contact lens care

Compliance: The Little Things Can Make a Difference

BY SUSAN J. GROMACKI, OD, MS, FAAO

When it comes to instructing our patients regarding contact lens care, we rightly emphasize the obvious: wash your hands, rub your lenses and always use fresh solution. We must emphasize and repeat these steps because many patients do not comply with even these basic instructions.

However, don't overlook that it may be one of the little things that can make or break success with contact lens wear and can prevent infection. We practitioners may take these steps for granted, but many of our patients may be completely unaware of them—unless we speak up.

The Little Things of Lens Care

Consider giving patients these additional instructions:

► Always close the top of the solution bottle. Leaving the cap off gives pathogens a point of entry into the bottle 24 hours a day. Although there are preservatives in the bottle, it may still lead to contamination. Most patients store solution bottles in the bathroom, which has the highest concentration of bacteria, fungi and protozoans in the home.

In addition, leaving the cap off results in evaporation, which increases the solution's osmolarity. According to Bausch & Lomb, this noncompliant behavior contributed to the 2006 outbreak of Fusarium keratitis by causing an increased concentration of polymers within the ReNu with MoistureLoc solution.

You can set a good example for patients by always closing the caps on the bottles in your office.

► Don't touch the tip of the solution bottle to anything. Doing so can introduce pathogens into the bottle.

► Don't share your contact lenses or lens case with anyone. This includes those closest to patients, kin or otherwise.

► Clean your lens case daily. A dirty case renders obsolete all good efforts to maintain clean lenses. Once clean, cases should be air dried and covered with a clean towel (except CIBA Vision's ProGuard case, which should be closed to maintain its antimicrobial properties.) Patients should replace cases every one-to-three months.

► No sleeping in your lenses (unless practitioner-prescribed). The studies are endless citing the increased incidence of microbial keratitis, hypoxic complications, etc. in extended wear versus daily wear. This may be obvious to us, but it's highly worth emphasizing to our patients.

► Use only disinfecting solution for storage. Saline and rewetting drops are not FDA-approved for disinfection.

► Don't transfer your solution to another bottle, even for travel. This negates the sterile environment in which the solution was packaged.

► Do not swim or use a hot tub while wearing contact lenses. Our practice believes the safest recommendation is to avoid these activities even with immediate disposal of daily lenses following pool use. We include these instructions as part of every new contact lens patient's information.

► Don't rinse soft contact lenses with tap water. We all know the proclivity of Acanthamoeba in water — and of the outbreak linked with Complete Moisture Plus solution (Advanced Medical Optics) — but our patients probably don't. We owe it to them to provide the highest standard of education. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #151.

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.