Resolving Filmy GPs, Part 1
By Edward S. Bennett, OD, MSEd, FAAO; Robert M. Grohe, OD, FAAO; Marlane J. Brown, OD, FAAO; Susan Resnick, OD, FAAO; Michael A. Ward, MMSc, FAAO; & Derek Louie, OD, FAAO
A very common question that I am asked by consumers through www.contactlenses.org is: “I have been a long-time GP wearer without problems, but my new pair of lenses filmed up soon after I received them—what can be done?” In this and my next column, several experts from the GP Lens Institute Advisory Committee provide their approaches to this challenging problem.
1. Lens Material/Laboratory
It is first important to examine the front surface of the lenses. The problem could result from residual pitch polish on the surface from the manufacturing process. You can often remove this with an extra-strength cleaner such as Optimum ESC (Lobob) or Boston Laboratory Cleaner (Bausch + Lomb). The lens can then be reconditioned by rubbing the surfaces with the recommended wetting solution. Certainly, this problem occurs less if the lenses have been plasma-treated.
If this problem occurs frequently with the same laboratory, consider changing laboratories. The material could also be different from the lab's previous lens materials. Although current GP materials are usually successful while also meeting corneal oxygen needs, they also have subtle differences. If the new material was plasma-treated, but a previous care regimen that included an abrasive cleaner was still used, this could impact wettability.
2. Eye Health
After lens removal, evaluate potential ocular surface problems. Carefully evaluate the eyelids. A patient may have significant meibomian gland inspissation, telangiectasia, and debris in the lashes. In this case, treating the lid disease may be necessary before the contact lenses perform properly. Treatment may include warm compresses, a special eyelid cleanser such as OcuSoft scrubs (OcuSoft, Inc.), use of Azasite (Inspire Pharmaceuticals) or Restasis (Allergan), or an oral medication such as doxycycline for a period of time. Likewise, if patients are taking topical medications not compatible with GP lens wear, they should wait 15 to 20 minutes after use before reapplying lenses. Evaluate the upper lid for papillary hypertrophy as well as tear quality and volume.
3. Age and Gender
Filmy GP lenses are not uncommon with post-menopausal females experiencing dryness-related problems. The common features among this group are tear film changes due to advancing age as well as the use of a multitude of skin care products (eye-related, in particular) to “ward off” the signs of aging. These individuals should sparingly use any such cosmetic products that cause the lens surfaces to become hydrophobic. Advise them to use oil-based products very sparingly, if needed, before bed and not to reapply them in the morning. Also, some eye makeup removers have an oily component and may “drift” from the eyelids into the tear film. Also instruct them on the proper application of eyeliner so as not to block the meibomian glands.
In addition, advise such patients to use a tear supplement before applying their lenses to effectively dilute any residual oils that may have “crept” into the tear film overnight. Using a drop before applying the contact lenses will also help flush away debris that may have built up in the tear film overnight. Blink Contacts (Abbott Medical Optics) or Refresh Optive Sensitive (Allergan) may work well for this. CLS
Dr. Bennett is assistant dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. You can reach him at firstname.lastname@example.org. Dr. Grohe specializes in contact lenses and anterior segment in his suburban Chicago practices while also being associated with the Northwestern University School of Medicine. Dr. Brown is an associate of Minnesota Eye Consultants, a specialty care anterior segment practice in Minneapolis, Minn. She works with contact lens patients who have challenging corneas as well as pre-operative and post-operative patients. Dr. Resnick is a principle in the New York City-based contact lens specialty practice, Drs. Farkas, Kassalow, Resnick and Associates P.C. She's a Diplomate in Cornea and Contact Lenses, AAO, and is a frequent author and lecturer. She is a consultant or advisor to Vistakon, has received lecture or authorship honoraria from Alcon, Alden Optical, and Ciba Vision, and she has a licensing agreement with Safigel, Inc. Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and director, Emory Contact Lens Service. You can reach him at email@example.com. Dr. Louie is an assistant professor of ophthalmology at Casey Eye Institute, Oregon Health & Science University, Portland, Ore. A large portion of his practice is focused on providing contact lens services for patients who have challenging corneal topography.