contact lens care and compliance

Looking Ahead and Reflecting On Where We've Been

BY MICHAEL A. WARD, MMSC, FAAO

Contact lens care has come into finer focus in the last few years. Our industry experienced negative publicity following some new lens care product formulation recalls and associated infectious outbreaks. We've learned from each incident. We have a much better understanding now as to how fungi can use multipurpose solution (MPS) polymer films to harbor and protect. We also know that the ability of Fusarium to attach to and penetrate lenses depends on both the Fusarium species and the type of lens polymer.

An outbreak involving Acanthamoeba sp. has left lingering questions regarding amoeba concentrations and chlorination levels in our public water supply and its possible association with increased microbial keratitis (MK). Meta-analysis of Fusarium and Acanthamoeba infections clearly shows that their incidence is on the rise. But, looking on the bright side, our attention has been refocused on contact lens care procedures and proper patient instruction and compliance.

What We Learned

Both recent major contact lens care solution-related MK outbreaks (Fusarium and Acanthamoeba keratitis) have been significantly associated with patients' improper lens care practices and risky lens wearing behaviors. The most common patient error in lens care is topping off the lens case with MPS product in place of proper emptying, air-drying and filling the lens case well with fresh MPS.

Major risk factors for MK include overnight lens wear, wearing lenses during water activities (e.g. while showering, using hot tubs, swimming) and improper lens storage case care.

Overnight lens wear remains the major risk factor for contracting contact lens-associated MK. Recent articles by Dart et al (2008) and Stapleton et al (2008) illustrate that the incidence of MK has not been reduced by newer silicone hydrogel lens polymers; in fact, the opposite appears to be the case.

It's important to keep contact lens surfaces clean. Meibomian gland secretions, makeup, hand and facial creams, etc., are potentially attracted to the lipophilic nature of silicone hydrogel lens surfaces. Digital rubbing of the lens surfaces with MPS products helps to remove these deposits, resulting in crisper vision and greater comfort.

A More Compliant Future

With the downturn in our economy it's even more important to review proper lens care practices and to continually educate our patients on acceptable and unacceptable lens wear and care practices. For a convenient list of lens care recommendations, see the September 2008 Contact Lens Care column titled, "The Bullet List of Contact Lens Care Recommendations" (also available in the archive at www.clspectrum.com).

It's well recognized that approximately half of two-week and one-month disposable contact lens wearers extend their lens life beyond what is prescribed — by roughly doubling the lens replacement cycle. Daily disposable (single use) lenses have the best compliance record for being replaced as prescribed.

Patients value your instructions and advice even if they don't comply. Consider that every patient you see is investing his time and resources in seeking your expertise and advice. Patients depend on you to protect and enhance their vision, which reinforces their sense of well being and visual enjoyment to experience the beauty of each season. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #158.

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. He is also a consultant to B&L and has participated as an advisory panel member for AMO.