Contact Lens Care & Compliance
Contact Lens Care & Compliance
No Lens Care, Period
BY MICHAEL A. WARD, MMSC, FAAO
The reason for this unusual title for a lens care column is to emphasize the “no care” necessity of daily disposable (DD) contact lens use. That’s right, no solutions and no case should be offered to patients fit in daily disposable lenses. Period.
Why is this simple concept important enough to bring up in a lens care column? I was recently asked, “If a patient were to reuse his daily disposable lenses, what solution would you recommend?” Following my initial expletive deleted reaction, we discussed the potential perils of reusing DD contact lenses.
DD lenses were first introduced in the mid 1990s. Their popularity has grown as perceptions regarding their cost, convenience, and safety have evolved, as have new technologies. Contact Lens Spectrum reported that DD lenses accounted for approximately 17 percent of U.S. contact lens fits and refits in 2012, and this modality has been the fastest growing segment of the market over the last two to three years (Nichols, 2013). The latest generation of DD silicone hydrogel lenses (e.g., 1-Day Acuvue TruEye [Vistakon], Dailies Total1 [Alcon], Biotrue Oneday [Bausch + Lomb], and MyDay [CooperVision]) offers high gas exchange, relatively high water content, and greater end-of-day comfort.
The Risk of Misuse
The downside to these new products is the propensity to reuse or to sleep in these comfortable new lenses. The thought of reusing DD lenses is anathema to the philosophy and benefits of daily disposability, and the considerable risks of microbial keratitis associated with overnight contact lens use are well understood.
The benefits of prescribing single-use lenses are many. DD lenses have the highest levels of compliance and patient satisfaction and the lowest rate of unscheduled clinic visits.
DD lenses are convenient and the safest choice for part-time or occasional contact lens wearers because their use removes the concerns for lens storage. The lack of care solution use eliminates the possibilities of solution-associated toxicity, hypersensitivity, and lens case contamination.
Disposing of the lens each day removes deposits and accumulated debris from the ocular environment. Even if a wearer’s hands were not pristine clean at the time of lens application, it is unlikely that microbes could grow during the short wearing time into a sufficient inoculum to overcome the eye’s defense mechanisms and cause an infection.
The only case of microbial keratitis that I’ve encountered with the use of daily disposables was in an orthopedic surgeon who was stretching them for two days at a time, storing the used lenses in the opened blister packs overnight. Boost et al (2011) found that 95 percent of once-used daily disposable lenses stored overnight in their opened blister packs were contaminated with bacteria.
For a practitioner to recommend reuse of daily disposable lenses is in violation of the FDA-approved package insert (e.g., “Lenses should be disposed of each day upon removal from the eye.”— Alcon package insert file # 92013817 I DAILTOT1), and likely carries other potential practitioner liabilities beyond putting patients at risk for adverse events. As I stated at the beginning of this column, no solutions and no case should be offered to patients fit in daily disposable lenses. Period. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #213.
Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. You can reach him at firstname.lastname@example.org.
Contact Lens Spectrum, Volume: 28 , Issue: August 2013, page(s): 23