a Case for Clean Cases
SUSAN J. GROMACKI, OD, MS, FAAO
One of the most overlooked components of good
contact lens care and essential for maintaining good corneal health
is a clean contact lens case. Even the most conscientious hand-washing, rubbing
and rinsing can't combat the pathogens that can grow in a dirty contact lens case.
In this article, I'll discuss what can happen when a contact
lens case isn't cleaned and replaced regularly. I'll also review an easy, five-step
process you can teach your patients.
Acanthamoebae are more prevalent when patients
do not adhere to lens care and storage instructions.
What's Growing There?
In a 1997 study of 141 new soft contact lens wearers, Lakkis and
colleagues1 reported 70%
of contact lens cases were contaminated by bacteria, fungi, yeasts or amoebae. As
you might expect, shorter lens wearing times and longer lens storage times did reduce
the percentage of contaminated cases. Meanwhile, in a separate study, Caroline and
Andre2 discovered that 42%
of contact lens cases cultured positively for bacteria alone.
bacteria that adhere to contact lens cases undergo a series of transformations,
one of which involves releasing an exopolysaccharide glycocalyx biofilm that protects
the bacteria and allows them to live off of one another. This in turn creates a
strain more resistant to lens disinfection products.
Using a fresh, new lens case is a surefire way to eliminate the
risk of microbial biofilms, which begin to develop within 1 week of the life of
the case.3 However, there's
another little-known issue with brand new cases.
New plastics actually absorb the preservatives in disinfecting
solutions, which hampers disinfection during the first few days of the life of the
case. The amount of lost disinfection depends on the solution and the case. The
plastic reaches a saturation point after about 7 days, and it's highly unlikely
disinfection rates ever dip below FDA-approved levels. Interestingly, because of
this absorption, the FDA regulates the types of plastics that can be used for solution
bottles but not for contact lens storage cases.
In general, lower density or softer plastic absorbs more. Therefore,
the effect is most pronounced with flat-pack cases the ones we buy in bulk
and hand out free to our patients. The phenomenon is so recognized throughout the
eyecare industry that some companies even pre-
cycle their cases before performing
After rinsing the contact lens case, it's important
to let it air dry with the lids open.
Some plastics also can absorb the color in custom-tinted lenses.
In fact, Crystal Reflections Inc. specifically warns against storing its red or
black-tinted lenses in flat-pack cases, as the flat-pack cases tend to draw out
some of the color. This warning does not apply to printed process lenses, such as
CIBA Vision's dot matrix lens, because the color becomes part of the monomer and
will not fade or leach.
Five Steps to Cleaner Cases
You and your staff should reinforce your lens care instructions
to patients at each visit. Emphasize the following good habits:
1. Always wash your hands
before applying or removing your
contact lenses, including when you open or close the lens storage case.
2. Discard used solution immediately after removing your lenses
from the case each day.
Rinse your lens case thoroughly, including the underside of the lids, with either
hot tap water or a disinfecting solution.
4. Air dry your case with the lids open.
5. Replace your lens case at least four times a year.
Antibacterial Case Coming Soon
Wouldn't it be great if the contact lens case instead of
being a source of contamination actually contributed to the lens disinfection
process? Well, help is on the way.
CIBA Vision has developed the Pro-Guard lens case with antibacterial
properties. The storage case, currently available as MicroBlock in Europe and Canada,
is made of polypropylene infused with silver, an inorganic antibacterial agent.
Pro-Guard has been clinically proven to reduce the incidence of
lens case contamination. The Pro-Guard lens case is FDA-approved and is expected
to debut in the United States later this year.
As a practitioner, you may have concerns about case contamination.
I've found the best way to monitor this is to ask your patient to bring his lens
case with him when he comes in for an examination so you can see firsthand what
the case looks like.
Never overlook the value of a clean contact lens case to limit
pathogenic growth and reduce the chance of microbial keratitis.
Just as you educate your patients on proper contact lens replacement
and disinfection, it's equally important to educate them about proper care of
their contact lens case.
Dr. Gromacki has served
as a faculty member at the University of Michigan Department of Ophthalmology and
1. Lakkis C, Harding AS, Brennan NA. Case contamination with
hydrogel lens wear. Clin Exper Optom. 1997:May-June;111.
2. Caroline PJ, Andre MP. Searching for an antimicrobial contact
lens case. CL Spectrum. 2005;20:56.
3. Smythe JL. The forgotten lens care step. CL Spectrum.
Contact Lens Spectrum, Issue: February 2006