Contact Lens Care & Compliance

Make Case Care a Priority in Your Practice

BY SUSAN J. GROMACKI, OD, MS, FAAO

The contact lens case has long been a highly overlooked component of the contact lens disinfection process. To this day, there is still no consensus among practitioners, researchers, and industry as to how often to replace cases. And what's more, the United States Food and Drug Administration (FDA) does not require the presence of a contact lens case for the Stand-Alone Test for microbial disinfection. In addition, the FDA's 1997 guidance document for contact lens solutions reported “no guidance or standard developed on the final lens case performance or on the interaction or compatibility of the lens case with the variety of the solutions used for overnight storage and disinfection.” (Gleason, 2009).

Following the keratitis outbreaks among contact lens wearers, the FDA posted contact lens care recommendations on its Web site, including the instruction to replace cases every three to six months. Case replacement and care was one of the specific topics for which the FDA sought advice from its Ophthalmic Devices Panel at its historic meeting on June 10, 2008. The Panel concluded, however, that it could not recommend exactly how often a contact lens case should be replaced or how it should be dried until research provided more information.

Recent Investigations

Two years later, publications are providing new research and comprehensive literature reviews regarding contact lens cases. Here is some of the latest information:

• Biofilms (multicellular for mations of organisms that can aid in bacterial adhesion and colonization by secreting substances that act as a scaffold) are most responsible for the transfer of resistant organisms from the lens case to the contact lens itself. They also can render resistance to the biocide properties of lens care products (Hall and Jones, 2010; Szczotka et al, 2010).

• Manufacturers (Ciba Vision, Aquify; Abbott Medical Optics, Complete; Bausch + Lomb, ReNu MultiPlus; and Alcon, Opti-Free Replenish) vary in their case replacement recommendations, from no instructions given to one to three months (Wu et al, 2010).

• Among practicing optometrists, 30 percent educate patients to rub their lens cases to clean them; 52 percent instruct patients to rinse their cases with disinfecting solution, and 77 percent recommend air drying cases after rinsing. Instructions for case replacement ranged from one to six months (Wu et al, 2010).

• Thirty percent to 82 percent of cases show contamination with pathogens (Wu et al, 2010; Yung et al, 2007).

• Without consistent instructions, only 26 percent of patients replace their contact lens cases in one month or less; almost 50 percent replace them after five months or longer, and 10 percent never replace them (Dumbleton et al, 2010).

Set Guidelines for Case Care

Researchers and educators have begun to take a closer look at case care. It is up to us to follow their lead and emphasize case care within our practices. Because no universal standards exist, we each must develop our own set of instructions. A good starting point is to clean, rinse (with solution, not tap water), and dry cases after use and to replace them every one to six months. Ultimately, it is our responsibility to communicate proper case care instructions to our lens wearers. If we all (manufacturers, the FDA, practitioners, and patients) work together, we can prevent case contamination. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #177.

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Dr. Gromacki is a Diplomate in the Cornea, Contact Lenses, and Refractive Technologies section of the American Academy of Optometry. She is chief research optometrist at Keller Community Hospital in West Point, N.Y.