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So(  Contact  Lens  Solu3ons    &  

Pa3ent  Instruc3on  

Maria  K.  Walker,  OD,  MS,  FAAO  February  2,  2017  

Terminology  

•  CL:  Contact  lenses  •  SCL:  So(  Contact  Lenses  •  HEMA:  Hydrogel  (Contact  Lenses)  •  SiHy:  Silicone  Hydrogel  (Contact  Lenses)  • MPS:  Mul3-­‐purpose  solu3on  

2016  Distribu3on  of  CL  FiSng  

JJ  Nichols.  Contact  Lens  Spectrum.Jan  2017.  

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2016  Distribu3on  of  CL  FiSng  

JJ  Nichols.  Contact  Lens  Spectrum.Jan  2017.  

Pa3ent  Educa3on  •  Very  important  to  the  success  of  CL  wear  •  Noncompliance  and  lack  of  knowledge  are  primary  causes  of  

SCL  adverse  events  

•  Four  (prac33oner)  factors  contribute  to  pa3ent  noncompliance  

 1.  Poor  instruc3on    2.  No  instruc3on    3.  Poor  example    4.  Overloading  pa3ent  with  informa3on  at  dispense  

Pa3ent  Educa3on  

•  Applica3on  of  lenses:  •  Washing  and  drying  hands  •  Opening  blister  pack  •  Determining  lens  inversion  

(taco  test)  •  Actually  apply  lenses  (several  

acceptable  methods)  –  Can  demonstrate  if  a  CL  wearer  –  Can  have  staff  do  this,  but  be  sure  

they  are  well  trained  –  Adequate  ligh3ng  and  mirrors  

Set  up  a  good  example  in  your  office!  

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Taco  Test  

Pa3ent  Educa3on  

•  Removal  of  lenses:  •  Hand  washing!  •  “Floa3ng”  lenses  prior  to  removal  if  3ght  

 

Youtube,  www.aocle.org  

Pa3ent  Educa3on  

•  Lens  Cleaning:  Most  important  educa5onal  step!  

 •  Pa3ents  will  be  most  compliant  if  their  cleaning  system  is  simple  and  innexpensive  

•  Rub  and  rinse  analogy    •  Proper  management  of  CL  cases  

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Pa3ent  Educa3on  

•  Increasing  wear  3me  gradually  for  adapta3on    •  NO  Tap  water…never  EVER  EVER  with  so(  lenses!    •  Avoid  swimming  and  showering  •  Not  as  much  of  concern  with  daily  disposable      

•  Generally  daily  and  monthly  are  easier  for  pa3ents  to  remember  proper  replacement  •  1st  and  15th  replacement  for  bi-­‐weekly  

Lens  Deposits  

Mucin  balls  

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Pa3ent  Educa3on  •  ALWAYS  give  new  CL  wearers  wrihen  instruc3on  

Cosme3cs  &  Contact  Lenses  

•  Makeup    •  Suntan  lo3ons  •  A(er-­‐shave  lo3on  •  Shampoo  •  Oils  /  creams  •  Acne  medica3ons  •  Accutane  

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History  of  SCL  Care  Solu3ons  

•  1971:  First  Hydrogel  Solu3ons  •  Mid  1980s  –  MPS  evolved  •  Introduc3on  of  polyaminopropyl  biguanide  and  

polyquaternium-­‐1  (preserva3ves)  

•  August  15,  2010:  FDA  guidance  recommends  manufacturers  remove  “no-­‐rub”  from  bohles.  

•  Heat  –  uncommon  now    •  Original  chemical  disinfectants  

SCL  Solu3on  Components  

•  Disinfectants  •  Preserva3ves  (Chela3ng  agents)  •  Surfactants  •  Lubrica3ng  agents  •  WeSng  Agents  •  (minor  components):  Tonicity,  pH/buffers,  stabilizers  

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Preserva5ve  Toxicity  

Preserva5ve  Toxicity  

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Preserva3ve  Toxicity  •  2002  study  on  corneal  staining  in  hydrogel  lens  wearers  

•  500  full  3me  wearers,  20  clinical  sites  •  Any  staining  present  in  at  least  one  eye:  55.7%  •  Moderate/severe  staining:  8%  •  No  correla3on  to  care  system  

Steps  of  SCL  Disinfec3on  •  Physical  (rubbing,  rinsing)  vs.  Chemical  (soak  3me)  •  Chemical:  – Myristamidopropyl  dimethylamine  (Aldox)  

•  An3-­‐fungal  and  an3-­‐amoebic  ac3vity  –  Polyquaternium-­‐1  (Polyquad)  

•  Also  binds  cell  membrane  components…bad?  –  Polyhexamethylene  biguanide  (Dymed,  TrisChem)  

•  Binds  (-­‐)phospholipids  in  cell  membranes.  (problem?)  – Hydrogen  peroxide  (3%  =  30,000ppm)  

•  Very  toxic  at  3%  •  Neutralized  to  <100ppm  

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H2O2  solu5ons  

•  Commonly  used  when  pa5ents  have  preserva5ve  sensi5vity  

•  Kills  bacteria  and  fungi  •  3%  used  (30,000ppm)  •  Pla5num  catalyst  or  catalase  neutralizer  – Leaves  the  lenses  in  a  non-­‐preserved  solu5on  aMer  neutraliza5on  

Advanced  Cleaning  Systems  

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