contact lens case reports
When the Solution is the Problem
BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ, FAAO

Patient JM is a 29-year-old female who has been wearing daily wear soft contact lenses for seven years. Her current contact lens correction consists of ­4.50D Frequency 55 aspheric lenses (CooperVision), which she replaces monthly. JM reports compliance with the replacement regimen and her past history of lens usage substantiates her claims. She recently presented for routine follow up requesting a refill of her lens prescription.

Figure 1. Contact lens solution-induced tarsal plate inflammation.
Figure 2. Some private-label lens care products.

Visual acuities with JM's current lenses were 20/15 OU. Slit lamp exam showed that the lenses fit well and were free of deposits. The corneas and bulbar conjunctiva were within normal limits and essentially free of injection and staining. Routine examination of the tarsal plates revealed the presence of mild inflammation with an absence of giant papillae (Figure 1).

Upon further questioning, JM commented that her wearing time and lens comfort had decreased because of symptoms of dryness that she attributed to her history of seasonal allergies. She also admitted to changing her lens care regimen from our recommended brand to the "whatever was on sale" brand. In fact, her storage solution was a private-label saline with no disinfecting properties.

We dispensed new lenses to JM and gave her a sample of the multi-purpose solution that she'd used before switching to the private-label products. She called several weeks later to inform us that her dryness symptoms had improved "a million percent" and that she was again comfortable wearing her lenses all day.

Private-Label Products

Recent AC Nielsen data as of November 2004 indicate that in the previous 52-week period, private-label brands of lens care products are a major player in the U.S. solution market (Table 1). These numbers indicate that approximately one out of four of our patients have abandoned their recommended lens care system for private-label products. (U.S. sales of private-label solutions command 25 percent of the lens care market.)

However, the biggest clinical concern may be the fact that corporate decisions can result in periodic changes in the solution formulation, yet the product's brand name and outward labeling remain the same in the eyes of the patient (Figure 2). Therefore, it's important that we continue to instruct our patients on the proper use of our suggested contact lens care products.

Patrick Caroline is an associate professor of optometry at Pacific University and is an assistant professor of ophthalmology at the Oregon Health Sciences University. Mark André is director of contact lens services at the Oregon Health Sciences University and serves as an assistant professor of optometry at Pacific University.