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Should Patients Rinse Their GP Lenses With Tap Water?
BY KEITH PARKER, NCLEC
When I was a child, my mother would warn my friends and me whenever we went camping down by the river, “Don't go near the water.” Of course she had good reason, as the currents of the Merrimac River are well known for taking at least a few swimmers a year to their death.
Is it Safe to Go Near the Water?
So is the water safe? I am, of course, speaking now not of the underlying currents of a raging river, but of our tap water. The question truly needs to be asked: Is our tap water safe?
The fact is, tap water in the United States is not what it used to be. The amount of pharmaceutical drugs and byproducts that get into the water supply through sewage alone is a major problem according to the Environmental Working Group (EWG). These pharmaceutical drugs combined with the residual byproducts of agricultural chemicals used on our crops along with antibiotics and hormones found in animal waste across the nation create a chemical in-balance to our once-thought-to-be-safe tap water.
If you search the Internet for tap water testing or go to www.ewg.org and enter your zip code, you may be surprised to find out what is really in your tap water. The Wall Street Journal published an article in August 2008 titled “What's Coming From Your Tap?” which states, “Of particular concern, experts say, are endocrine-disrupting compounds — found in birth-control pills, mood-stabilizers and other drugs — which are linked to birth defects in wildlife. Also alarming are antibiotics, which if present in water systems, even in small amounts, could contribute to the rise of drug-resistant strains of bacteria, or so-called super bugs.”
Contact Lenses and Tap Water
The FDA released a statement in December 2007 warning patients that it is no longer recommended to rinse any contact lens, whether soft or GP, or any contact lens storage case with tap water.
So why do we do it? Our international colleagues have said for years that tap water is not safe for rinsing GP lenses before application. We don't allow our soft lens patients to rinse their soft lenses with tap water. The FDA says we shouldn't do it. So why do we still do it?
The United States was the last country to officially say, “Do not use tap water with any type of contact lens.” I have heard practitioners ask, “Why all the fuss over tap water? If it is safe enough to drink, why is it bad for GP lenses?” The considerations for drinking tap water are different from the problems associated with tap water exposure to the eye and to the contact lens surface. It is important to point out that our digestive system is probably much more powerful in handling the variety and virulence of microbial organisms that challenge it.
Furthermore, it may not be just a question of health. I speak with patients and practitioners regularly about their dilemma of non-wetting, filmy, uncomfortable, and gritty GP lenses that result in inconsistent vision. In my opinion, just as important is the negative effect tap water exposure causes by creating a non-wetting lens surface due to the numerous chemical byproducts. It is these non-wetting considerations that decrease comfort and visual performance of GP lenses.
Soft lenses, due to their hydrophilic absorption properties, have never been allowed to be exposed to tap water. So why do we allow it with GP lenses? I believe that with GP lenses, most practitioners are stuck in the past. They consider GP lenses to be like the old PMMA lenses of yesteryear. GPs are not thought of as the continuing revolutionary modalities that they actually are.
Consider this…GP lenses were the first contact lenses to be approved for seven days of overnight wear. GP lenses were the first contact lenses used for fitting every type of irregular cornea due to disease, trauma, and even poor refractive surgery outcomes. GP lenses might be considered as the first, original “wavefront” technology contact lenses because the tear layer eliminates so much corneal astigmatism. Visual performance with a well-fitted, well-manufactured GP lens may be the best visual corrective device known to mankind.
So, back to the water. Dissatisfaction with GP lens performance is again often due to filmy, cloudy, gritty, inconsistent vision and performance. These common complaints may be easily remedied by eliminating the tap water rinse before application. For example, current studies show that simply rinsing plasma-treated GP materials with common tap water greatly diminishes the wettability of the plasma-treated lens surfaces. This means that when a new plasma-treated GP lens is rinsed with everyday tap water from the public water supply, the surfaces are rendered as hydrophobic (non-wetting) as before the plasma treatment process.
Stay Away From the Water
So, what can we do about this? The same thing we do with soft lenses. Warn every patient against the use of tap water. Prescribe a no-tap-water solution compliance regimen for your GP lens patients. When a multipurpose solution is recommended, remind every patient that an additional cleaning may be necessary once a week or maybe more to assure proper cleaning of the lens surface. If tap water is required to rinse these cleaners, then instruct patients to immediately rinse the tap water with saline or an approved multipurpose solution before storing the lenses overnight in the appropriate wetting, conditioning, or multipurpose disinfecting storage solution.
What else can we do? We can prescribe better compliance programs for GP lens wearers. Instead of giving them the free sample you have in the cabinet and sending them on their way to fend for themselves in the grocery store contact lens solution aisle, you can prescribe specific recommendations to your patients on how to best keep their GP lenses clean, fresh, and comfortable. You can do this by prescribing not only the proper methods and solutions needed to clean their GPs, but also by prescribing a hand soap approved for contact lens use. Most hand soaps on in the marketplace contain lanolin, perfumes, coloring, and fragrance that all can have a negative effect on any contact lens.
Remember: a clean lens, is a healthy lens, is a comfortable lens, is a happy patient.
Prescribe compliance. Your patients deserve it and your practice will benefit with fewer patient dropouts and time-consuming complaints. End tap water use with all patients and lenses. This education starts with you. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #166.
Keith Parker has been in the contact lens industry since 1976. He is owner and president of Advanced Vision Technologies and was formerly the general manager of Essilor Contact Lens Division. He has served as the president of the CLMA Board of Directors and currently still serves on the Board. Keith has participated on numerous advisory panels and lectured on contact lens-related subjects throughout the United States and abroad.