As a profession, we have seen the benefits of transitioning patients to contact lens modalities that are replaced frequently. Innovations in material technologies have allowed advanced designs, including greater oxygen permeability to provide a healthier, more comfortable wearing experience.
As a profession, we have seen the benefits of transitioning patients to contact lens modalities that are replaced frequently. Soft lenses that were replaced on a yearly basis were at one point in time the standard of care, but daily, two-week and monthly disposable contact lenses have quickly taken over the market. Innovations in material technologies have allowed advanced designs, including greater oxygen permeability to provide a healthier, more comfortable wearing experience.
CDC and lens care
However, poor compliance can negate many of the benefits that contact lens wear can provide our patients. Recently, the Centers for Disease Control (CDC) released its Morbidity and Mortality Weekly Report (MMWR),1 which reviewed Contact Lens Medical Device Reports and assessed the data for risk factors, outcomes, and any microorganisms identified. The report highlighted the need for ongoing education to our patients about proper contact lens wear and care habits.
According to the MMWR report, nearly one out of every five reports of adverse events described a patient who had a scarred cornea, needed a corneal transplant, or had reduced vision after a contact-lens related eye infection. The true proportion of contact lens-associated infections that result in eye damage unfortunately cannot be determined from the medical device report database.
More than one out of every four reports described patients who weren’t caring for their lenses properly, were wearing them for too long, or wearing them while sleeping. Contact lens wear and care behaviors that increase the chance of getting an eye infection-yet are easily avoided-include wearing contact lenses while sleeping and wearing lenses for longer than recommended.
Look to your practice
Two habits incorporated into clinical practice can give you insights into how patients wear and care for their lenses.
First, simply have patients bring in their contact lens case, solution, and any other products they use to care for their eyes or their lenses. Also, have them bring in any remaining contact lenses that they may have.
If the lenses were purchased from your practice, you will be able to quickly determine how frequently the lenses are being replaced and ultimately how compliant-or non-compliant-patients are with their lens wear.
Second, ask patients to remove their lenses in the exam room and see what they do when they remove them. Do they wash their hands or do they simply take their lenses out? Do they top off solution or simply place lenses in the case that contains solution? Or do they fill the lens case with fresh solution? When they place the lenses back on their eyes, do they wash their hands?
Observing these behaviors in the office along with inspecting what they bring into the practice will give you insights into the true care habits that these patients pursue with their contact lenses and lens care.
CDC recommendations for patients
The CDC’s healthy contact lens wear and care recommendations focus on hygiene habits, proper use of lenses and supplies, and annual appointments with an eyecare provider. The recommendation advocate avoiding behaviors related to contact lens wear that can increase the chance of getting an eye infection.
Three habits are commonly reported as risky and can be easily remedied. Instruct your patients to:
• Don’t sleep in contact lenses without discussing with their eyecare practitioner. Sleeping in contact lenses has been shown to increase the chance of an eye infection by six to eight times.1
• Don’t top off, or add new contact lens solution to old solution that has been sitting in the case. Adding new solution to used solution can lower antimicrobial activity of the solution. 1
• Replace your contact lenses as often as recommended by your eyecare practitioner. Studies have shown that contact lens wearers who do not replace their lenses as often as recommended have more complications and report more eye problems than contact lens wearers who follow the replacement recommendations.1
What it means to you
It is refreshing to see reports encouraging appropriate lens care and advocating for regular eye care. When worn appropriately, contact lenses provide a remarkable opportunity for our patients. But when abused, they can alter the normal physiological health of the ocular surface, including the cornea.
Knowing this information about our patients and understanding the potential ramifications to ocular health, what is an appropriate defense in arming our patients with best chances to effectively and comfortably wear contact lenses in a safe and healthy manner?
Adopt these three habits to encourage safe and healthy lens wear:
• Appropriately educate the patient on the supplies that she has brought into the office. This gives you a firsthand look at what she is actually using to care for her lenses and the condition of her supplies, including her case. It also gives you the opportunity to see if she is in fact utilizing the solution that you recommended for her and provides opportunities to educate her on appropriate care.
• Encourage appropriate use of contact lens solutions and handwashing. Just as important as using the appropriately recommended solution is making sure that patients completely replace the solution in their contact lens cases prior to storing their lenses in the solution. Additionally, make sure that you educate your patients to clean their hands prior to lens handling.
• Encourage appropriate replacement schedules for your lens wearers. This is particularly important for those patients who wear lenses longer than the approved wear schedules. Consider educating all patients on the value of an annual supply of contact lenses. Not only are there often financial advantages to an annual supply, having such a supply encourages patients to replace their lenses when they are supposed to because they have a ready supply of lenses.
Although there are potential dangers to wearing contact lenses inappropriately, when worn correctly contact lenses can provide patients with healthy, comfortable vision. Through increased awareness of inappropriate behaviors and then proper education to counter these behaviors, our patients can enjoy the benefits of contact lenses while minimizing their risk.
1.Centers for Disease Control and Prevention. Contact Lens–Related Corneal Infections-United States, 2005–2015. MMWR. 2016 Aug 19; 65(32);817–820.