contact lens care

The Case of Silicone Hydrogels and the Park Ranger

BY SUSAN J. GROMACKI, OD, MS, FAAO

A 33-year-old white female reported as a new patient to my practice. She was wearing Focus Monthly contact lenses (vifilcon A, CIBA Vision) and reported decreased acuity at distance.

The patient said she replaced her lenses monthly as prescribed, but stored them in saline solution. Although many patients use the word saline to mean multi-purpose solution (MPS), my detailed questioning confirmed that she really was using saline. The patient also reported that she did not rinse or digitally rub her lenses after removal.

Despite this and a wearing time of 17 hours per day, the patient reported good comfort with her lenses. However, slit lamp examination revealed a grade 2 GPC and 360 degrees of corneal neovascularization OU.

We talked about the examination results and I then reviewed the benefits of silicone hydrogel lenses, such as more oxygen and less protein deposition. We also discussed the importance of proper contact lens disinfection in preventing infection.

After the discussion, we refit the patient into Biofinity silicone hydrogel lenses (comfilcon A, CooperVision). The fitting went well. The patient had 20/20 vision in both eyes and excellent centration, movement and comfort. I dispensed these lenses along with Clear Care (CIBA Vision) and thorough lens care instructions.

An Unexpected Result

At the one-week follow up, I expected the best: a happy patient and reduced GPC and neovascularization. The patient stated that her vision was better, but that her contact lenses were less comfortable than her previous pair.

Figure 1. The park ranger's left contact lens.

I then considered all of the possible differentials — increased modulus, increased lipid deposition, less wetting, too loose, too tight, decentered, a material/solution interaction. It was none of these.

After viewing her lenses, I determined that it was paint. Yes, paint, on her lenses (Figure 1). Upon questioning, the patient — who also happens to be a park ranger — admitted that she and her staff had been painting bunk beds in preparation for the summer camping season. "Paint day" coincided serendipitously with the receipt of her new contact lenses.

So, I dispensed a fresh, new pair of silicone hydrogel lenses, and a few days later she ordered a year's supply. In the end, this park ranger left my office a happy camper!

Lessons Learned

This case taught me a few lessons. It's always important to consider all of the potential differentials prior to viewing our patients, even if our initial instincts are incorrect. This is especially wise in these days of managed care when we have less time to see patients.

Secondly, timing is everything. It was ironic that her symptoms had nothing at all to do with her new silicone hydrogel lenses or with the solution, but rather with her profession.

And lastly, most solutions are compatible with most materials most of the time. Although we must consider this as a differential, in my experience it's a rare occurrence, especially with a hydrogen peroxide system. CLS

Dr. Gromacki is a Diplomate in Cornea and Contact Lenses in the American Academy of Optometry. She has a specialty contact lens and post-surgical co-management practice as part of a multi-subspecialty ophthalmology group in Ann Arbor, MI.