Treatment Plan

The Care and Feeding of Contact Lenses

BY LEO SEMES, OD, FAAO; MONICA K. HINES, OD; & DANIEL DELIGIO, OD

The benefits of contact lens wear aren’t realized when the lenses are used inappropriately or proper hygiene is neglected. To address the nearly 1 million healthcare visits related to contact lens complications occurring annually, the U.S. Centers for Disease Control and Prevention (CDC) released a report highlighting these complications and the means to avoid them (Collier et al, 2014).

An online survey was used to assess the prevalence of contact lens hygiene-related risk behaviors, such as replacement schedule, sleeping in contact lenses, lens exposure to water, use of solution, and hand washing habits (Cope et al, 2015).

Astonishingly, roughly 99% of respondents reported at least one hygiene behavior associated with increased risk of contact lens-induced infection or inflammation. Nearly 50% reported extending the replacement schedule of the contact lenses, and more than 80% kept the cases for longer than recommended. Half of the respondents admitted to sleeping overnight in contact lenses not approved for such use, and more than 85% admitted to napping in them. More than half topped off old disinfecting solution with new solution. Nearly 85% of contact lens wearers showered while wearing lenses, and more than 60% reported swimming in them. More than 30% reported a previous history of a red and/or painful eye that required a doctor’s visit.

CDC Recommendations

The CDC recommends contact-lens care standards to mitigate the risk of related complications (Cope et al, 2015), including instructing patients to never sleep in lenses unless instructed to by an eyecare provider; discard lenses as directed; replace cases every three months; and avoid contact lens exposure to water. Patients are also encouraged to have an updated pair of backup spectacles in case of emergencies. In addition, patients should remove contact lenses immediately and call an eyecare provider if eye pain, redness, discomfort, or blurry vision occurs (Cope et al, 2014); use the RSVP acronym (redness, sensitivity to light, vision decrease, pain) to assess the situation.

Our role as primary eyecare providers is to screen and select patients who are responsible and demonstrate good contact lens hygiene. We also should have protocols in place to ensure that patients are educated on proper contact lens wear and care in a way that they will understand and remember. Have patients demonstrate proper care before leaving the office, and have educational reference sheets to take home.

On return visits, query patients on their contact lens care routine and/or have them demonstrate it. Do they wash their hands before handling lenses? How does the contact lens case look? Does the case have old disinfecting solution in it?

Patients should be extensively educated on healthy contact lens habits before you finalize the prescription and dispense trial lenses. They should be aware of the risks and complications associated with contact lens abuse. Lens hygiene includes avoiding exposing contact lenses to all water, replacing lenses and cases as directed, and washing hands before handling lenses. Patients should avoid sleeping in lenses unless directed to by their practitioner. They also should empty used disinfecting solution and fill the case with fresh solution daily. If a contact lens-related complication occurs, it is recommended that patients discontinue wear and visit their prescriber. CLS

For references, please visit www.clspectrum.com/references and click on document #241.

Dr. Semes is a professor of optometry at the University of Alabama School of Optometry in Birmingham (UABSO). He is a consultant or advisor to Alcon, Allergan, and Regeneron, and he is a stock shareholder in HPO. Dr. Hines is currently a Framily Practice resident at UABSO. Dr. Deligio is currently a Cornea and Contact Lenses resident at UABSO.