SlideShare a Scribd company logo
1 of 95
CARE AND MAINTENANCE OF
CONTACT LENSES
MANOJ ARYAL
B. Optometry
IOM,
Maharajgunj Medical Campus
PRESENTATION LAYOUT
• Introduction
• Overview of care and maintenance
 Care and maintenance of soft contact lenses
 Care and maintenance of RGP contact lenses
 Lens deposits
 Patient education and compliance: use and care of
contact lenses
 Discussion
Introduction
 Most crucial aspect of contact lens wear
 Influence the success of contact lens wear and
patient’s satisfaction with their lenses
Overview Of Care And Maintenance
 Purpose:
Clean lens
Good comfort
Good vision
Safe lens wear
Components:
 Cleaner
Daily cleaner
Weekly/protein cleaner
 Rinsing solution
 Disinfecting solution
 Lubricating/Re-wetting solution
 Lens storage cases
Cleaners
Most common components
 Surfactants(surface
active agents)
Non-ionic
Ionic
Anionic
Cationic
Amphoteric
 Buffers
 Osmolality adjusting
agents
 Preservatives
 Chelating agents
 water
 Cationic surfactants are not normally used with SCLs
bcz.
 They may be bind with lens particles
 Preservatives are primarily used to protect the
cleaning solutions from microbial contaminations
after opening
 Surfactant cleaners:
 Normally used in conjunction with finger rubbing
 Rubbing step is always followed by rinsing step
 Rubbing: dislodges the contaminants
 Rinsing: removes the displaced contaminants
Daily Cleaner
Function
 To remove:
 Loosely bound foreign
matter
 Cell debris
 Mucus,lipid, protein
 Cosmetics or other surface
contamination
Dailey cleaners
Contains friction enhancing agents/polymeric beads
 These are the small solid particles that behave as a mild
abrasive but which do not affect lens surface
 Eg. Allergan LC 65&B&L sensitive eye daily cleaners
 Extra strength daily
cleaner
 Alcon Opti-clean,
Polycleans ii
 B&L Concentrated
cleaner
 CIBA Miraflow
 General procedure:
 Wash hands
 Place lens in palm of hand
 Place 2-3 drop of cleaner on each lens
 Rub with forefinger for about 15 seconds per side using a to
and fro and fro action. Rolling the forefinger in both
directions cleans the lens periphery
Weekly cleaners:
Usually formulated for protein removal
Sometimes called enzymatic cleaners bcz. most
contains one or more proteolytic enzymes
Rinsing Solutions
Function:
 Removal of loosened lens contaminants
 Removal of residual cleaners
 Rehydrate lens
 Resolve enzyme tabs
Most common and most economical rinsing solution is
saline
 Saline:
 Isotonic saline can also be used:
 As a medium for enzyme treatment in some regimens
 To elute unbound adsorbed or absorbed lens
contaminants
 To rehydrate lens
Disinfectio
nFunctions:
 Kill or deactivate potentially pathogenic organisms includes
 Bacteria
 Fungi
 Virus
 Amoebas
 Maintain lens hydration
 Types
 Thermal
 Chemical
Conventional
Polymeric
Tablet
 Hydrogen peroxide
Thermal Disinfection
 High temperature kill micro-organism
by:
 Denaturation of cell components
 Disruption of plasma membranes
 DNA damage
 2 methods of applying heat to lenses in
a lens storage case
 Wet:
 immersing the lens case in water at or near its boiling
point or
 Placing the lens case above boiling water
 Dry:
 direct heating of lens case by a matching, snug fitting,
electrically heated device
 After heating cycle allow lens to cool before use
Advantages
 Short disinfection cycle
times(10-30)
 Very effective in
destroying
microorganisms
 Low risk of toxic or
allergic reactions
Disadvantages
 Incompatible with some
lenses(usually SCLs)
 Suitable electrical power for
heat units may not always be
available
 Can cause lens discoloration
 Increased protein deposition
Chemical Disinfection
 Conventional Chemicals:
 Thimerosal
 Chlorhexidine
 Sorbic acid
 Benzalconium chloride
 Iso-propyl alcohol
 Thimerosal:
 Effective as anti-fungal agent
 Reduced effect when combined with
EDTA
 Cytotoxic to corneal epithelium
 Chlorhexidine gluconate:
 Antibacterial agent
 Leaches from Group 1 to Group 4
 Benzalkonium chloride
 Antibacterial agent
 Cytotoxic
 Sorbic acid
 Anti bacterial with limited antifungal
activity
 Not cytotoxic
 Causes discolouration of lenses
 Alcohol:
 Cleaners: isopropyl alcohol and ethanol
 Disinfection : isopropyl alcohol
 E.g.CIBA Miraflow used in disinfecting solutions
 Both disinfectants and cleaners contain large conc. of
alcohol
 Cleaner 20%
 Disinfectant 17%
Chemical Disinfection:
Disinfectant Sensitivity
Symptoms
 Sudden decrease in ocular
tolerance
 Decreased wearing time(2-
4 hour)
 Burning, grittiness, dry
sensation
Signs
 Conjunctival redness
 Epithelial damage
 Corneal inflammation
diffuse corneal staining resulting
from a reaction to a disinfectant or
a preservative.
A mild red eye (conjunctival
hyperaemia) due to
sensitivity to a solution component,
usually the
disinfectant.
 Disinfectant sensitivity depends upon:
 Preservative type
 Preservative concentration
 Lens material
 Soaking time
Lens age
 Patient susceptibility
Polymeric Disinfection
 Relatively recent class of disinfection
 Most common examples are
 PHMB
 Polyquaternium-1
 Used in multipurpose solution
 E.g B&l Mps ReNu,Alcon
Opti-Free,
Allergan Complete ,CIBA Solo care
soft
 Disadvantages
 Reduced disinfecting
power
 Rub/rinse still required
 Compliance is more
important
Tablet Based System
 Chlorine tablet system
 Halane(sodium dichloroisocyanurate)
 Halazone(poly(dichlorosulphanoyl)benzoi
c acid)
 E.g Alcon Softab, Sauflon Aerotab
 Chlorhexidine
 E.g Optim eyes
Hydrogen Peroxide
Disinfection
 Along with thermal disinfection is one of the earliest SCLs disinfection method
 Hydrogen peroxide:
 Produces free oxygen radicals which are very reactive and quickly bind to many cell components
 Decomposes to water and oxygen
 Requires neutralization
 Can be formulated preservative free
 Can be supplied in one-step form
 Must be stabilized
Hydrogen peroxide: neutralization
Non selective anti-microbial agent
Minimum 3 hr in 3%h2o2 recommended
Bacteria 10-15 min
Fungi 60 min
Acanthomoeba 3-6 hour
Neutralization:
2-step peroxide disinfection
1-step peroxide disinfection
 Neutralizers:
 Sodium pyruvate:
Na2C3H3O3+H2O2=NaC2H3O2+H2O+CO
2
 Sodium sulphite:
Na2SO3+H2O2=Na2SO4+H2O
 Sodium thiosulphate:
2Na2S2O3+H2O2=Na2S4O6+2NaOH
 Sodium tetrathionate
 Highly deleterious to cornea
2-step peroxide neutralization: stoichiometric(reactive)
Neutralization
2-Step H2O2 Systems: Catalytic
Neutralization
 Have longer neutralization time
 In either tablet or solution form, neutralization and equilibrium time
of 10-15 minutes are generally adequate for low water content
lenses
Higher water SCLs require longer times of up to 1 hour
 Neutralizers:
 Catalytic disc in second lens case
 Catalase solution or tablet
2- Step Peroxide Disinfection
Advantages
 Can vary time of disinfection
 Concurrent protein removal
possible
 Suited to occasional wear
Disadvantages
 Less convenient
 Some have preserved
neutralization solution
 Potential for irritation
 expensive
1-step neutralization system
 Formulated so that the peroxide disinfection and neutralization are
performed during the recommended time
 With tablet using system a delay is applied to the neutralization
phase
 With disc-based systems, no delay is applied to the neutralization
phase
 When neutralization is performed as separate step, the system is
called atwo-step neutralization
 Disadvantages:
 Inflexible neutralization time
 H2o2 concentration decreases rapidly(3%-1%in less than 10 min)
 Not effective against fungi and acanthamoeba species
 Catalytic disc needs regular replacement
 Potential for irritation
 Possible recontamination
 In systems using catalytic disc, whenever H2O2 is in contact with
the disc, the concentration is decreasing
 User of disc based 1- step systems should be instructed to place
their lenses in lens baskets before pouring peroxide solution into
the case
 If not, much of the peroxide is neutralized by exposure to the disc
before lenses are immersed
H2O2: Effect On Lens
Parameters
 May cause reversible parameters changes in high water lenses
 HWC requires longer soaking time to reverse
 Caution:
 Discomfort and irritation follow lens insertion if residual peroxide
present
 No permanent damage to normal ocular tissues
 Corneal staining might be observed
Protein Removers
 Most protein removers are based on enzymes
 Enzymes cleaners work by leaving substrate specific enzymes
break down their target molecules, thereby facilitating their
removal
Protease target proteins
Lipase target lipids
 While amylase targets polysaccharides
 Enzymes can also remove other types of deposits if they are
incorporated in the protein deposits
 Enzymes may also break bonds between the lens materials and
proteins
 Enzymatic cleaning does not replace the disinfection system
 Procedure:
 Used regularly, after the daily cleaner and rinsing step
 Lenses should be soaked in enzyme dissolved in
solution/saline for 15 min to overnight, depending upon
manufacturer
 Lenses should be thoroughly rubbed and rinsed again
afterwards
 Enzymatic protein removers
Contain one of the following
 Papain
 Pancreatin
 Subtilisin A &B
 Papain:
 protease i.e. enzyme that act as protein specifically
 Derived from papaya plant
 Usually have a slightly unpleasant odour due to the inclusion of cysteine
 Binds to contact lens material and can cause sensitivity reaction
 Short 15 min soaking time possible
E.g. Allergans Soflens enzymatic cleaner or Profree
 Subtilisin A&B:
 Proteases
 Subtilisin A formulated specifically for use in hydrogen
peroxide lens care systems
 Subtilisin B is formulated for use in conventional
chemical and thermal systems
Re-wetting/ Lubricating Drops
 Used for:
 Promote comfort
 Reduce deposit induced friction b/w eyelids and
corneal surface
 Rehydrates the lens
 Lubricating and re-wetting eye drops are
formulated with viscosity-enhancing
agents(commonly polyvinyl alcohol,
methylcellulose etc)
Lens Storage And Cases
 To avoid contamination, lens cases should be rinsed after every
use and the lenses stored in fresh solution
 Acanthamoeba and other free living protozoans are especially
prevalent among those using tap water for rinsinf their lens cases,
using home made saline as a rinsing solution for contact lenses, or
swimming with contact lenses.
 Biofilm or glycocalyx formation on the surface of contact lens
storage cases can horbour pseudomonas aeruginosa and serratia
marcesens
 Care of lens cases:
 Discard used solutions
 Scrub with a toothbrush and detergent weekly.oil free
soaps or detergents are recommended
 Rinse with hot water and rub thoroughly with a clean, dry
tissue
Lens replacement schedule and
care regimen
 Daily disposable:
 Does not require use of surfactant cleaner, disinfecting solution or weekly enzyme
 If needed the patient can use in eye re wetting drops or sterile saline for rinsing prior to insertion
 Regular disposables
 Suitable care includes multi-purpose solutions
 No weekly protein removal is needed
 Other options:
 Surfactant cleaners
 1-step hydrogen peroxide disinfection
 Lubricating/re-wetting solutions
Care regimen guidelines for
frequently replaced
lenses,conventional lens
wearers
In-office diagnostic(trial set)
lenses SCL use heat if possible otherwise peroxide
 RGP use peroxide or store lens dry
 Re-disinfect non disposable inventory trial lenses at least once a month
 In-office procedures
 Oxidising agents
 Standing waves
 Ultrasound
 Ultraviolet
 Microwave
Common oxidizing agents used are LiprofinTM, 6 or 9% peroxide
Care and maintenance
 Important steps for patients
 Wash hand prior to handling lenses
 Rub each side of each lens for 10-15 seconds using a surfactant cleaner
 Rinse each lens thoroughly in normal saline
 Disinfect contact lenses in fresh disinfecting solution in a clean storage case
 Remember
 Do not mix solution type and brands
 Assess patients compliance
 Repeat instructions and assess demonstration to patient
 Remind patient to clean lens case weekly
The Message
 C lean
 R inse
 A nd
 D isinfect
 L enses
 E very time
RGP Care And Maintenance
 Purpose:
 Minimize deposit accumulation
 Increase lens wettability
 Facilitate comfort and vision during lens wear
 Deposits:
RGP material containing
Siloxane are more prone to protein deposits
Fluorine are more susceptible to lipid coating
 Practitioner choose low Dk over high Dk RGP material despite the
benefits of higher oxygen permeability
 The high Dk RGP lenses are more susceptible to lens surface
deposits than their low to moderate Dk counterparts
 Cleaner :
 daily surfactants
 Protein removers
 Disinfecting or soaking solution
 Wetting solution
 lubricants
 Daily surfactant:
 Similar to their SCL counterpart
 An alcohol based cleaner is well suited to fluorosiloxane lenses
which tend to acquire lipid deposits
 Patient should be cautioned against soaking RGP lenses in
alcohol based cleaner
 Further, they should be adjusted to rinse their lenses
thoroughly immediately after using such cleaners bcz. they
have been shown to alter lens parameters if allowed to remain
in contact with the lenses
 Enzyme: recommended for protein removal in deposit prone
wearers
 Polish: may be necessary for lenses over 12-18 months old
 Cleaning pad; may be effective in removing some deposits
from RGP lenses
 Avoid:
 Vigorous rubbing
 Excessive pressure on lens
 Prolonged cleaning with mildly abrasive cleaners
 Recommended technique:
 Place the lens in the palm of hand
 Rub lens with finger for minimum of 10 seconds
 Rinse with saline or tap water approved for drinking
Disinfectio
n Although microorganisms can not readily attach to RGP
lens surfaces , they can attach to deposits
 RGP lens should not be thermally disinfected
As this can cause warpage
 Soaking time (4hour to overnight or as recommended)
 Preservatives used includes:
 Thimerosal
 Phenyl mercuric nitrate
 Benzalkonium chloride
 Chlorhexidine
 Poly(amino propyl bigunide)
 And polyquaternium-1
H2O2 IS NOT NORMALLY USED GOR RGP LENSES
 Wetting and soaking:
 It is better for RGP lens wearer to wet-store their lenses
 If RGP lens are stored dry, parameters such as BOZR will
invariably flatten and the lens surfaces may not wet properly
 Wet storage also improves initial on eye comfort and greatly
assists microbial control of lens storage conditions
 RGP wetting and soaking solution contains:
 Antimicrobial agents to disinfect the lenses and to preserve the
solution after initial opening
 Wetting agent to improve lens wettability
 Viscosity-enhancing agent to thicken the formulation
 Buffer system to adjust and maintain solution pH
 Salts to adjust solution osmolality
 Wetting agents:
 Better wetting result in better vision and greater comfort
 Improve the wetting characteristics of the lens surface:
 Convert hydrophobic surface to hydrophilic
 Assist tear film to spread more easily and evenly on lens
surface
 Increase comfort on insertion
 E.g. Poly vinyl alcohol, Polyvinyl pyrolidone, Polysorbate
 RGP lens non-wetting areas due to:
 Deposits
 Manufacturing process
 Polishing compounds
 Surface combinations
 Rinsing solutions
 RGP lens can be inserted directly into the eye after soaking in
appropriate wetting/soaking solutions
 Burning on insertion: change to a less viscous solutions
 Stinging on insertion: change solution
 RGP-MPS
 One bottle system(OBS)
 Combination of cleaning, disinfecting, and soaking functions
 E.g. Allergan Total, Boston Simplicity, CIBA SOLO-care-hard
 Lubricating drops:
 Used during lens wear to:
 Improve comfort
 Clean lens surface
 Maintain lens wettability
Trial Set Disinfection/Storage
 RGP trial lens disinfection: the method recommended is:
 Clean with alcohol-based cleaner immediately after use
 Place in a clean container
 Wet storage in a soaking solution when lens is not being used
 Clean the storage solution periodically(monthly)
 Clean lens again immediately before next use
Summery
 Because of their non-absorbent nature, surface
properties, rigidity and durability RGP lenses are easier to
care for
 Clean ,rinse and disinfect lens every time(CRADLE)
 RGP lens kept in use longer than SCLs
Therefore efficacious lens care area more important
 Consider a programmed replacement scheme
Contact Lens Deposits
 Definition:
Any lens surface coating or lens matrix formation which
is not flushed or rinsed from the lens by the tears during
blinking. In effect, anything that remains on the surface
despite blinking is a deposit
Deposit formation:
 Tear protein(lysozyme) are
attached to the lens
 Tear evaporates and leave
residue on the lens
 After protein are deposited,
other components of the tear
film (such as mucin) may
adhere to protein
 Over time. Layers build up and
structural changes take
place(e.g. Denaturation)
Factors influencing
lens deposition:
 Individual difference in
tears
 Lens materials
 Care system
 Wearing schedule
EW might induce more
deposits than DW
 Environment
 Patient hygiene
Types Of Deposits
Teal related
 Protein
 Lipid
 Jelly bumps
 Inorganic deposits
Non-tear related
 Fungi
 Lens discoloration
 Mercurial deposits
 Cigarette residues
 Surface
combination
 Rust spots
 Protein deposits:
 Are a semi-opaque or translucent film usually thin whitish and
superficial
 Have a frosted glass appearance
 may cover lens surface partially or full
 Cause the lens surface to become hydrophobic
 Can crack and peel if thick
 Factors favouring a build up of protein on a contact lens:
 short BUT
 Ionic binding capacity
 Inadequate cleaning especially of the lens periphery
 Altered blinking
 Heat disinfection
 Tear deficiency or altered tear composition
 Chronic allergies and GPC
Lipid Deposits
 Appears as greasy, smooth, and shiny adherent films on
both RGP and soft contact lenses
 Best observed between blinks
 Appears as a thick ,oily coating
 Lipids involved includes: phospholipids, neutral fats,
triglyceride, cholesterol, cholesterol esters, and fatty acids
 Origin: mainly from meibomian gland
 Predisposing factors:
 Tear film quality
 Slow blink pattern
 Poor lens compliance
 Careless use of inappropriate cosmetics/lotions
Jelly Bumps
 Appear as a clumps of raised transluscent mulberry
like deposits
 Typically form in inferior, exposed portion of lens
 Occur more frequently in high water, ionic, EW
lenses
Predisposing factors
 Quality of tear film
 Poor blinking
 Lens surface
contamination
 HWC>LWC
 Aphakia cleaning
consequences
 Large and numerous jelly bumps lead to
wearer discomfort
 Large deposits can cause the lens to
attach to the upper lid so that each blink
causes excessive lens movement
 When located within pupil zone-visual
acuity can fluctuating
 Maya also cause mechanical irritation of
tarsal conjunctiva
 In extreme case, may cause CLPC
Inorganic Deposits
 Calcium carbonate deposits
 Calcium phosphate deposits
 Appearance:
 White crystalline specks
 Can be small or large
 Rough surface
 Penetrate lens surface if severs
Fungal Deposits
 Appearance:
 Filamentary growth on and into lens
 Usually white, brown or black
 Fungal formation
 Spores on lens surface from eye or
environment
 Proliferates to large visible growth
 Penetrate lens matrix
 Contact lens good medium for fungal
gruwth
Lens Discoloration
 Can result from:
 Natural lens ageing
 Surface contamination
 Mercurial deposits
Mercurial deposits:
 Appear as a greyish to
black discoloration
 Reuse of thimerosal
containing solution is
one cause
 To prevent avoid
mercury based
preservatives
Ageing
 Polymer breakdown
 Chemical absorption
 Handling
 Stress and strain
 deposition
 Surface contamination
 Make up
 Moisturizing lotions
 Hairspray
 Chemical fumes
 Management
 Advice patient on good hygiene
 Proper care and maintenance
 Do not reuse solutions
 Smokers should be warned
Lens Deposition :Rust spots
 Appearance:
 Small superficial raised
spots
 Colored orange to black
 Can be few to
numerous
DISCUSSION
Importance of rub and rinse in use of multipurpose contact lens
solution.
Optom Vis Sci. 2011 Aug
PURPOSE : The introduction of contact lens multipurpose disinfection
solution (MPDS) that can be used in conjunction with a "no-rub" regimen has
simplified lens care requirements. Once adhered to a surface, microorganisms
can become less susceptible to disinfection. The aim of the study was to
evaluate the effect of various regimen steps on the efficacy of MPDS when
used with silicone hydrogel and conventional lenses.
RESULTS: Overall, the greatest efficacy of MPDSs was observed when "rub and
rinse" was performed before disinfection with each of the microorganisms tested,
regardless of lens type. "No rub and no rinse" steps resulted in a greater load of
microorganisms remaining on lenses compared with the other regimens (p < 0.05).
When "rinse-only" was performed before disinfection, the MPDS containing
polyquad performed generally better (p < 0.05) than MPDSs containing
polyhexamethylene biguanide against bacteria. Significantly, less microorganisms
were recovered from galyfilcon A than from other lenses (p < 0.05) when MPDSs
were used with "rinse-only" step.
CONCLUSIONS:
 This study has demonstrated that "rub and rinse" is the most effective regimen
and should be recommended in conjunction with all multipurpose lens care
solutions and all contact lens types, particularly with silicone hydrogel lenses.
Comparative antimicrobial efficacy of multi-purpose lens care
solutions using the FDA's guidelines
 PURPOSE: evaluated six single-bottle, multi-purpose lens
care solutions and a two component lens care system for
disinfection efficacy according to the stand-alone primary
criteria within the recently published U.S FDA Guidelines.
 RESULTS:
 ReNu and ReNu MultiPlus met the FDA's acceptance criteria for stand-alone
disinfectants against all challenge organisms: Staphylococcus aureus,
Serratia marcescens, Pseudomonas aeruginosa, Candida albicans, and
Fusarium solani. Opti-Free Express failed to meet the FDA's stand-alone
disinfectant acceptance criteria for S. aureus, S. marcescens and C. albicans
and Opti-Free Express with Opti-Free Supraclens failed to meet the
acceptance criteria for either S. aureus and C. albicans. Opti-One failed to
meet the FDA's stand-alone disinfectant acceptance criteria for C. albicans
and F. solani. Both Complete and Solo-Care failed to meet the FDA's
acceptance criteria for C. albicans.
 CLAO J. 2001 Jan;27(1):16-22.
 Disinfection efficacy of contact lens care solutions against ocular
pathogens
 PURPOSE:
 Three commercially available products labeled as multi-purpose
contact lens solutions, one multi-purpose disinfecting solution, and
a hydrogen peroxide system were evaluated for antimicrobial
activity according to the current International Organization for
Standardization (ISO) and the U.S. Food and Drug Administration
(FDA) stand-alone procedure for disinfecting products. One multi-
purpose solution was selected to assess its antimicrobial activity
against two human corneal isolates of Pseudomonas aeruginosa.
 RESULTS:
 ReNu MultiPlus (Bausch & Lomb, Rochester, NY), AOSEPT (CIBA Vision Corporation,
Duluth, GA), and Opti-Free Express with Aldox (Alcon Laboratories, Ft. Worth, TX) were the
only lens care products that met the stand-alone criteria for all required microorganisms
within their minimum recommended disinfection time. Of these, ReNu MultiPlus provided
the greatest overall antimicrobial activity. ReNu MultiPlus demonstrated a significantly
higher mean log reduction of Staphylococcus aureus and Serratia marcescens than Opti-
Free Express. ReNu MultiPlus also gave a higher mean log reduction of S. aureus and S.
marcescens than AOSEPT, and a higher mean log reduction of Candida albicans and
Fusarium solani than AOSEPT, Complete Comfort Plus (Allergan, Irivine, CA), and Solo-
Care (CIBA Vision Corp.) (at 4 hours). Both Complete Comfort Plus and Solo-Care (at 4
hours) met the primary acceptance criteria for bacteria; however, neither product
possessed enough antimicrobial activity to meet the minimum criteria for yeast or mold.
ReNu Multiplus was effective against corneal isolates of P. aeruginosa.
 CONCLUSION:
 ReNu MultiPlus, AOSEPT, and Opti-Free Express met the requirements of the stand-alone
primary criteria for disinfecting solutions. ReNu MultiPlus demonstrated the greatest
overall disinfection efficacy, as well as excellent activity against clinical strains of P.
aeruginosa
 Contact lens care products effect on corneal sensitivity and
patient comfort
 PURPOSE:
 To evaluate the possible effect of two leading soft contact
lens care products on corneal sensitivity, relative comfort,
and superficial corneal staining in adapted disposable soft
contact lens wearers.
 RESULTS:
 Patients habitually using OPTI-FREE Express reported higher comfort ratings than
did patients using ReNu MultiPlus. On crossover, patients who initially used ReNu
MultiPlus experienced similar comfort when using OPTI-FREE Express, but OPTI-
FREE Express users experienced a substantial decrease in comfort when switched
to ReNu MultiPlus. Esthesiometry showed significant differences in average
sensitivity in favor of OPTI-FREE Express (P=0.0041). Statistical trends supported
observed increases in corneal sensitivity when switching to OPTI-FREE Express and
decreased corneal sensitivity when switching to ReNu MultiPlus. ReNu MultiPlus
was also associated with slightly more corneal staining.
 CONCLUSIONS:
 ReNu MultiPlus, a biguanide-based contact lens care product, was associated with
decreased comfort during midday and end-of-day periods. ReNu MultiPlus was
also associated with significant reduction in relative corneal sensitivity compared
to Polyquad-based OPTI-FREE Express. Disturbance to normal corneal sensitivity
may play a role in contact lens-related dry eye and discomfort. Further
investigation is warranted
Care and maintenance of
SCLs
 SCLs are susceptible to deposits due to:
 Lenses are covered by pre-lens film all the times
 The tear film undergoes hydration and
dehydration cycle as a result of blinking and
evaporation bw blinks
 Lens is a subject to atmospheric changes and
pollutants
 Decreased surface wettability is likely to
accelerate deposition
Deposits: Complications
 Irritation and reduced comfort
 Reduced visual acuity
 Shortened lens life
 Increased potential for infection
 Increased incidence of GPC

More Related Content

What's hot

Coloured contact lens
Coloured contact lensColoured contact lens
Coloured contact lensfarisfrn
 
Frame types and parts
Frame types and partsFrame types and parts
Frame types and partsAyushiPatel59
 
Manufacturing of contact lenses
Manufacturing of contact lensesManufacturing of contact lenses
Manufacturing of contact lensesAswin J
 
Insertion and removal of rgp contact lens.
Insertion and removal of rgp contact lens.Insertion and removal of rgp contact lens.
Insertion and removal of rgp contact lens.Anandhan K
 
Soft Contact Lenses: Material, Fitting, and Evaluation
Soft Contact Lenses: Material, Fitting, and EvaluationSoft Contact Lenses: Material, Fitting, and Evaluation
Soft Contact Lenses: Material, Fitting, and EvaluationZahra Heidari
 
Vision standards for various occupation
Vision standards for various occupationVision standards for various occupation
Vision standards for various occupationOPTOM FASLU MUHAMMED
 
Soft toric Contact Lens
Soft toric Contact LensSoft toric Contact Lens
Soft toric Contact LensManish Dahal
 
Examination protocol for Contact Lenses
Examination protocol for Contact LensesExamination protocol for Contact Lenses
Examination protocol for Contact LensesPuneet
 
Contact Lens Care Solution & Extend Wear
Contact Lens Care Solution & Extend WearContact Lens Care Solution & Extend Wear
Contact Lens Care Solution & Extend WearTahseen Jawaid
 
Visual acuity in preschool children
Visual acuity in preschool childrenVisual acuity in preschool children
Visual acuity in preschool childrenzarin45
 
Contact lens fitting in keratoconus copy
Contact lens fitting in keratoconus   copyContact lens fitting in keratoconus   copy
Contact lens fitting in keratoconus copykamal thakur
 

What's hot (20)

Contact lens solutions
Contact lens solutionsContact lens solutions
Contact lens solutions
 
Coloured contact lens
Coloured contact lensColoured contact lens
Coloured contact lens
 
Low Vision Aids
Low Vision AidsLow Vision Aids
Low Vision Aids
 
Frame types and parts
Frame types and partsFrame types and parts
Frame types and parts
 
Pediatric contact lens
Pediatric contact lensPediatric contact lens
Pediatric contact lens
 
Manufacturing of contact lenses
Manufacturing of contact lensesManufacturing of contact lenses
Manufacturing of contact lenses
 
Insertion and removal of rgp contact lens.
Insertion and removal of rgp contact lens.Insertion and removal of rgp contact lens.
Insertion and removal of rgp contact lens.
 
Rose K lens.pptx
Rose K lens.pptxRose K lens.pptx
Rose K lens.pptx
 
Maddox rod
Maddox rodMaddox rod
Maddox rod
 
Soft Contact Lenses: Material, Fitting, and Evaluation
Soft Contact Lenses: Material, Fitting, and EvaluationSoft Contact Lenses: Material, Fitting, and Evaluation
Soft Contact Lenses: Material, Fitting, and Evaluation
 
Vision standards for various occupation
Vision standards for various occupationVision standards for various occupation
Vision standards for various occupation
 
Introduction to cl fitting
Introduction to cl fittingIntroduction to cl fitting
Introduction to cl fitting
 
Anisometropia
AnisometropiaAnisometropia
Anisometropia
 
Soft toric Contact Lens
Soft toric Contact LensSoft toric Contact Lens
Soft toric Contact Lens
 
Examination protocol for Contact Lenses
Examination protocol for Contact LensesExamination protocol for Contact Lenses
Examination protocol for Contact Lenses
 
Contact Lens Care Solution & Extend Wear
Contact Lens Care Solution & Extend WearContact Lens Care Solution & Extend Wear
Contact Lens Care Solution & Extend Wear
 
Visual acuity in preschool children
Visual acuity in preschool childrenVisual acuity in preschool children
Visual acuity in preschool children
 
Contact lens fitting in keratoconus copy
Contact lens fitting in keratoconus   copyContact lens fitting in keratoconus   copy
Contact lens fitting in keratoconus copy
 
spectacle refraction versus ocular refraction
spectacle refraction versus ocular refractionspectacle refraction versus ocular refraction
spectacle refraction versus ocular refraction
 
Progressive addition lenses
Progressive addition lensesProgressive addition lenses
Progressive addition lenses
 

Viewers also liked

Care and maintenance of soft contact lenses
Care and maintenance of soft contact lensesCare and maintenance of soft contact lenses
Care and maintenance of soft contact lensesAmrit Pokharel
 
care and maintenance of soft contact lenses
 care and maintenance of soft contact lenses care and maintenance of soft contact lenses
care and maintenance of soft contact lensesVishakh Nair
 
RGP lens care and maintenance
RGP  lens care and maintenanceRGP  lens care and maintenance
RGP lens care and maintenanceRaju Kaiti
 
CONTACT LENS CARE & MAINTENCE
CONTACT LENS CARE & MAINTENCECONTACT LENS CARE & MAINTENCE
CONTACT LENS CARE & MAINTENCEfarisfrn
 
Different Types and Brands In Contact Lens Solution
Different Types and Brands In Contact Lens SolutionDifferent Types and Brands In Contact Lens Solution
Different Types and Brands In Contact Lens Solutionlenspick
 
Soft contact Lens-manufacturing methods.
Soft contact Lens-manufacturing methods.Soft contact Lens-manufacturing methods.
Soft contact Lens-manufacturing methods.Irine Jeba
 
Soft Contact Lens Fitting
Soft Contact Lens FittingSoft Contact Lens Fitting
Soft Contact Lens FittingVishakh Nair
 
Manufacturing methods of soft contact lens - presentation at www.eyenirvaan.com
Manufacturing methods of soft contact lens - presentation at www.eyenirvaan.comManufacturing methods of soft contact lens - presentation at www.eyenirvaan.com
Manufacturing methods of soft contact lens - presentation at www.eyenirvaan.comEyenirvaan
 
Orthoptic evaluation 1
Orthoptic evaluation 1Orthoptic evaluation 1
Orthoptic evaluation 1Pushkar Dhir
 
Spherical RGP contact lens fitting and prescribing
Spherical RGP contact lens fitting and prescribingSpherical RGP contact lens fitting and prescribing
Spherical RGP contact lens fitting and prescribingPabita Dhungel
 
Optics of RGP contact lens
Optics of RGP contact lensOptics of RGP contact lens
Optics of RGP contact lensPabita Dhungel
 
contact lens material
contact lens materialcontact lens material
contact lens materialRajeshwori
 
Reliability Growth Planning: Its Concept, Applications, and Challenges
Reliability Growth Planning: Its Concept, Applications, and Challenges Reliability Growth Planning: Its Concept, Applications, and Challenges
Reliability Growth Planning: Its Concept, Applications, and Challenges ASQ Reliability Division
 
Contact lens for Keratoconus case study
Contact lens for Keratoconus case studyContact lens for Keratoconus case study
Contact lens for Keratoconus case studyNoor Munirah Aab
 

Viewers also liked (20)

Care and maintenance of soft contact lenses
Care and maintenance of soft contact lensesCare and maintenance of soft contact lenses
Care and maintenance of soft contact lenses
 
care and maintenance of soft contact lenses
 care and maintenance of soft contact lenses care and maintenance of soft contact lenses
care and maintenance of soft contact lenses
 
RGP lens care and maintenance
RGP  lens care and maintenanceRGP  lens care and maintenance
RGP lens care and maintenance
 
Contact Lenses
Contact LensesContact Lenses
Contact Lenses
 
CONTACT LENS CARE & MAINTENCE
CONTACT LENS CARE & MAINTENCECONTACT LENS CARE & MAINTENCE
CONTACT LENS CARE & MAINTENCE
 
Contact lenses
Contact lensesContact lenses
Contact lenses
 
Different Types and Brands In Contact Lens Solution
Different Types and Brands In Contact Lens SolutionDifferent Types and Brands In Contact Lens Solution
Different Types and Brands In Contact Lens Solution
 
fitting RGP lenses
fitting RGP lensesfitting RGP lenses
fitting RGP lenses
 
Soft contact Lens-manufacturing methods.
Soft contact Lens-manufacturing methods.Soft contact Lens-manufacturing methods.
Soft contact Lens-manufacturing methods.
 
Soft Contact Lens Fitting
Soft Contact Lens FittingSoft Contact Lens Fitting
Soft Contact Lens Fitting
 
Manufacturing methods of soft contact lens - presentation at www.eyenirvaan.com
Manufacturing methods of soft contact lens - presentation at www.eyenirvaan.comManufacturing methods of soft contact lens - presentation at www.eyenirvaan.com
Manufacturing methods of soft contact lens - presentation at www.eyenirvaan.com
 
Contact lens
Contact lensContact lens
Contact lens
 
Orthoptic evaluation 1
Orthoptic evaluation 1Orthoptic evaluation 1
Orthoptic evaluation 1
 
Spherical RGP contact lens fitting and prescribing
Spherical RGP contact lens fitting and prescribingSpherical RGP contact lens fitting and prescribing
Spherical RGP contact lens fitting and prescribing
 
Optics of RGP contact lens
Optics of RGP contact lensOptics of RGP contact lens
Optics of RGP contact lens
 
contact lens material
contact lens materialcontact lens material
contact lens material
 
Presentation1
Presentation1Presentation1
Presentation1
 
Reliability Growth Planning: Its Concept, Applications, and Challenges
Reliability Growth Planning: Its Concept, Applications, and Challenges Reliability Growth Planning: Its Concept, Applications, and Challenges
Reliability Growth Planning: Its Concept, Applications, and Challenges
 
Presbyopic cl
Presbyopic clPresbyopic cl
Presbyopic cl
 
Contact lens for Keratoconus case study
Contact lens for Keratoconus case studyContact lens for Keratoconus case study
Contact lens for Keratoconus case study
 

Similar to Care and maintenance of contact lenses

CARE AND MAINTANENCE OF SOFT CONTACT LENS.pptx
CARE AND MAINTANENCE OF SOFT CONTACT LENS.pptxCARE AND MAINTANENCE OF SOFT CONTACT LENS.pptx
CARE AND MAINTANENCE OF SOFT CONTACT LENS.pptxreshmasu
 
CARE AND MAINTAINANCE OF SOFT CONTACT LENS
CARE AND MAINTAINANCE OF SOFT CONTACT LENS CARE AND MAINTAINANCE OF SOFT CONTACT LENS
CARE AND MAINTAINANCE OF SOFT CONTACT LENS Ashwin Pawar
 
Contact Lens Care and Maintenance
Contact Lens Care and MaintenanceContact Lens Care and Maintenance
Contact Lens Care and MaintenanceRabindraAdhikary
 
Opthalmic products
Opthalmic productsOpthalmic products
Opthalmic productsArshad Khan
 
Ocular drug delivery system rucha
Ocular drug delivery system ruchaOcular drug delivery system rucha
Ocular drug delivery system ruchaDanish Kurien
 
contact lens solution
contact lens solutioncontact lens solution
contact lens solutionMaryam Fida
 
Contact Lens Deposits, Contact lens Aftercare, Overview of care and Maintenance
Contact Lens Deposits, Contact lens Aftercare, Overview of care and MaintenanceContact Lens Deposits, Contact lens Aftercare, Overview of care and Maintenance
Contact Lens Deposits, Contact lens Aftercare, Overview of care and MaintenanceMaryam Fida
 
SVP SEM- VIII 2020.pptx
SVP SEM- VIII 2020.pptxSVP SEM- VIII 2020.pptx
SVP SEM- VIII 2020.pptxvvengya
 
Materials used in endodontics and tooth isolation
Materials used in endodontics and tooth isolationMaterials used in endodontics and tooth isolation
Materials used in endodontics and tooth isolationEdward Kaliisa
 
Eye, Ear And Nose Formulations
Eye, Ear And Nose FormulationsEye, Ear And Nose Formulations
Eye, Ear And Nose FormulationsLiesl Brown
 
Eye, Ear And Nose Formulations
Eye, Ear And Nose FormulationsEye, Ear And Nose Formulations
Eye, Ear And Nose FormulationsLiesl Brown
 
eye drop and ointment.ppt
eye drop and ointment.ppteye drop and ointment.ppt
eye drop and ointment.pptKoushalDhamija1
 
ophthalmic preparations 5062856ophthalmic preparations.ppt
ophthalmic preparations 5062856ophthalmic preparations.pptophthalmic preparations 5062856ophthalmic preparations.ppt
ophthalmic preparations 5062856ophthalmic preparations.pptAbdelrhman Abooda
 
Ophthalmic preparations
Ophthalmic preparationsOphthalmic preparations
Ophthalmic preparationsSrikanth Avn
 

Similar to Care and maintenance of contact lenses (20)

CARE AND MAINTANENCE OF SOFT CONTACT LENS.pptx
CARE AND MAINTANENCE OF SOFT CONTACT LENS.pptxCARE AND MAINTANENCE OF SOFT CONTACT LENS.pptx
CARE AND MAINTANENCE OF SOFT CONTACT LENS.pptx
 
CARE AND MAINTAINANCE OF SOFT CONTACT LENS
CARE AND MAINTAINANCE OF SOFT CONTACT LENS CARE AND MAINTAINANCE OF SOFT CONTACT LENS
CARE AND MAINTAINANCE OF SOFT CONTACT LENS
 
Contact Lens Care and Maintenance
Contact Lens Care and MaintenanceContact Lens Care and Maintenance
Contact Lens Care and Maintenance
 
Opthalmic products
Opthalmic productsOpthalmic products
Opthalmic products
 
Ocular drug delivery system rucha
Ocular drug delivery system ruchaOcular drug delivery system rucha
Ocular drug delivery system rucha
 
contact lens solution
contact lens solutioncontact lens solution
contact lens solution
 
Contact Lens Deposits, Contact lens Aftercare, Overview of care and Maintenance
Contact Lens Deposits, Contact lens Aftercare, Overview of care and MaintenanceContact Lens Deposits, Contact lens Aftercare, Overview of care and Maintenance
Contact Lens Deposits, Contact lens Aftercare, Overview of care and Maintenance
 
SVP SEM- VIII 2020.pptx
SVP SEM- VIII 2020.pptxSVP SEM- VIII 2020.pptx
SVP SEM- VIII 2020.pptx
 
Opthalmic preparation
Opthalmic preparationOpthalmic preparation
Opthalmic preparation
 
Materials used in endodontics and tooth isolation
Materials used in endodontics and tooth isolationMaterials used in endodontics and tooth isolation
Materials used in endodontics and tooth isolation
 
Ophthalmic Products
Ophthalmic ProductsOphthalmic Products
Ophthalmic Products
 
Eye, Ear And Nose Formulations
Eye, Ear And Nose FormulationsEye, Ear And Nose Formulations
Eye, Ear And Nose Formulations
 
Eye, Ear And Nose Formulations
Eye, Ear And Nose FormulationsEye, Ear And Nose Formulations
Eye, Ear And Nose Formulations
 
STERILIZATION BY CHEMICAL MEANS
STERILIZATION BY CHEMICAL MEANSSTERILIZATION BY CHEMICAL MEANS
STERILIZATION BY CHEMICAL MEANS
 
eye drop and ointment.ppt
eye drop and ointment.ppteye drop and ointment.ppt
eye drop and ointment.ppt
 
Dry eye treatment
Dry eye treatmentDry eye treatment
Dry eye treatment
 
ophthalmic preparations 5062856ophthalmic preparations.ppt
ophthalmic preparations 5062856ophthalmic preparations.pptophthalmic preparations 5062856ophthalmic preparations.ppt
ophthalmic preparations 5062856ophthalmic preparations.ppt
 
Ophthalmic preparations
Ophthalmic preparationsOphthalmic preparations
Ophthalmic preparations
 
Antibacterial methods
Antibacterial methods Antibacterial methods
Antibacterial methods
 
Downstreaming process
Downstreaming processDownstreaming process
Downstreaming process
 

More from Manoj Aryal

Monocular Fixation
Monocular FixationMonocular Fixation
Monocular FixationManoj Aryal
 
Lateral geniculate nucleus
Lateral geniculate nucleusLateral geniculate nucleus
Lateral geniculate nucleusManoj Aryal
 
Slit Lamp Biomicroscopy
Slit  Lamp BiomicroscopySlit  Lamp Biomicroscopy
Slit Lamp BiomicroscopyManoj Aryal
 
Optical Coherence Tomography
Optical Coherence TomographyOptical Coherence Tomography
Optical Coherence TomographyManoj Aryal
 
Development Of Vision
Development Of VisionDevelopment Of Vision
Development Of VisionManoj Aryal
 
Therapeutic Contact lenses
Therapeutic Contact lensesTherapeutic Contact lenses
Therapeutic Contact lensesManoj Aryal
 

More from Manoj Aryal (9)

Monocular Fixation
Monocular FixationMonocular Fixation
Monocular Fixation
 
Keratoconus
KeratoconusKeratoconus
Keratoconus
 
Lateral geniculate nucleus
Lateral geniculate nucleusLateral geniculate nucleus
Lateral geniculate nucleus
 
Visual Acuity
Visual AcuityVisual Acuity
Visual Acuity
 
MYOPIA
MYOPIAMYOPIA
MYOPIA
 
Slit Lamp Biomicroscopy
Slit  Lamp BiomicroscopySlit  Lamp Biomicroscopy
Slit Lamp Biomicroscopy
 
Optical Coherence Tomography
Optical Coherence TomographyOptical Coherence Tomography
Optical Coherence Tomography
 
Development Of Vision
Development Of VisionDevelopment Of Vision
Development Of Vision
 
Therapeutic Contact lenses
Therapeutic Contact lensesTherapeutic Contact lenses
Therapeutic Contact lenses
 

Care and maintenance of contact lenses

  • 1. CARE AND MAINTENANCE OF CONTACT LENSES MANOJ ARYAL B. Optometry IOM, Maharajgunj Medical Campus
  • 2. PRESENTATION LAYOUT • Introduction • Overview of care and maintenance  Care and maintenance of soft contact lenses  Care and maintenance of RGP contact lenses  Lens deposits  Patient education and compliance: use and care of contact lenses  Discussion
  • 3. Introduction  Most crucial aspect of contact lens wear  Influence the success of contact lens wear and patient’s satisfaction with their lenses
  • 4. Overview Of Care And Maintenance  Purpose: Clean lens Good comfort Good vision Safe lens wear
  • 5. Components:  Cleaner Daily cleaner Weekly/protein cleaner  Rinsing solution  Disinfecting solution  Lubricating/Re-wetting solution  Lens storage cases
  • 6. Cleaners Most common components  Surfactants(surface active agents) Non-ionic Ionic Anionic Cationic Amphoteric  Buffers  Osmolality adjusting agents  Preservatives  Chelating agents  water
  • 7.  Cationic surfactants are not normally used with SCLs bcz.  They may be bind with lens particles  Preservatives are primarily used to protect the cleaning solutions from microbial contaminations after opening
  • 8.  Surfactant cleaners:  Normally used in conjunction with finger rubbing  Rubbing step is always followed by rinsing step  Rubbing: dislodges the contaminants  Rinsing: removes the displaced contaminants
  • 9. Daily Cleaner Function  To remove:  Loosely bound foreign matter  Cell debris  Mucus,lipid, protein  Cosmetics or other surface contamination
  • 10. Dailey cleaners Contains friction enhancing agents/polymeric beads  These are the small solid particles that behave as a mild abrasive but which do not affect lens surface  Eg. Allergan LC 65&B&L sensitive eye daily cleaners
  • 11.  Extra strength daily cleaner  Alcon Opti-clean, Polycleans ii  B&L Concentrated cleaner  CIBA Miraflow
  • 12.  General procedure:  Wash hands  Place lens in palm of hand  Place 2-3 drop of cleaner on each lens  Rub with forefinger for about 15 seconds per side using a to and fro and fro action. Rolling the forefinger in both directions cleans the lens periphery
  • 13. Weekly cleaners: Usually formulated for protein removal Sometimes called enzymatic cleaners bcz. most contains one or more proteolytic enzymes
  • 14. Rinsing Solutions Function:  Removal of loosened lens contaminants  Removal of residual cleaners  Rehydrate lens  Resolve enzyme tabs Most common and most economical rinsing solution is saline
  • 15.  Saline:  Isotonic saline can also be used:  As a medium for enzyme treatment in some regimens  To elute unbound adsorbed or absorbed lens contaminants  To rehydrate lens
  • 16. Disinfectio nFunctions:  Kill or deactivate potentially pathogenic organisms includes  Bacteria  Fungi  Virus  Amoebas  Maintain lens hydration
  • 17.  Types  Thermal  Chemical Conventional Polymeric Tablet  Hydrogen peroxide
  • 18. Thermal Disinfection  High temperature kill micro-organism by:  Denaturation of cell components  Disruption of plasma membranes  DNA damage  2 methods of applying heat to lenses in a lens storage case
  • 19.  Wet:  immersing the lens case in water at or near its boiling point or  Placing the lens case above boiling water  Dry:  direct heating of lens case by a matching, snug fitting, electrically heated device  After heating cycle allow lens to cool before use
  • 20. Advantages  Short disinfection cycle times(10-30)  Very effective in destroying microorganisms  Low risk of toxic or allergic reactions Disadvantages  Incompatible with some lenses(usually SCLs)  Suitable electrical power for heat units may not always be available  Can cause lens discoloration  Increased protein deposition
  • 21. Chemical Disinfection  Conventional Chemicals:  Thimerosal  Chlorhexidine  Sorbic acid  Benzalconium chloride  Iso-propyl alcohol
  • 22.  Thimerosal:  Effective as anti-fungal agent  Reduced effect when combined with EDTA  Cytotoxic to corneal epithelium  Chlorhexidine gluconate:  Antibacterial agent  Leaches from Group 1 to Group 4
  • 23.  Benzalkonium chloride  Antibacterial agent  Cytotoxic  Sorbic acid  Anti bacterial with limited antifungal activity  Not cytotoxic  Causes discolouration of lenses
  • 24.  Alcohol:  Cleaners: isopropyl alcohol and ethanol  Disinfection : isopropyl alcohol  E.g.CIBA Miraflow used in disinfecting solutions  Both disinfectants and cleaners contain large conc. of alcohol  Cleaner 20%  Disinfectant 17%
  • 25. Chemical Disinfection: Disinfectant Sensitivity Symptoms  Sudden decrease in ocular tolerance  Decreased wearing time(2- 4 hour)  Burning, grittiness, dry sensation Signs  Conjunctival redness  Epithelial damage  Corneal inflammation
  • 26. diffuse corneal staining resulting from a reaction to a disinfectant or a preservative. A mild red eye (conjunctival hyperaemia) due to sensitivity to a solution component, usually the disinfectant.
  • 27.  Disinfectant sensitivity depends upon:  Preservative type  Preservative concentration  Lens material  Soaking time Lens age  Patient susceptibility
  • 28. Polymeric Disinfection  Relatively recent class of disinfection  Most common examples are  PHMB  Polyquaternium-1  Used in multipurpose solution
  • 29.  E.g B&l Mps ReNu,Alcon Opti-Free, Allergan Complete ,CIBA Solo care soft  Disadvantages  Reduced disinfecting power  Rub/rinse still required  Compliance is more important
  • 30. Tablet Based System  Chlorine tablet system  Halane(sodium dichloroisocyanurate)  Halazone(poly(dichlorosulphanoyl)benzoi c acid)  E.g Alcon Softab, Sauflon Aerotab  Chlorhexidine  E.g Optim eyes
  • 31. Hydrogen Peroxide Disinfection  Along with thermal disinfection is one of the earliest SCLs disinfection method  Hydrogen peroxide:  Produces free oxygen radicals which are very reactive and quickly bind to many cell components  Decomposes to water and oxygen  Requires neutralization  Can be formulated preservative free  Can be supplied in one-step form  Must be stabilized
  • 32. Hydrogen peroxide: neutralization Non selective anti-microbial agent Minimum 3 hr in 3%h2o2 recommended Bacteria 10-15 min Fungi 60 min Acanthomoeba 3-6 hour Neutralization: 2-step peroxide disinfection 1-step peroxide disinfection
  • 33.  Neutralizers:  Sodium pyruvate: Na2C3H3O3+H2O2=NaC2H3O2+H2O+CO 2  Sodium sulphite: Na2SO3+H2O2=Na2SO4+H2O  Sodium thiosulphate: 2Na2S2O3+H2O2=Na2S4O6+2NaOH  Sodium tetrathionate  Highly deleterious to cornea 2-step peroxide neutralization: stoichiometric(reactive) Neutralization
  • 34. 2-Step H2O2 Systems: Catalytic Neutralization  Have longer neutralization time  In either tablet or solution form, neutralization and equilibrium time of 10-15 minutes are generally adequate for low water content lenses Higher water SCLs require longer times of up to 1 hour  Neutralizers:  Catalytic disc in second lens case  Catalase solution or tablet
  • 35. 2- Step Peroxide Disinfection Advantages  Can vary time of disinfection  Concurrent protein removal possible  Suited to occasional wear Disadvantages  Less convenient  Some have preserved neutralization solution  Potential for irritation  expensive
  • 36. 1-step neutralization system  Formulated so that the peroxide disinfection and neutralization are performed during the recommended time  With tablet using system a delay is applied to the neutralization phase  With disc-based systems, no delay is applied to the neutralization phase  When neutralization is performed as separate step, the system is called atwo-step neutralization
  • 37.  Disadvantages:  Inflexible neutralization time  H2o2 concentration decreases rapidly(3%-1%in less than 10 min)  Not effective against fungi and acanthamoeba species  Catalytic disc needs regular replacement  Potential for irritation  Possible recontamination
  • 38.  In systems using catalytic disc, whenever H2O2 is in contact with the disc, the concentration is decreasing  User of disc based 1- step systems should be instructed to place their lenses in lens baskets before pouring peroxide solution into the case  If not, much of the peroxide is neutralized by exposure to the disc before lenses are immersed
  • 39. H2O2: Effect On Lens Parameters  May cause reversible parameters changes in high water lenses  HWC requires longer soaking time to reverse  Caution:  Discomfort and irritation follow lens insertion if residual peroxide present  No permanent damage to normal ocular tissues  Corneal staining might be observed
  • 40. Protein Removers  Most protein removers are based on enzymes  Enzymes cleaners work by leaving substrate specific enzymes break down their target molecules, thereby facilitating their removal Protease target proteins Lipase target lipids  While amylase targets polysaccharides
  • 41.  Enzymes can also remove other types of deposits if they are incorporated in the protein deposits  Enzymes may also break bonds between the lens materials and proteins  Enzymatic cleaning does not replace the disinfection system
  • 42.  Procedure:  Used regularly, after the daily cleaner and rinsing step  Lenses should be soaked in enzyme dissolved in solution/saline for 15 min to overnight, depending upon manufacturer  Lenses should be thoroughly rubbed and rinsed again afterwards
  • 43.  Enzymatic protein removers Contain one of the following  Papain  Pancreatin  Subtilisin A &B
  • 44.  Papain:  protease i.e. enzyme that act as protein specifically  Derived from papaya plant  Usually have a slightly unpleasant odour due to the inclusion of cysteine  Binds to contact lens material and can cause sensitivity reaction  Short 15 min soaking time possible E.g. Allergans Soflens enzymatic cleaner or Profree
  • 45.  Subtilisin A&B:  Proteases  Subtilisin A formulated specifically for use in hydrogen peroxide lens care systems  Subtilisin B is formulated for use in conventional chemical and thermal systems
  • 46. Re-wetting/ Lubricating Drops  Used for:  Promote comfort  Reduce deposit induced friction b/w eyelids and corneal surface  Rehydrates the lens  Lubricating and re-wetting eye drops are formulated with viscosity-enhancing agents(commonly polyvinyl alcohol, methylcellulose etc)
  • 47. Lens Storage And Cases  To avoid contamination, lens cases should be rinsed after every use and the lenses stored in fresh solution  Acanthamoeba and other free living protozoans are especially prevalent among those using tap water for rinsinf their lens cases, using home made saline as a rinsing solution for contact lenses, or swimming with contact lenses.  Biofilm or glycocalyx formation on the surface of contact lens storage cases can horbour pseudomonas aeruginosa and serratia marcesens
  • 48.
  • 49.  Care of lens cases:  Discard used solutions  Scrub with a toothbrush and detergent weekly.oil free soaps or detergents are recommended  Rinse with hot water and rub thoroughly with a clean, dry tissue
  • 50.
  • 51. Lens replacement schedule and care regimen  Daily disposable:  Does not require use of surfactant cleaner, disinfecting solution or weekly enzyme  If needed the patient can use in eye re wetting drops or sterile saline for rinsing prior to insertion  Regular disposables  Suitable care includes multi-purpose solutions  No weekly protein removal is needed  Other options:  Surfactant cleaners  1-step hydrogen peroxide disinfection  Lubricating/re-wetting solutions
  • 52. Care regimen guidelines for frequently replaced lenses,conventional lens wearers
  • 53. In-office diagnostic(trial set) lenses SCL use heat if possible otherwise peroxide  RGP use peroxide or store lens dry  Re-disinfect non disposable inventory trial lenses at least once a month  In-office procedures  Oxidising agents  Standing waves  Ultrasound  Ultraviolet  Microwave Common oxidizing agents used are LiprofinTM, 6 or 9% peroxide
  • 54. Care and maintenance  Important steps for patients  Wash hand prior to handling lenses  Rub each side of each lens for 10-15 seconds using a surfactant cleaner  Rinse each lens thoroughly in normal saline  Disinfect contact lenses in fresh disinfecting solution in a clean storage case  Remember  Do not mix solution type and brands  Assess patients compliance  Repeat instructions and assess demonstration to patient  Remind patient to clean lens case weekly
  • 55. The Message  C lean  R inse  A nd  D isinfect  L enses  E very time
  • 56. RGP Care And Maintenance  Purpose:  Minimize deposit accumulation  Increase lens wettability  Facilitate comfort and vision during lens wear  Deposits: RGP material containing Siloxane are more prone to protein deposits Fluorine are more susceptible to lipid coating
  • 57.  Practitioner choose low Dk over high Dk RGP material despite the benefits of higher oxygen permeability  The high Dk RGP lenses are more susceptible to lens surface deposits than their low to moderate Dk counterparts  Cleaner :  daily surfactants  Protein removers  Disinfecting or soaking solution  Wetting solution  lubricants
  • 58.  Daily surfactant:  Similar to their SCL counterpart  An alcohol based cleaner is well suited to fluorosiloxane lenses which tend to acquire lipid deposits  Patient should be cautioned against soaking RGP lenses in alcohol based cleaner  Further, they should be adjusted to rinse their lenses thoroughly immediately after using such cleaners bcz. they have been shown to alter lens parameters if allowed to remain in contact with the lenses
  • 59.  Enzyme: recommended for protein removal in deposit prone wearers  Polish: may be necessary for lenses over 12-18 months old  Cleaning pad; may be effective in removing some deposits from RGP lenses  Avoid:  Vigorous rubbing  Excessive pressure on lens  Prolonged cleaning with mildly abrasive cleaners
  • 60.  Recommended technique:  Place the lens in the palm of hand  Rub lens with finger for minimum of 10 seconds  Rinse with saline or tap water approved for drinking
  • 61. Disinfectio n Although microorganisms can not readily attach to RGP lens surfaces , they can attach to deposits  RGP lens should not be thermally disinfected As this can cause warpage  Soaking time (4hour to overnight or as recommended)
  • 62.  Preservatives used includes:  Thimerosal  Phenyl mercuric nitrate  Benzalkonium chloride  Chlorhexidine  Poly(amino propyl bigunide)  And polyquaternium-1 H2O2 IS NOT NORMALLY USED GOR RGP LENSES
  • 63.  Wetting and soaking:  It is better for RGP lens wearer to wet-store their lenses  If RGP lens are stored dry, parameters such as BOZR will invariably flatten and the lens surfaces may not wet properly  Wet storage also improves initial on eye comfort and greatly assists microbial control of lens storage conditions
  • 64.  RGP wetting and soaking solution contains:  Antimicrobial agents to disinfect the lenses and to preserve the solution after initial opening  Wetting agent to improve lens wettability  Viscosity-enhancing agent to thicken the formulation  Buffer system to adjust and maintain solution pH  Salts to adjust solution osmolality
  • 65.  Wetting agents:  Better wetting result in better vision and greater comfort  Improve the wetting characteristics of the lens surface:  Convert hydrophobic surface to hydrophilic  Assist tear film to spread more easily and evenly on lens surface  Increase comfort on insertion  E.g. Poly vinyl alcohol, Polyvinyl pyrolidone, Polysorbate
  • 66.  RGP lens non-wetting areas due to:  Deposits  Manufacturing process  Polishing compounds  Surface combinations  Rinsing solutions  RGP lens can be inserted directly into the eye after soaking in appropriate wetting/soaking solutions  Burning on insertion: change to a less viscous solutions  Stinging on insertion: change solution
  • 67.  RGP-MPS  One bottle system(OBS)  Combination of cleaning, disinfecting, and soaking functions  E.g. Allergan Total, Boston Simplicity, CIBA SOLO-care-hard  Lubricating drops:  Used during lens wear to:  Improve comfort  Clean lens surface  Maintain lens wettability
  • 68. Trial Set Disinfection/Storage  RGP trial lens disinfection: the method recommended is:  Clean with alcohol-based cleaner immediately after use  Place in a clean container  Wet storage in a soaking solution when lens is not being used  Clean the storage solution periodically(monthly)  Clean lens again immediately before next use
  • 69. Summery  Because of their non-absorbent nature, surface properties, rigidity and durability RGP lenses are easier to care for  Clean ,rinse and disinfect lens every time(CRADLE)  RGP lens kept in use longer than SCLs Therefore efficacious lens care area more important  Consider a programmed replacement scheme
  • 70. Contact Lens Deposits  Definition: Any lens surface coating or lens matrix formation which is not flushed or rinsed from the lens by the tears during blinking. In effect, anything that remains on the surface despite blinking is a deposit
  • 71. Deposit formation:  Tear protein(lysozyme) are attached to the lens  Tear evaporates and leave residue on the lens  After protein are deposited, other components of the tear film (such as mucin) may adhere to protein  Over time. Layers build up and structural changes take place(e.g. Denaturation) Factors influencing lens deposition:  Individual difference in tears  Lens materials  Care system  Wearing schedule EW might induce more deposits than DW  Environment  Patient hygiene
  • 72. Types Of Deposits Teal related  Protein  Lipid  Jelly bumps  Inorganic deposits Non-tear related  Fungi  Lens discoloration  Mercurial deposits  Cigarette residues  Surface combination  Rust spots
  • 73.  Protein deposits:  Are a semi-opaque or translucent film usually thin whitish and superficial  Have a frosted glass appearance  may cover lens surface partially or full  Cause the lens surface to become hydrophobic  Can crack and peel if thick
  • 74.  Factors favouring a build up of protein on a contact lens:  short BUT  Ionic binding capacity  Inadequate cleaning especially of the lens periphery  Altered blinking  Heat disinfection  Tear deficiency or altered tear composition  Chronic allergies and GPC
  • 75. Lipid Deposits  Appears as greasy, smooth, and shiny adherent films on both RGP and soft contact lenses  Best observed between blinks  Appears as a thick ,oily coating  Lipids involved includes: phospholipids, neutral fats, triglyceride, cholesterol, cholesterol esters, and fatty acids  Origin: mainly from meibomian gland
  • 76.  Predisposing factors:  Tear film quality  Slow blink pattern  Poor lens compliance  Careless use of inappropriate cosmetics/lotions
  • 77. Jelly Bumps  Appear as a clumps of raised transluscent mulberry like deposits  Typically form in inferior, exposed portion of lens  Occur more frequently in high water, ionic, EW lenses
  • 78. Predisposing factors  Quality of tear film  Poor blinking  Lens surface contamination  HWC>LWC  Aphakia cleaning consequences  Large and numerous jelly bumps lead to wearer discomfort  Large deposits can cause the lens to attach to the upper lid so that each blink causes excessive lens movement  When located within pupil zone-visual acuity can fluctuating  Maya also cause mechanical irritation of tarsal conjunctiva  In extreme case, may cause CLPC
  • 79. Inorganic Deposits  Calcium carbonate deposits  Calcium phosphate deposits  Appearance:  White crystalline specks  Can be small or large  Rough surface  Penetrate lens surface if severs
  • 80. Fungal Deposits  Appearance:  Filamentary growth on and into lens  Usually white, brown or black  Fungal formation  Spores on lens surface from eye or environment  Proliferates to large visible growth  Penetrate lens matrix  Contact lens good medium for fungal gruwth
  • 81. Lens Discoloration  Can result from:  Natural lens ageing  Surface contamination  Mercurial deposits
  • 82. Mercurial deposits:  Appear as a greyish to black discoloration  Reuse of thimerosal containing solution is one cause  To prevent avoid mercury based preservatives Ageing  Polymer breakdown  Chemical absorption  Handling  Stress and strain  deposition
  • 83.  Surface contamination  Make up  Moisturizing lotions  Hairspray  Chemical fumes
  • 84.  Management  Advice patient on good hygiene  Proper care and maintenance  Do not reuse solutions  Smokers should be warned
  • 85. Lens Deposition :Rust spots  Appearance:  Small superficial raised spots  Colored orange to black  Can be few to numerous
  • 86. DISCUSSION Importance of rub and rinse in use of multipurpose contact lens solution. Optom Vis Sci. 2011 Aug PURPOSE : The introduction of contact lens multipurpose disinfection solution (MPDS) that can be used in conjunction with a "no-rub" regimen has simplified lens care requirements. Once adhered to a surface, microorganisms can become less susceptible to disinfection. The aim of the study was to evaluate the effect of various regimen steps on the efficacy of MPDS when used with silicone hydrogel and conventional lenses.
  • 87. RESULTS: Overall, the greatest efficacy of MPDSs was observed when "rub and rinse" was performed before disinfection with each of the microorganisms tested, regardless of lens type. "No rub and no rinse" steps resulted in a greater load of microorganisms remaining on lenses compared with the other regimens (p < 0.05). When "rinse-only" was performed before disinfection, the MPDS containing polyquad performed generally better (p < 0.05) than MPDSs containing polyhexamethylene biguanide against bacteria. Significantly, less microorganisms were recovered from galyfilcon A than from other lenses (p < 0.05) when MPDSs were used with "rinse-only" step. CONCLUSIONS:  This study has demonstrated that "rub and rinse" is the most effective regimen and should be recommended in conjunction with all multipurpose lens care solutions and all contact lens types, particularly with silicone hydrogel lenses.
  • 88. Comparative antimicrobial efficacy of multi-purpose lens care solutions using the FDA's guidelines  PURPOSE: evaluated six single-bottle, multi-purpose lens care solutions and a two component lens care system for disinfection efficacy according to the stand-alone primary criteria within the recently published U.S FDA Guidelines.
  • 89.  RESULTS:  ReNu and ReNu MultiPlus met the FDA's acceptance criteria for stand-alone disinfectants against all challenge organisms: Staphylococcus aureus, Serratia marcescens, Pseudomonas aeruginosa, Candida albicans, and Fusarium solani. Opti-Free Express failed to meet the FDA's stand-alone disinfectant acceptance criteria for S. aureus, S. marcescens and C. albicans and Opti-Free Express with Opti-Free Supraclens failed to meet the acceptance criteria for either S. aureus and C. albicans. Opti-One failed to meet the FDA's stand-alone disinfectant acceptance criteria for C. albicans and F. solani. Both Complete and Solo-Care failed to meet the FDA's acceptance criteria for C. albicans.
  • 90.  CLAO J. 2001 Jan;27(1):16-22.  Disinfection efficacy of contact lens care solutions against ocular pathogens  PURPOSE:  Three commercially available products labeled as multi-purpose contact lens solutions, one multi-purpose disinfecting solution, and a hydrogen peroxide system were evaluated for antimicrobial activity according to the current International Organization for Standardization (ISO) and the U.S. Food and Drug Administration (FDA) stand-alone procedure for disinfecting products. One multi- purpose solution was selected to assess its antimicrobial activity against two human corneal isolates of Pseudomonas aeruginosa.
  • 91.  RESULTS:  ReNu MultiPlus (Bausch & Lomb, Rochester, NY), AOSEPT (CIBA Vision Corporation, Duluth, GA), and Opti-Free Express with Aldox (Alcon Laboratories, Ft. Worth, TX) were the only lens care products that met the stand-alone criteria for all required microorganisms within their minimum recommended disinfection time. Of these, ReNu MultiPlus provided the greatest overall antimicrobial activity. ReNu MultiPlus demonstrated a significantly higher mean log reduction of Staphylococcus aureus and Serratia marcescens than Opti- Free Express. ReNu MultiPlus also gave a higher mean log reduction of S. aureus and S. marcescens than AOSEPT, and a higher mean log reduction of Candida albicans and Fusarium solani than AOSEPT, Complete Comfort Plus (Allergan, Irivine, CA), and Solo- Care (CIBA Vision Corp.) (at 4 hours). Both Complete Comfort Plus and Solo-Care (at 4 hours) met the primary acceptance criteria for bacteria; however, neither product possessed enough antimicrobial activity to meet the minimum criteria for yeast or mold. ReNu Multiplus was effective against corneal isolates of P. aeruginosa.  CONCLUSION:  ReNu MultiPlus, AOSEPT, and Opti-Free Express met the requirements of the stand-alone primary criteria for disinfecting solutions. ReNu MultiPlus demonstrated the greatest overall disinfection efficacy, as well as excellent activity against clinical strains of P. aeruginosa
  • 92.  Contact lens care products effect on corneal sensitivity and patient comfort  PURPOSE:  To evaluate the possible effect of two leading soft contact lens care products on corneal sensitivity, relative comfort, and superficial corneal staining in adapted disposable soft contact lens wearers.
  • 93.  RESULTS:  Patients habitually using OPTI-FREE Express reported higher comfort ratings than did patients using ReNu MultiPlus. On crossover, patients who initially used ReNu MultiPlus experienced similar comfort when using OPTI-FREE Express, but OPTI- FREE Express users experienced a substantial decrease in comfort when switched to ReNu MultiPlus. Esthesiometry showed significant differences in average sensitivity in favor of OPTI-FREE Express (P=0.0041). Statistical trends supported observed increases in corneal sensitivity when switching to OPTI-FREE Express and decreased corneal sensitivity when switching to ReNu MultiPlus. ReNu MultiPlus was also associated with slightly more corneal staining.  CONCLUSIONS:  ReNu MultiPlus, a biguanide-based contact lens care product, was associated with decreased comfort during midday and end-of-day periods. ReNu MultiPlus was also associated with significant reduction in relative corneal sensitivity compared to Polyquad-based OPTI-FREE Express. Disturbance to normal corneal sensitivity may play a role in contact lens-related dry eye and discomfort. Further investigation is warranted
  • 94. Care and maintenance of SCLs  SCLs are susceptible to deposits due to:  Lenses are covered by pre-lens film all the times  The tear film undergoes hydration and dehydration cycle as a result of blinking and evaporation bw blinks  Lens is a subject to atmospheric changes and pollutants  Decreased surface wettability is likely to accelerate deposition
  • 95. Deposits: Complications  Irritation and reduced comfort  Reduced visual acuity  Shortened lens life  Increased potential for infection  Increased incidence of GPC