Care and maintenance of soft contact lenses


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The presentation I have made and uploaded provides you with an in-depth insight into the care and maintenance aspects of soft contact lens wear and use.

The author does not assume responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.
No copyright infringement, or plagiarism intended.
Amrit Pokharel

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Care and maintenance of soft contact lenses

  1. 1. Amrit Pokharel
  2. 2. Outline of the presentation Why care for contact lenses? Deposit and types Lens care regimen  Components of lens care solution  Functions  Steps in lens care and maintenance  Types of disinfectants  Do-s and Don‟t-s
  3. 3. Purpose of Care andMaintenance Failure to prescribe proper lens care regimen Failure of compliance  Reduced comfort  Reduced vision  Increased risk of contamination---complications/ infections  Dissatisfied patients  Coverging to Failure of CL wear
  4. 4. Outline of the presentation . Deposits and Types . . . . . .
  5. 5. Deposits and Types “…Any lens surface coating or matrix formation which is not flushed or rinsed from a lens by tears during blinking” Types of deposits:  External  Eye make-up, air pollutants, etc.  Internal  Tear components-protein, lipid, mucin, etc
  6. 6. Contact lens Deposits How do deposits form on contact lens surface?  Interaction between lens and content of tears  Evaporation of tears leaves residue on lens  Lens chemistry attracts tear film constituents( proteins, lipids, mucin, calcium)
  7. 7. How do protein deposits getdenatured?
  8. 8. Lipid deposits
  9. 9. JellyBumps
  10. 10. Purpose of Care andmaintenance Clean lenses:  To prevent/minimize deposits  To maintain hydration and wettability  To provide comfort and clear vision  To prevent or reduce the risk of ocular infection/inflammation
  11. 11. Deposit complications Reduced visual acuity Lens dryness- proteins repel water and the lens may dry up more easily Irritation and reduced comfort shortened wear time Cause allergic response Micro-organism‟s attachment to deposits may cause eye infection
  12. 12. Outline of the presentation . . .Lens care regimen  Components of lens care solution  Functions  Steps in lens care and maintenance  Types of disinfectants  Do-s and Don‟t-s
  13. 13. Components of Care andMaintenance Daily cleaner Rinsing solution Disinfecting solution Protein removers Lubricating/rewetting solution Lens storage case
  14. 14. Compliance Vs Non-Compliance Simple system and Instruction  Bettercompliance  Easy convenient Complicated System Confusion Non-compliance Lens wear complications
  15. 15. Essential Steps of Care andMaintenance Cleaning Rinsing Disinfecting Extra Steps  Protein Removal  Lubricating/Rewetting
  16. 16. Daily cleaning and/orrinsing removes majorityof Micro-organisms
  17. 17. Essential Steps of Care andMaintenance Cleaning . . .
  18. 18. Daily cleaner- Functions To remove  Loosely bound foreign matter  Cell debris  Mucus, lipid , protein  Cosmetic or other surface contamination  Majority of micro-organisms
  19. 19. Daily cleaner Composition Surfactants Buffers Osmolality adjusting agents Preservatives Water
  20. 20. Surfactant Cleaners Remove deposits by  Interactingwith deposits  Displacing deposits from lens surface Emulsify oils and lipids Destroy/dislodge micro-organisms Prepare lens for rinsing and disinfection
  21. 21. Daily cleaner procedures Wash the hand Place the lens in the palm of the hand Place 2-3 drops of cleaner on each lens surface Rub with forefinger for about 10-15 sec per side using to and fro and circular action Rolling the fore-finger in both directions Clean lens periphery Rinse well
  22. 22. Daily Lens Care Procedure
  23. 23. Hand washing  Reduced bio-burden  With water-based soaps  Often forgotten step
  24. 24. Rubbing the lens 10-15 sec on each side To and fro action Removal of environmental and protein deposits Reduces risks of infection
  25. 25. Consumer‟s perception of NoRub Simply put the lens into the case after removal No digital cleaning, No rinsing Simple, carefree, convenient lens care Reduced usage of lens care solution
  26. 26. Essential steps of Care andMaintenance . Rinsing . .
  27. 27. Rinsing  Wash off loosened debris  Decrease risk of deposit related problems
  28. 28. Essential steps of Care andMaintenance . . Disinfecting .
  29. 29. Disinfecting system Kill or Deactivate potentially pathogenic organisms including  Bacteria  Fungi  Viruses  Amoebae Maintains lens hydration— stable parameters
  30. 30. Disinfection  Store the lens for at least 4 hours in FRESH solution  Decrease the risk of infections
  31. 31. Types of Disinfection Heat  ThermalUnit  Microwave Chemical  Oxidative  Hydrogen Peroxide  Chlorine  Cold chemicals  Various disinfectants
  32. 32. Thermal Disinfection Original form of disinfection- discontinued in the market Procedures  Clean and rinse lenses  Place lenses in fresh saline in lens case  Heat to 70-80 deg for 10-12 min  After heat cycle, allow lenses to cool before use
  33. 33. Thermal disinfection Advantages  Disadvantages  Short disinfection  Incompatible with cycle times some lenses, eg.  Highly effective High water content; antimicrobial action may cause  Low risk or allergic discolouration and reactions deformation  Increased protein deposits( cook the protein) and causes allergy  Suitable power may not be always
  34. 34. ChemicalDisinfection
  35. 35. Chemical Disinfection Disinfection achieved by the presence of preservatives  Thimerosal, Chlorhexidine, Sorbic acid Disinfection depends on the concentration and type of preservative Preservatives are potential irritants though rare
  36. 36. Chemical Disinfection Actions vary in modes:  Cellmembrane disruption- Benzalkonium chloride  Enzyme Inhibition-Thimerosal  Protein Coagulation-EDTA Cold chemicals  Thimerosal, Chlorhexidine, Sorbic acid, ATAC, Isopropyl alcohol, Polyquad, Dymed, Phenylmercuric nitrate
  37. 37. Modern Chemical Disinfectants Used in Mutipurpose (All-in-one ) solutions: Polyaminopropyl biguanide (PABA, PHMB) Quaternary-ammonia (Poyquad) & Aldox
  38. 38. Multipurpose solutions Single bottle of solution for cleaning, rinsing, disinfecting and removing protein Advantages  Simple,convenient, easy transport  Enhanced safety due to lower toxicity and complications  Does not cause protein denaturation  Improved compliance Disadvantage  Small incidence of mild sensitivity reactions
  39. 39. Hydrogen peroxide Advantages  Disadvantages  Preservative free-  Inflexible theoretically less neutralisation time( allergy lens must be fully  Effective disinfection neutralised before use)  H202 concentration decreased rapidly (3% to 1% in <10 min)- decreased anti-microbial efficacy
  40. 40. Hydrogen peroxide stepsystems
  41. 41. Hydrogen peroxide stepsystems
  42. 42. Antimicrobial efficacy A battery of tests is carried out to make out the anti-microbial efficacy of disinfecting solutions:  One million (6 log units or 106) microorganisms (CFUs) permillilitre are added to the test solution)  The USP Preservative Effectiveness test requires a solution to decrease microorganisms by 3 log units ( or 1000) after 14 days and no subsequent regrowth for a further 14 days.
  43. 43. Antimicrobial efficacy A battery of tests is carried out to make out the anti-microbial efficacy of disinfecting solutions:  To pass as a disinfectant FDA‟s Office of Medical Devices imposes two additional requirements on an agent:  At least 14 days, the original solution is rechallenged by a 105 CFU/mL inoculum and the solution must again cause a 3-log reduction in micro-organisms over the following 14 days  The solution must be fungistatic to yeasts and fungi during the 28-day test.
  44. 44. Lens care regimen and deposittypes Protein deposits  Lipid deposits  Chemical  Thermal disinfection disinfection  Avoid chlorhexidine-  Hydrogen peroxide because it increases is preferred surface  Proteolytic enzyme hydrophobicity and weekly allows lipid adhesion  If thermal is  Enzyme cleaning necessary, low heat with a lipase  Advise non-ionic  Avoid FDA Group I and low water and II materials content material
  45. 45. Lens care regimen and deposittypes Calcium deposits  Calculi  Thermal disinfection  Lipid solvent cleaner  Hydrogen peroxide(  Lipase-containing low pH dissolves enzyme calcium)  In-eye lubricants in  Proteolytic enzyme EW lenses and may help clean more  Avoid tight fitting frequently lenses  Tears with  Prescribe glyceryl potassium methyl methacrylate deficiency worsen (CSI) material calculi problem so
  46. 46. Lens care regimen and deposittypes Rust spots  Discoloured lenses  Consider thermal  Discard the lens as disinfection far as possible  Smokers usually get  Hydrogen peroxide lenses discoloured disinfection systems due to nicotine may make them less interactions obvious  Usually a/w protein deposits so consider the steps for the protein deposit management
  47. 47. Lens care regimen and Dryeyes Dry-eyed patients  Dry-eyed patients  Dilute the saline by  Use in-eye 20-50% with boiled lubricants frequently distilled water. This  Re-soak the pair for temporarily 15-30 min during the increases the water day content of the lens  Cosider protein which is then slowly removal frequently released onto the as protein deposits eyes. are usual.  Avoid thermal  Refit with low water, disinfection as far as non-ionic materials.
  48. 48. Choice of Lens Care SystemSCL Heat MPS Hydrogen PeroxideGroup I √√√Group IIGroup IIIGroup IV Bleaches colour in cosmetic contact
  49. 49. Recommendations Discard solution everyday Rub and rinse step is essential with combination solution Keep nozzle closed Narrow openings Clean and rinse well Soak for recommended time
  50. 50. Essentials steps of Care andMaintenance . . . Extra steps- Protein Removal
  51. 51. Protein Removers Effectively remove protein deposits Have NO effect on most other deposits React by breaking protein molecules For heavy depositors
  52. 52. Protein removal procedure Use regularly after daily wear and rinsing step Lenses should be soaked in enzyme, dissolve in solution/saline for 15 min or overnight depending on the manufacturer Lenses should be thoroughly rubbed and rinsed again afterwards
  53. 53. Essentials steps of Care andMaintenance . . . Extra steps - Lubricating/ Rewetting
  54. 54. Rewetting or Lubricating Drops Alleviating signs of dryness and discomfort Flushing irritation particles from eye and CL Rehydrating lens
  55. 55. Care for Lens Cases Scrub with tooth brush using cleaning solution weekly Rinse with saline or disinfecting solution Air dry upside down Replace case regularly
  56. 56.  Wash your hands before handling contact lenses Check the position of lenses before insertion
  57. 57.  Cosmetics/Make- ups Put contact lenses in  After applying hair products like hairspray  Before applying cosmetics especially eye makeup
  58. 58.  Instruction for makeup  Insert the lenses before applying makeup  Remove the lenses before taking makeup off
  59. 59.  Avoid harmful or Irritating Fumes while the Lenses Are On
  60. 60.  Do Rinse the Lenses  Always before inserting the lens and after removing it from the eye  Rinse the lens with contact lens solutions suggested by contact lens practitioners/optometrists
  61. 61.  Clean and change the solution in the case daily Keep the contact lenses either in your eyes or in your lens case
  62. 62.  Do not let hair spray or other cosmetic aerosols come in contact with the lenses Avoid Long and Dirty Nails
  63. 63.  Do not swim with contact lenses if yes with swimming goggles only
  64. 64.  Don‟t sleep with contact lenses  Remove the lenses before going to sleep  Your cornea may not get the necessary oxygen* while asleep *Continuous wear lenses or Extended wear lenses with High Dk can be used upon practitioner‟s recommendations
  65. 65.  The following have interactions potentially hazardous to CL wear:  Tetracycline  Rifampin  Preserved products  Aspirin  Antihypertensives  Tricyclicantidepressants  Antihistamines  Anticholinergics
  66. 66. Additional Tips for Hygienic CLWear Do not mix solution types and brands Never soak/store lenses in saline or tap water Don‟t put solutions and lens case in the toilet or refrigerator Don‟t touch the tip of any contact lens solution Don‟t use any topical eye drops while wearing.
  67. 67. Immediate contact with ECP If the eyes get red and irritated or if you feel any pain remove the lenses and contact eye care practitioner
  68. 68. How to avoid infection Deposits can be avoided by maintaining a good lens care regimen Cleaning Disinfection Following the instruction Shorter is better-Disposables, small packs of solution (120 ml or 360 ml rather than 500 ml)
  69. 69. Why disposable? More comfortable Healthy More hygienic Convenience of spare pair at hand Longer wearing time Contact lenses related infection and complication are on the low in disposables.
  70. 70. Methods Fifty consecutively presenting patients form each of two teaching clinics who had presented for routine after-care examinations, and had undergone at least two previous after- care visits were surveyed in the study. The contact lens teaching clinics were at the Queensland Institute of Technology and the University of Melbourne. Carried out by the students under the supervision of optometrists.
  71. 71. Methods Patients in this survey had been wearing contact lenses for an average of 2.6 years( range 0.25 to 8 years). Most wore lenses 7 days per week and 8 to 14 hours per day. Only patients wearing daily wear lenses were included; 82% wore soft lenses and and 18 wore hard lenses Lens Distribution soft lenses Hard Lenses 18% 82 %
  72. 72. Strategies to bolster compliance Strategies to improve patient compliance must address these basic causes, and are usually considered in four classes: 1) Education, so that the availability of correct information is maximized. 2) Improved communication techniques, so that information is provided in a brief, clearly categorised and specific way( usually using more than one medium to emphasize the importance of key areas. Use of visuals is instrumental
  73. 73. Strategies to bolster compliance Strategies to improve patient compliance must address these basic causes, and are usually considered in four classes: 3) Organisational procedures, so that the cost, complexity and nature of recommended care systems are tailored to the specific needs of individual patients. The example could be the use of an MPS which aims to promote patient compliance. 4) Behavioural modifications: The use of verbal or written commitments by contact lens patients.
  74. 74. How to enhance compliance? Educate staff and the patient o Simple written and verbal instructions o Reinforce few key points many times o Practical demonstration/visuals Review lens care at every visit Keep patients coming back for more o Compliance packs/offers o Recall system o Regular contact through mailers
  75. 75. Summary Minimal adverse reactions achieved by:  Clean, well-fitted lenses  Adequate physiological performance  Appropriate choice of care system  Regular monitoring of patients  Patient compliances
  76. 76. References: F. Stapleton, A. J. Phillips and G. A. Hopkins. Chapter 4 „ Drugs and solutions in contact lens practice and related microbiology‟ in Contact Lenses, 4th Edition, Butterworth Heinemann, 1997 IACLE Contact Lens Course, Module 5, 1ST Edition, The International Association of Contact Lens Educators, 2000
  77. 77. References: Shovlin J: Systemic Medications and their interaction with soft contact lenses. Int Contact Lens Clin 17: 250, 1990 Kristine D. OD, Lakshman N. Physical Properties of Soft Contact Lens Solutions.Optometry and Vision Science 2007;85:122-128 Edward S. Bennet and Barry A. Weismann, Clinical Contact Lens Practice text book,