A few weeks ago, I had a “routine” vision exam on my schedule. Lo and behold, when I walked into the room to see the patient, routine took on a different connotation. The patient had been successfully wearing corneal GP lenses since 2018. Suddenly, in the last six months, the lenses had become intolerable.

First, I looked at the fit of the lenses on the eye and examined the current state of the lenses. It was a textbook lid-attached fit and his lenses were in good shape and free of deposits. I then had the patient remove his lenses so that we could measure them and examine the optical quality (check for warpage, etc.), which I delegate to technicians.

Then, I proceeded to roll up my sleeves and examine his ocular surface. No surprise: he had an almost instantaneous tear breakup time and a mild amount of corneal and conjunctival staining. Aha! I have the solution! Oh, wait…it’s been discontinued! Oh, wait…it’s back on the market! Trying to follow the GP contact lens cleaning production is becoming like a game of Whac-A-Mole. When I first graduated from optometry school, I had my favorite GP cleaner; then it was gone, and now it is back.

For dry eye patients, or those who have heavy protein and lipid deposits, finding the right GP solution for either scleral lenses or corneal GP lenses can be an easy, yet effective, way to circumvent possible contact lens dropout.

Studies have shown that components of the tear film collect on the surfaces of contact lenses and are believed to cause contact lens discomfort (Nichols and Sinnott, 2006; Ingólfsson and Andersen, 2011). Alcohol-based cleaners can be helpful in removal of both lipid and protein deposits in patients who suffer from dry eye and may have an increase of these deposits or volume in the tear film. Alcohol is a modulator that acts on and penetrates the lipid bilayer; it can also alter proteins and cause breakdown (Nichols and Sinnott, 2006).

Another option is to consider an additional cleaning step in which an alcohol-based cleaner coupled with a very mild fine abrasive cleaner is the added element that patients need to fully remove deposits during their nightly cleaning prior to disinfection (Bennett and Wagner, 2014).

Use caution, as even a mildly abrasive cleaner could disrupt lenses that have plasma coating. Of course, when a polyethylene glycol (PEG) coating is applied to lenses, the manufacturer has indicated that alcohol-based cleaners are contraindicated.

Another additional step that can be added to the patient’s care regime is a weekly treatment with a more intensive cleaner during which lenses are soaked for 30 minutes to remove heavy deposits. However, this can be challenging for patients to adhere to weekly and works best for those who do well with specific instructions (Bennett and Wagner, 2014).

Finally, hydrogen peroxide-based cleaning systems have been shown to be effective in the removal of contact lens deposits and can affect the disinfection system (Gabriel, 2021). They can be used as an alternative and may be more advantageous for these patients.

It is often useful to double up (using an alcohol-based cleaner for manual cleaning, followed by the overnight use of a hydrogen peroxide-based system for overnight disinfection) routinely for dry eye GP nightly cleaning. If needed, add in extra cleaners weekly. I recently had a patient tell me she used toothpaste to clean her lenses. Obviously, that was a hard pass. CLS

REFERENCES

1. Nichols JJ, Sinnott LT. Tear Film, contact lens, and patient-related factors associated with contact lens-related dry eye. Investig Ophthalmol Vis Sci. 2006 Apr;47:1319-1328.
2. Ingólfsson HI, Andersen OS. Alcohol’s effects on lipid bilayer properties. Biophys J. 2011 Aug;101:847-855.
3. Bennett ES, Wagner H. Gas-permeable lens care and patient education. In Bennett ES, Henry VA, eds. Clinical Manual of Contact Lenses. 4th Edition. Philadelphia, PA: Lippincott, Williams & Wilkins; 2014:157-186
4. Gabriel MM, McAnally C, Chen H, Srinivasan S, Manoj V, Garofalo R. Hydrogen Peroxide Disinfecting Solution for Gas Permeable Contact Lenses: A Review of the Antimicrobial Efficacy, Compatibility, and Safety Performance of a One-Step Lens Care System. Clin Optom (Auckl). 2021 Jan;13:7-14.