cultivating compliance

Taming Contact Lens Noncompliance Issues: Act I

BY ROSALYNN H. NGUYEN, OD, & TIMOTHY B. EDRINGTON, OD, MS, FAAO

The eyecare field has seen a steady increase in the popularity of contact lens wear due to the advent of new materials and technologies. Recent reports of infections and lens care system recalls have made both eyecare professionals and patients cautious. Extensive media coverage has made Acanthamoeba, Pseudomonas and especially Fusarium household terms. However, it's important to realize that we can help prevent these severe corneal infections and other contact lens complications with proper patient education and appropriate lens care.

These recent events prompt us to discuss various strategies and issues to minimize lens wear complications. The following is a list of our top 10 contact lens non-compliance issues we regularly encounter in the clinical setting.

10. H₂O, oh no! Patients should avoid wearing their contact lenses while in pools, hot tubs and the ocean. It's best to completely avoid lens wear while in contact with tap water due to the risk of Acanthamoeba infection.

Prescription goggles are available to aid underwater vision. However, if patients are wearing lenses for water activities, prescribing daily disposable lenses may be the most desirable option.

9. Aye, there's the rub! Digital rubbing still remains an effective method of cleaning contact lenses regardless of the care system that patients use.

New lens materials, such as the silicone hydrogels, adhere more lipids and mucus, thus making the mechanical step in the cleaning process beneficial. Moreover, the trend of extended wear lenses with longer replacement schedules makes it increasingly important to minimize deposits, such as protein, to prevent long-term complications and to increase lens comfort.

8. Double, double toil and trouble; when old solutions are used and H₂O₂ doesn't bubble! Warn patients to never reuse or top-off solution, and to always use new solution in the rinsing and soaking process. This is especially important with hydrogen peroxide systems because topping-off puts patients at risk of inadequate disinfection by diluting the 3% hydrogen peroxide solution.

In addition, by not replacing the solution in hydrogen peroxide care systems daily, patients are essentially soaking their lenses long-term in saline, which has no disinfection properties.

7. To have spectacles or not to have spectacles — that is the question. Even though contact lenses may be the primary source of vision correction for a patient, encourage lens wearers to have a spare pair of spectacles in their current prescription.

Spectacles are necessary for emergencies, ocular infections or for circumstances in which contact lens wear is contraindicated or inconvenient. Furthermore, recommend that patients wear spectacles for one hour in the morning before applying lenses and for one hour each evening after removal to allow their corneas a full complement of oxygen after awakening and before bed.

6. Messing with make-up. Advise patients to apply contact lenses before putting on make-up and to remove their lenses before make-up removal, which helps minimize the deposition of makeup debris on contact lenses. This rule also applies to creams and moisturizers.

Using make-up that's compatible with contact lens materials is also recommended. You can find a list of compatible make-up in Tyler's Quarterly Parameter Guide or on the Web.

Now it's time for intermission. Stay tuned for the final installment of our Top 10 list in a future Contact Lens Spectrum. CLS

Dr. Nguyen completed her residency training in Cornea and Contact Lenses at the Southern California College of Optometry in June 2008. Dr. Edrington is a professor at the Southern California College of Optometry. E-mail him at tedrington@scco.edu.