl 1:S11-7.