Your Dirty Patients: Contact Lenses Need Rescuing!
ByPaddy Kamen
Sticking harmful microbes in the eye is no one’s idea of a good time. Yet it happens frequently with contact lens wearers. Why? Because they aren’t careful enough.
Two surveys by Johnson & Johnson Vision Care, published in May 2011 in Contact Lens & Anterior Eye, the journal of the British Contact Lens Association, found that astonishing numbers of users are not compliant in every major area of contact lens care.
The studies were done independently of the sponsor and participants were blind to who the sponsor was. In the first study, 645 frequent replacement contact lens wearers answered questions about lens replacement frequency. In the second survey, 787 frequent replacement wearers answered questions about lens disinfection, hygiene and storage case replacement. All respondents wore hydrogel and silicone hydrogel lenses prescribed for two-week or monthly replacement.
Survey results demonstrated that vast numbers of contact lens users simply do not take lens care instructions seriously enough to comply.
Almost half (44 per cent) of respondents never washed their hands with soap prior to lens insertion or removal. Forty-six per cent did not fill their empty cases with fresh disinfecting solution every day and 33 per cent cleaned their contact lens cases monthly or less often.
What Are They Thinking?
How might a consumer be thinking about the importance of proper hygiene with respect to their lenses? One imagines that they push the envelope, experience no repercussions and then assume that the instructions are too rigid.
Sheila Hickson-Curran, director of medical affairs with VISTAKON®, says the relationship between contact lens wear and care and complications is well documented. She believes that experiences of non-compliance with no ill effects do reinforce poor behaviour. “However, by not following instructions on proper wear and care, contact lens wearers are more likely to experience discomfort and may put themselves at greater risk for infection or other serious complications, such as microbial keratitis.”
The ‘rub’ or ‘no rub’ debate appears to have been put to rest. This fall, Bausch + Lomb launched a global initiative instructing consumers on a ‘rub-and-rinse’ regimen for use with their multi-purpose contact lens solution, replacing the former ‘no-rub’ instructions on all packaging for renu® fresh™ in Canada.
The Canadian Association of Optometrists applauds the move because the mechanical step of rubbing lenses helps to remove microbial organisms that may cause microbial keratitis. “Moving towards a rub-and-rinse routine is consistent with recommendations made by eye care organizations, regulatory agencies and eye care professionals,” said Glenn Campbell, executive director of the Canadian Association of Optometrists.
The new cleaning instructions include these steps:
1. Using three drops of multi-purpose solution on each side of the contact lens, gently rub for 20 seconds;
2. Thoroughly rinse each side of the lens for five seconds with multi-purpose solution;
3. Place cleaned lenses in a lens case, fill with fresh solution and soak for at least four hours.
Bausch + Lomb also advises against reusing solution and recommends replacing lens cases monthly.
Keith Harrison is an optician who specializes in contact lens fitting at Harrison Optical Services at theTorontoWesternHospital. He stresses the importance of educating patients from day one and continually reinforcing the importance of good hygiene at each opportunity. “I tell patients that their planned replacement soft lenses should feel as good on the last day of wear as it did on the first. The point is not to see how long it takes before you have a complication. In my experience problems develop as a result of people topping up solution (rather than replacing it entirely), not changing solution, not doing a rub and rinse, not changing their cases routinely, and not maintaining good case hygiene.”
The Johnson & Johnson research agrees on every point. According to their news release: “Failure to empty and replace the full volume of contact lens disinfecting solution was one of the few significant behavioral factors found in the U.S. Center for Disease Control and Prevention investigation of the Fusarium outbreak of 2005.”
Josh Josephson, O.D., chairman of the ophthalmic devices section of the Standards Council of Canada and a founding member of the International Society for Contact Lens Research, says that case hygiene is just as important as personal hygiene when it comes to preventing eye infection in contact lens wearers.
“The internal walls of cases build up a biofilm of microorganisms that are released into the solution in planktonic form. So if patients are in the habit of ‘topping up’, rather than placing fresh solution in a new case, the antibacterial agents that remain in the partially used solution can be overwhelmed by the destructive microorganisms. This happens when the case has been used for a minimum of four weeks.”
Clearly patient compliance comes down to the patient fully realizing the importance of infection prevention. Change will take a concerted effort on the part of contact lens fitters and the industry. It’s good to see this happening. Short of having ‘contact lens police’ visiting people’s washrooms, education seems to be the only way forward.
