contact lens care
Caring for Silicone Hydrogels
BY JENNIFER L. SMYTHE, OD, MS, FAAO
Silicone hydrogel contact lenses are flexible devices. And not just literally, either. Patients can safely wear them for 30 nights of continuous wear or they can benefit from wearing them as a daily wear modality. Patients can and often will remove their lenses for a variety of reasons during a month-long period. That's why it is important to design an appropriate lens care regimen for whatever wearing schedule you recommend.
Tailor a Care Regimen
Regardless of wear schedule, you should always dispense a lens care system with silicone hydrogels. Instruct patients to clean the lenses every time they remove them and to completely disinfect lenses before reapplication.
What's the best lens care regimen for silicone hydrogel patients? That depends on lens material, patient lifestyle and wear modality.
Reported problems with solution incompatibility aren't specifically related to individual lens care systems or to individual lens materials, but rather to an interaction between the two. Currently only Alcon has approval to label its Opti-Free Express specifically for use with silicone hydrogel lenses. However, patients can use all approved soft contact lens care regimens with silicone hydrogels.
To date, the only adverse interaction documented in the literature is corneal staining observed in some individuals wearing PureVision (Bausch & Lomb) lenses and using ReNu Multi-Plus (B&L) on a daily basis. This response has not been noted with other lens care regimens.
When silicone hydrogels first became available it was rumored that using hydrogen peroxide would alter the physical parameters of the lenses. This clinical finding has occurred only with repeated use of UltraCare (Advanced Medical Optics) and PureVision lenses.
Consider Lifestyle & Modality
To achieve success with continuous wear, you must relay to patients that they accept added responsibility by wearing their lenses overnight. For example, to decrease the risk of adverse responses, they should remove the lenses under certain circumstances, such as during illness or after swimming.
Contact lens acute red eye (CLARE) is an inflammatory reaction to endotoxins from Gram-negative bacteria. These organ isms have been recovered from the throats and nasolacrimal ducts of CLARE patients who have cold-like symptoms. Temporarily discontinuing overnight contact lens wear during illness may reduce the risk of this type of inflammatory event.
Several cases of microbial keratitis that have occurred in silicone hydrogel continuous wear patients include a history of swimming while wearing the lenses immediately before the adverse response. Therefore, patients should completely disinfect their lenses before sleeping in them after swimming or being in a hot tub.
If compliance is a concern because of the amount of soak time required to properly use a system, then recommend the following two quick options on the market:
1. CIBA Vision's SOLO-care Plus this product's package insert includes both "rub" and "no-rub" instructions. The soak time with this solution after rubbing and rinsing is only five minutes.
2. CIBA Vision's Quick Care this is also a five-minute system with the additional benefit of an alcohol-based cleaner that works well on lipophilic contact lenses.
On-eye cleaning rewetting drops, such as Alcon's Clerz Plus and AMO's Complete Blink-N-Clean, can benefit some patients who are prone to posterior lens debris or surface deposition. Regular use of these products has even extended lens wearing time for certain individuals.
Dr. Smythe is an associate professor of optometry at Pacific University and is in private group practice in Beaverton, Ore.