Pediatric and Teen CL Care

Replacement Compliance Just Isn't Enough

BY MARJORIE J. RAH, OD, PHD

A 17-year-old male presented to the clinic as a new patient for his annual contact lens examination. He was wearing Air Optix Night & Day Aqua (Ciba Vision) lenses and reported wearing them for 30 days continuous wear. At the end of the month, he would remove the lenses and leave them out overnight to give his eyes a break. Lens wear would resume the following day with a new pair.

On occasion, if the lenses felt uncomfortable, he would remove and clean them with a multipurpose solution and then reapply. He was unsure of the name of the contact lens care system he was using. He reported that he is compliant with the 30-day replacement schedule.

Upon slit lamp examination, the lenses were well-positioned on the eye and moving freely; however, small circular red deposits were evident on both lens surfaces. The ocular surfaces were clear except for grade 1 diffuse corneal staining in each eye. When questioned about the red deposits, the patient admitted to wearing the contact lenses during an auto mechanics class and had been painting with a sprayer the previous day. Although he had been wearing eye protection, paint had deposited on the surface of the lenses. He was unaware of the paint on his lenses and had therefore not removed them for cleaning.

Need for a Lens Care Overhaul

Although this patient's lenses are approved by the U.S. Food and Drug Administration for 30-day continuous wear, we recommended that he remove his lenses at least weekly and definitely on the days that he had auto shop class. Although the patient was not happy with removing his lenses more frequently for cleaning and disinfecting, he and his mother agreed to the new wearing and care schedule. He was also educated regarding the importance of maintaining a rigorous replacement schedule of 30 days. Proper use of the multipurpose solution was reviewed along with proper hand hygiene, proper cleaning and replacement of his lens case, and the increased risks involved with swimming or showering while wearing contact lenses.

Patient noncompliance is a significant concern. In a study by Wu et al (2010), 11 percent of patients reported poor hand washing prior to lens handling, 37 percent were not properly cleaning the lenses, 13 percent admitted to topping off solution, and 60 percent wore their contact lenses during water activity (59 percent were not wearing goggles or daily disposable lenses).

Although the patient in this case reports compliance with replacement schedule, patients are often noncompliant with their recommended replacement schedule (Dumbleton et al, 2009). Patients wearing two-week silicone hydrogels were the most likely to be noncompliant with recommended wearing schedules compared with those wearing one-month replacement silicone hydrogels and daily disposables.

The researchers also found that 30 percent of patients were unsure of the name of the lens care system they were using. This was true of the patient in the above case. The study also reported that 94 percent of compliant patients and 76 percent of noncompliant patients agree or strongly agree that if their eye-care practitioner tells them to do something to care for their contact lenses, they do it.

These studies stress the importance of patient education in the office. At each visit, remind patients of proper lens care practices, hygiene, and wearing schedules. CLS

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

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Dr. Rah has been a staff optometrist at the Massachusetts Eye and Ear Infirmary Contact Lens Service where she specialized in medically necessary and other advanced contact lens designs. Since writing this article she has joined Bausch + Lomb as manager, Medical Affairs.