contact lens primer
What's the Solution?
BY TIMOTHY B. EDRINGTON, OD, MS, FAAO, & JOSEPH T. BARR, OD, MS, FAAO

As lens care systems become more convenient, practitioner and patient interest in the importance of lens care has diminished, leading to a decrease in the amount of office time devoted to lens care instructions.

Show Me the Proficiency!

When teaching your patients lens application, removal, recentering and care system use, you need to confirm patient understanding and proficiency. It is important for the patient to demonstrate proficiency prior to leaving your office with his contact lenses. This is especially true for lens removal. If a patient cannot confidently remove his lenses while in your office, the chance that he will be unable to remove the lenses that evening at home is increased. This causes concern to the patient and might necessitate a late evening visit to your office to assist with lens removal.

The Rub (and the Rinse And the Disinfection)

Digitally rubbing the lens with a separate surfactant cleaner or with a multi-purpose solution will loosen lens deposits and debris. Thorough rinsing will remove the loosened deposits and debris, as well as the surfactant cleaner, from the lens surface. Explaining the rub and rinse portion of the lens care process this way (or via a clever analogy) will help your patient understand the importance of these steps. To help a patient learn proper rubbing technique, rub the patient's palm with your finger to demonstrate the pressure to apply to his lenses. Minimal pressure may result in insufficient cleaning, whereas excessive pressure could warp the lens or add minus power to an RGP. If the patient's fingers are super-sized, or the lens base curve is steep (such as many keratoconus lenses), suggest a Q-tip to gently clean the base curve. Don't use a Q-tip with a wooden stick as it may scratch the lens.

Thorough rinsing will ensure that debris and surfactant cleaner are adequately removed. If sufficient rinsing does not occur, the patient may experience discomfort on lens application.

Instruct patients to replace the disinfecting/storage solution every evening. Again, if the patient understands the reason why this is indicated, he is more likely to comply. Explain that when retrieving lenses from the case, his fingers can potentially contaminate the solution. After discarding the solution at the time of lens application, the remaining solution should be rinsed from the case to allow the case to air dry.

Many patients clean their lenses in the morning after soaking them in solution overnight, but this minimizes the wetting benefits to an RGP of an overnight soak. Instruct him to clean and rinse the lens immediately after removal and soak the lens in fresh solution overnight put not to clean the lens in the morning. The patient may apply a wetting or conditioning drop prior to lens application to increase comfort on application.

Watch 1 or 2, Do 1 or 2, Teach 1 or 2

Lens application, removal, recentration and proper lens care should be demonstrated to the patient. The patient should then demonstrate lens handling proficiency and understanding of the care system procedures. Written instructions for home use should be provided. At the first follow-up visit, the patient should again demonstrate proficiency. Do not assume that previous or current contact lens wearers are familiar with the proper procedures.

Dr. Edrington is a professor at the Southern California College of Optometry. E-mail him at tedrington@scco.edu.

Dr. Barr is editor of Contact Lens Spectrum and assistant dean of Clinical Affairs at The Ohio State University College of Optometry.