How to get CL care back on track

February 17, 2012

An upsurge in resistant organisms colliding with a troubled economy have translated into more contact lens problems.

An upsurge in resistant organisms colliding with a troubled economy have translated into more contact lens problems, according to Joseph Shovlin, OD, FAAO, and James Thimons, OD, FAAO. Stressing the use of the latest multipurpose contact lens solutions (MPS), which target even resistant microorganisms, can be the first line of defense.

For some patients, the focus should involve a switch to a contact lens solution with stronger protection against harmful microorganisms. For others, the message may be that cutting costs and corners could harm eye health.

“The contact lens solution manufacturers have been facing a growing challenge relative to an increasing level of resistant organisms and new general epidemiologic and demographic distribution of resistant bacteria and other pathogens,” Dr. Thimons, of Ophthalmic Consultants of Connecticut in Fairfield, said. “The holy grail is to create a solution that’s capable of significant antibacterial protection for the patient while at the same time [creating one that can be used in a] comfortable, nontoxic fashion.”

Dr. Thimons said he has seen an increase in methicillin-resistant Staphylococcus aureus in his practice and a rise in resistant Pseudomonas aeruginosa after a hiatus, which was attributed to the initial efficacy of the fourth-generation fluoroquinolones.

“Part of my concern for patients is that they need to use a solution that’s capable of protection on a prophylactic level against these always-present organisms,” he said.

Inexpensive solutions, like those sold at large, discount retailers, can lack the properties necessary to protect against current bacterial and non-bacterial threats. Contact lens wearers who have had problems or are at risk should instead choose an antimicrobial solution that can help prevent repeat infections and corneal interactions.

Dr. Thimons and Dr. Shovlin recommend an MPS from Abbott Medical Optics (RevitaLens OcuTec) because of its compatibility with lens material and its strong profile against Acanthamoeba, fungus, and atypical bacteria.

Widespread coverage can also be achieved with other MPS (for example, Biotrue, Bausch + Lomb; and Opti-Free PureMoist, Alcon).

RevitaLens OcuTec “has an impressive log reduction in Acanthamoeba cysts,” Dr. Shovlin, of the Northeastern Eye Institute, Scranton, PA said. “Trophozoites can be killed by many disinfectants, even neoplastic agents, but cysts are quite hearty and require potent disinfectants.”

Because of increasing bacterial resistance, they recommend these 21st century solutions in three specific patient populations:

Children who handle or use contact lenses. They’re often least likely to be compliant with care instructions.

Patients with a history of contact lens problems, such as marginal infiltrates or bacterial ulcers.

Any patient with chronic, irritated eyes from contact lens wear and who is thinking about refractive surgery or another option.

“A significant percentage of those patients are treatable by simply changing them to a much more appropriate solution,” Dr. Thimons said. “That simple switch to a better solution makes the lenses more compatible, and often nothing more than that is necessary to solve what has been a long-standing contact lens problem.”

The storage case is another potential harbinger of microbes often overlooked. “Discarding solution daily from the case, allowing the case to air dry, and using fresh solution in the evening would dramatically reduce complications,” Dr. Shovlin said. “Replacing the case with every bottle of new solution purchased would significantly reduce the bacterial load and would also go a long way to help ensure safe contact lens wear.”

The recent economic downturn has been another cause for an uptick in contact lens complications. Patients have been known to “overwear” their lenses, using a 2-week pair for 3 or 4 weeks, or even months, and skimp on solutions.

“I see this more and more, and it’s a trend line that doctors need to be very concerned about,” Dr. Thimons said.

Dr. Shovlin concurred. “Even the noninfectious, inflammatory events are a nuisance and can add significant time and expense for the patient,” he said. OP

DISCLOSURE: Dr. Shovlin is a consultant for Abbot Medical Optics, Alcon, Bausch + Lomb, and Genzyme. Dr. Thimons lectures for Abbott Medical Optics, Alcon, and Bausch + Lomb.

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