cultivating compliance

Clean Up Your Lens Care Act

BY TIMOTHY B. EDRINGTON, OD, MS, FAAO

My perception is that contact lens practitioners and their staff members have become more lax with patient education regarding contact lens wear and care over the last 30 years.

The Not So Good Old Days

When soft contact lenses were first marketed in the United States in the early 1970s, the care system primarily prescribed was heat disinfection using home-made saline. Patients typically prepared the saline by dissolving salt tablets in distilled water. They generally reused the bottle without replacement or disinfection for months or years, which occasionally resulted in a spectacular technicolor display of fungus. The heat units were also prone to malfunction, resulting in a lack of disinfection.

Manufacturers later developed chemical lens care systems to resolve the problems associated with the use of unpreserved — and often contaminated — saline. Although early efforts were successful in reducing microorganisms, many patients were sensitive to or allergic to the preservatives and/or other ingredients in these lens solutions. Acute and chronic red eye responses were not uncommon.

During these early days of soft contact lens prescribing, it seemed that both eyecare practitioners and patients had more interest in the care system portion of lens wear. But as new and improved chemical care systems including hydrogen peroxide systems arrived on the scene, there were fewer red eye responses and patient complaints relative to the use of the solutions. Also, disposable soft contact lenses emerged in the late 1980s. Their more frequent lens replacement schedules diminished the need for heroic lens care to maintain a clean and comfortable lens. Perhaps we became more lax with our patient education regarding lens care during this time.

Recent History

Within the past two years came reports of increased — but small in number — incidences of corneal infections related to the use and misuse of specific soft contact lens care systems. Fusarium keratitis and Acanthamoeba keratitis, both rare corneal complications for contact lens wearers, were the identified causes, and two multipurpose contact lens solutions were voluntarily removed from distribution channels. In both cases the manufacturers thoroughly informed eyecare practitioners of the situation, and several organizations, as well as the contact lens industry, provided practitioners with educational information to further minimize any risks to our patients. I trust that this served as a reminder that we must make an appropriate effort to educate and re-educate our patients regarding proper lens wear and lens care.

Repeat After Me

Some helpful recommended advice resulted from the recent keratitis incidents:

• Wash your hands prior to handling your contact lenses.
• Don't top off solutions, but use fresh solutions for each disinfection.
• Clean and replace cases on a regular basis.
• Discontinue lens wear and immediately consult your eyecare practitioner if symptoms of pain, blurred vision, redness, increased tearing or photophobia occur.

I also continue to advise my contact lens patients to rub, rinse and disinfect their lenses in fresh solution upon lens removal.

I assume that in most practices a technician teaches lens application, removal and care. However, I feel that patients tend to improve their compliance if their eyecare practitioner reinforces key points of lens care. Therefore, before patients leave the office on dispensing day, I ask them to tell me step-by-step what they will do when they remove their lenses that evening. At follow-up visits, I ask patients to demonstrate the steps of their lens care regimen both upon removal and upon application. If you demonstrate that it's important to you, then it's more likely to be important to them. CLS

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