cultivating compliance

Improving Compliance with Contact Lens Care Products

BY VISHAKHA THAKRAR, OD, FAAO

The solution recalls from 2006 and 2007 are now hopefully just a painful memory for most of you. In the past year and a half, we've been reminded that compliance is essential to help prevent microbial keratitis. What have we learned from these events, and how can we apply what we've learned to patient care today?

Rub and Rinse is Back

'No-rub' multipurpose solutions (MPS) have been a dominant and effective part of lens care for several years. However, we know that for many patients, manual cleaning is necessary to appropriately care for their lenses. A ruband-rinse step can help remove debris, deposits and, most importantly, microorganisms from the lens. I find that emphasizing the importance of rubbing lenses even when I prescribe a no-rub solution can encourage further compliance.

Advanced Medical Optics (AMO) has recently released an MPS in the United States, Europe and Canada marketed as a "rub and rinse" solution. Complete MPS Easy Rub Formula contains Poloxamer 237 and has been sold globally for a number of years. We must be cognizant, however, that patients may try to use it as a no-rub MPS. Therefore, we must make sure to properly educate our patients before prescribing this solution.

Contact Lens Cases

Contamination may occur in up to 80 percent of contact lens cases (Figure 1) and may result in the formation of a biofilm. A biofilm is an aggregation of microorganisms to a surface or to one another, marked by a glycocalyx extracellular matrix. When microorganisms attach to a surface, they may become more tolerant to disinfecting agents. Lens cases are usually moist and act as ideal environments to facilitate biofilm formation. If cells from the biofilm are released and attach to a contact lens, the lens itself may act as the medium for pathogenic transmission to the eye.

Figure 1. Dirty contact lens case of a noncompliant patient.

To help avoid contact lens contamination, patients should clean cases daily with contact lens solution and leave to air dry. No solution should remain in the case. Patients should use fresh solution every time they disinfect their lenses and discard their case every one to three months.

Most solution manufacturers continue to reiterate the importance of caring for contact lens cases. A great deal of time and effort has been put into educating patients and practitioners over the past year and a half. This will help enforce compliance among our patients.

Hydrogen Peroxide

Hydrogen peroxide systems are very effective and break down microbial cell membranes through oxidation. Hydrogen peroxide 3% is effective against the cyst and trophozoite forms of Acanthamoeba, bacteria, fungi and certain viruses.

Lens Care in the Spotlight

Recent events have forced manufacturers and practitioners to take more notice of compliance issues. Lens care compliance is an ongoing issue in the contact lens industry, so we must take appropriate steps to educate our patients about proper lens care. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #146.

Dr. Thakrar currently practices in a private setting in Toronto and Oakville, Ontario. She is a graduate of The Ohio State University and completed a residency in cornea and contact Lenses at the New England College of Optometry.