Time to Review Basic Hygiene with Patients
With recent publications discussing adverse events associated with overnight orthokeratology, it's a good time to remind patients about lens care and handling instructions. Often the underlying cause of the adverse event relates to poor patient compliance.
The US Food and Drug Administration (FDA) requires that certain contact lens package inserts and instructions include recommendations to patients. This is beneficial information that, unfortunately, often goes unread.
We know that good hygiene is essential in the care and handling of all contact lenses. In fact, it may be the most important aspect of proper lens care. Unfortunately, patients might not remember the basics of proper hygiene.
Remind your patients that they should wash hands thoroughly with a mild soap, rinse their hands completely and dry them with a lint-free towel prior to touching the contact lenses. This may seem elementary, but a gentle reminder to your patients about proper lens care and hygiene at periodic intervals is essential in maintaining proper patient compliance.
As well as discussing proper hygiene, at each visit remind patients that they shouldn't wear their lenses "around the clock." Many patients believe that if they wear the lenses longer, the effect will last longer. Unfortunately, my experience has been that patients will reach a point of diminishing returns. In one such case in our clinic, the result was a microbial keratitis.
Trouble with Tap Water
Several times over the past few months, I've heard mention of the perils of using tap water with overnight orthokeratology lenses.
The package inserts and patient instructions that contact lens manufacturers provide for all GP lenses recommend rinsing the lens thoroughly with clean tap water or saline following cleaning and prior to disinfecting.
The unfortunate reality is that Acanthamoeba resides in tap water. Among the adverse events associated with corneal reshaping that have been reported, it seems that at least one article each year describes patients who have Acanthamoeba keratitis.
Is this because patients are reading the words "clean tap water" and not keeping it in the proper context? Do they see those words and decide on their own that it's okay to store lenses in tap water or to rinse the lenses in tap water prior to application?
Perhaps the best solution is to completely avoid tap water and recommend using sterile saline or multipurpose GP solutions for rinsing.
Keep Cases Clean
Dirty contact lens cases are another notorious source of bacterial contamination. To prevent bacterial growth in contact lens cases, remind patients to empty the case and rinse it with fresh, sterile rinsing solution and allow it to air dry every day. Again, avoiding tap water for rinsing may be the best recommendation you can give your patients.
Patients should also replace lens cases at regular intervals. Most care systems include a new lens case; therefore, a good recommendation is to replace the contact lens case when patients purchase new care systems.
While I realize that I've presented no new information here, I can't stress enough the importance of continuing education for patients.
Reality and the literature tell us that we're not free of poor compliance and the resulting consequences. An ounce of prevention is worth a pound of cure.
Dr. Rah is an assistant professor at the New England College of Optometry where she works primarily in the Cornea and Contact Lens Service in patient care, teaching and research.