care and maintenance of soft contact lenses

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  • When deposits accumulate on the contact lens, the following signs and symptoms may occur: *vision decrease *decrease in contact lens wetting ability *foreign body sensation, discomfort *allergic reaction, GPC *medium for adherence of microorganisms, increasing risk of infection
  • Example of CL materials under FDA classificxation Group 1 ( <50% H 2 O, nonionic polymers) telfilcon, tetrafilcon A, crofilcon, helfilcon, mafilcon, polymacon , lotrafilcon A. Group 2 ( >50% H 2 O, nonionic polymers) lidofilcon B, surfilcon A, lidofilcon A, netrafilcon A, hefilcon C, alfafilcon A, omafilcon A, vasurfilcon A, hioxifilcon A, nelfilcon A, hilafilcon A Group 3 ( <50% H 2 O, ionic polymers) bufilcon A, deltafilcon A, droxfilcon A, phemfilcon A, ocufilcon, balafilcon A Group 4 ( >50% H 2 O, ionic polymers) perfilcon, etafilcon A, focofilcon A, ocufilcon B, ocufilcon C, ocufilcon D, ocufilcon E, phemfilcon A, methafilcon A methafilcon B, vilfilcon A
  • care and maintenance of soft contact lenses

    1. 1. Care and Maintenance of Soft Contact Lenses Vishakh G Nair M.Optom,FIACLE
    2. 2. Outline of the presentation• Why care for contact lenses?• Deposits & Types• Lens care regimen • Components of lens care solution • Functions • Steps in lens care and maintenance • Types of disinfectants • Do-s & Don’t-s
    3. 3. Outline of the presentation• Why care for contact lenses?• Deposits & Types• Lens care regimen • Components of lens care solution • Functions • Steps in lens care and maintenance • Types of disinfectants • Do-s & Don’t-s
    4. 4. Purpose of Care and Maintenance• 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
    5. 5. Purpose of Care & Maintenance• Failure to prescribe proper lens care regimen• Failure of compliance Failure of  Reduced comfort  Reduced vision  Increased risk of contamination  complications/ infections CL wear  Dissatisfied patient
    6. 6. Outline of the presentation• Why care for contact lenses?• Deposits & Types• Lens care regimen • Components of lens care solution • Functions • Steps in lens care and maintenance • Types of disinfectants • Do-s & Don’t-s
    7. 7. Deposits & 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.
    8. 8. 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)
    9. 9. Protein Deposits
    10. 10. How do protein deposits get denatured? Environmental Factors: • Heat • Drying • Oxidation • UV lightNative Protein Denatured Protein• Transparent • Translucent/opaque• Natural part of tears • Strongly binds to lens• Beneficial to eyes surface (anti-microbial activity) • Harmful to eyes
    11. 11. Lipid Deposits
    12. 12. Jelly Bumps
    13. 13. Other DepositsCalcium Deposit Fungal Contamination Rust Spots
    14. 14. Deposit Complications• Reduced visual acuity• Lens dryness - proteins repel water & the lens may dry up more easily• Irritation and reduced comfort  shortened wear time• Cause allergic response (e.g. GPC)• Micro-organism’s attachment to deposits may cause eye infection
    15. 15. Non-wetting SCL surface
    16. 16. FDA Classification of Lens MaterialsGroup Water Content Charge I Low (< 50%) Non Ionic II High (> 50%) Non Ionic III Low Ionic IV High Ionic
    17. 17. Outline of the presentation• Why care for contact lenses?• Deposits & Types• Lens care regimen • Components of lens care solution • Functions • Steps in lens care and maintenance • Types of disinfectants • Do-s & Don’t-s
    18. 18. Components of Care and Maintenance½ Daily cleaner½ Rinsing solution½ Disinfecting solution½ Protein removers½ Lubricating/rewetting solution½ Lens storage case
    19. 19. Compliance Vs Non- ComplianceSimple system and Instruction - Better compliance - Easy and convenientComplicated System - Confusion - Non-compliance - Lens wear complications
    20. 20. Essential Steps of Care & Maintenance½ Cleaning½ Rinsing½ Disinfecting½ Extra Steps - Protein Removal - Lubricating / Re-wetting
    21. 21. Daily Cleaning and / or Rinsing removesmajority of Micro-organisms
    22. 22. Essential Steps of Care & Maintenance½ Cleaning½ Rinsing½ Disinfecting½ Extra Steps - Protein Removal - Lubricating / Re-wetting
    23. 23. Daily Cleaner - FunctionsTo Remove½ Loosely bound foreign matter - Cell debris - Mucus, lipid, protein - Cosmetic or other surface contamination½ Majority of micro-organisms
    24. 24. Daily Cleaner Composition• Surfactants• Buffers• Osmolality adjusting agents• Preservatives• Water
    25. 25. Surfactant Cleaners - Functions• Remove deposits by: – interacting with deposits – displacing deposits from lens surface• Emulsify oils and lipids• Destroy/dislodge micro-organisms• Prepare lens for rinsing and disinfection
    26. 26. Daily Cleaner Procedures½ Wash hands½ Place lens in the palm of the hand½ Place 2-3 drops of cleaner on each lens surface½ Rub with fore-finger for about 10-15 sec per side using to and fro and circular action½ Rolling the fore-finger in both directions½ Clean lens periphery½ Rinse well
    27. 27. Daily Lens Care ProceduresWash hands Either Rub + Rinse Disinfect Or Rinse Only
    28. 28. Hand washing - Reduce bio-burden - With water-based soaps - Often forgotten step
    29. 29. Rubbing the lens • 10-15 sec on each side • To and fro action • Removal of environmental & protein deposits • Reduces risks of infections
    30. 30. Consumer’s perception of No Rub• Simply put the lenses into lens case after removal• No digital cleaning, No rinsing• Simple, carefree, convenient lens care• Reduced usage of lens care solution
    31. 31. Essential Steps of Care & Maintenance½ Cleaning½ Rinsing½ Disinfecting½ Extra Steps - Protein Removal - Lubricating / Re-wetting
    32. 32. Rinsing • Wash off loosened debris • Decrease risk of deposit related problems
    33. 33. Essential Steps of Care & Maintenance½ Cleaning½ Rinsing½ Disinfecting½ Extra Steps - Protein Removal - Lubricating / Re-wetting
    34. 34. Disinfecting System½ Kill or Deactivate potentially pathogenicorganisms including -Bacteria -Fungi -Viruses -Amoebas½ Maintain lens hydration  stable parameters
    35. 35. Disinfection • Store the lenses for at least 4 hours in FRESH solution • Decreases the risk of infections
    36. 36. Types of DisinfectionHeat - Thermal Unit - MicrowaveChemical - Oxidative - Hydrogen peroxide - Chlorine - Cold Chemicals - Various disinfectants
    37. 37. 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°C for 10-20 minutes – After heat cycle, allow lenses to cool before use
    38. 38. Thermal DisinfectionAdvantages:• Short disinfection cycle times• Highly effective antimicrobial action• Low risk of toxic or allergic reactionsDisadvantages:• Incompatible with some lenses, e.g. high water content; may cause deformation & discoloration• Increased protein deposition (cook the protein onto the lens) & causes allergic response• Suitable electrical power for heat units may not always be available
    39. 39. Chemical Disinfection
    40. 40. Chemical Disinfection½ Disinfection achieved by the presencepreservative - Thiomersal, Chlorhexidine, Sorbic acid½ Disinfection depends on the concentrationand type of preservative½ Preservatives are potential irritants thoughrare
    41. 41. Modern Chemical Disinfectants• Used in Multi-Purpose (All-in-one) Solutions:• Polyaminopropyl biguanide (PABA, PHMB)• Quaternary-ammonia (Polyquad) & Aldox Much less incidence of solution sensitivity than older generation of disinfectants. Because the molecules specifically bind to cell membrane of micro-organism rather than human cells.Bacteria Human eye
    42. 42. Multipurpose SolutionsSingle bottle of solution for cleaning, rinsing, disinfection, & removing proteinAdvantages:• Simple, convenient, easy transport• Enhanced safety due to lower toxicity & complications• Doesn’t cause protein denaturation• Improved complianceDisadvantages:• Small incidence of mild sensitivity reactions
    43. 43. Hydrogen Peroxide Advantages: • Preservative free – theoretically less allergy • Effective disinfection Disadvantages: • Inflexible neutralization time (lens must be fully neutralized before use) • H2O2 concentration decreased rapidly (3% to 1% in <10mins) - decreased anti-microbial efficacy • Not suitable for all lens types • Potential for irritation on incomplete neutralization • Possible recontamination
    44. 44. Choice of Lens Care System SCL Heat MPS Hydrogen PeroxideLow water,    Non-ionicHigh water, Some  * Non-ionicLow water,    IonicHigh water,   * Ionic * Bleaches color in cosmetic CLs
    45. 45. Recommendations½ Discard solution everyday½ Rub and Rinse step is essential withcombination solution½ Keep nozzle closed½ Narrow openings½ Clean and rinse well½ Soak for recommended time
    46. 46. Essential Steps of Care & Maintenance½ Cleaning½ Rinsing½ Disinfecting½ Extra Steps - Protein Removal - Lubricating / Re-wetting
    47. 47. Protein Removers½ Effectively remove protein deposits½ Have no effect on most other deposits½ React by breaking protein molecules½ For heavy depositors; conventional lens user
    48. 48. Protein Removal Procedure½ Use regularly after daily wear and rinsing step½ Lenses should be soaked in enzyme, dissolvein solution / saline for 15 min or over nightdepending on manufacturer½ Lenses should be thoroughly rubbed andrinsed again afterwards
    49. 49. Essential Steps of Care & Maintenance½ Cleaning½ Rinsing½ Disinfecting½ Extra Steps - Protein Removal - Lubricating / Re-wetting
    50. 50. Rewetting or Lubricating Drops½ Alleviating signs of dryness and discomfort½ Flushing irritation particles from eye and CL½ Rehydrating lens
    51. 51. Care for Lens Cases½ Scrub with new tooth brush using cleaningsolution weekly½ Rinse with saline or disinfecting solution½ Air dry up-side down½ Replace case regularly
    52. 52. Dos and Donts ofCL care and maintenance
    53. 53. Do-s
    54. 54. Always wash your handsbefore handling contactlensesCheck the positionof lenses beforeinsertion
    55. 55. Cosmetics/Make-upPut your contact lenses in• after applying hair products like hairspray• before applying cosmetics, especially eye makeup.
    56. 56. Instruction for eye makeup• Insert your lenses before applying make up• Remove your lenses before taking your makeup off.
    57. 57. Avoid Harmful or Irritating Fumeswhile the Lenses Are on
    58. 58. Do Rinse the Lenses• Always before inserting the lens and after removing it from the eye• Rinse the lens with contact lenses solution suggested by your practitioner
    59. 59. Clean and change the solutionin the lens case Daily Keep your contact lenses either in your eyes or in your lens case
    60. 60. Don’t-s
    61. 61. Do not let hair spray orother cosmetic aerosolscome in contact withyour lenses.Avoid Long and DirtyNails
    62. 62. Do not Swim with contact lensesif Yes with swimming goggles only
    63. 63. Don’t sleep with contact lenses• Remove your lenses before going to sleep Your cornea may not get the necessary oxygen* while you are sleeping.* Continuous wear lenses or Extended wear lenses with HighDk can be used upon practitioner’s recommendations
    64. 64. Additional Tips for Hygienic CL Wear• Do not mix solution types and brands• Never soak/store lenses in saline or tap water• Don’t put your solutions and lens case in the toilet or refrigerator• Don’t touch the tip of the any contact lens solution• Don’t use any topical eye drops when wearing lenses
    65. 65. Dirty lenses can causeinfection / inflammation
    66. 66. Immediate contact with ECP• If your eyes get red and irritated or if you feel any pain remove your lenses and contact your eye care practitioner
    67. 67. 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 (120ml or 360ml rather than 500ml)
    68. 68. Why disposable ?• More comfortable• Healthy• More hygeinic• Convenience of spare pair at hand• Longer wearing time• Contact lenses related infection & complication reduces in disposables
    69. 69. How to enhance compliance?• Educate staff & the patient- Simple written & verbal instructions- Reinforce few key points many times- Practical demonstration/visuals• Review lens care at every visit• Keep patients coming back for more- Compliance packs/offers- Recall system- Regular contact through mailers
    70. 70. SummaryMinimized adverse reactions achieved by :• clean, well fitted lenses• adequate physiological performance• appropriate choice of care system• regular monitoring of patient• patient compliance

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