lens case reports
A Sure-fire Way to Remove GP Protein Buildup
PATRICK J. CAROLINE, FAAO, & MARK P. ANDRé, FAAO
After 50 years of combined clinical practice,
you'd think we could say that we've seen it all. However, one of the greatest joys
of clinical practice is the fact that every day presents previously unseen scenarios. We find ourselves constantly
repeating the immortal words of medicine: "Wow! We've never seen that before, but
here's how we're going to treat it."
Figure 1. The patient's Paragon CRT lens
surfaces before and after a single Progent cleaning.
What We'd Never Seen Before
One such case was that of an 18-year-old female student whom we
fit with Paragon CRT lenses. At the time of dispensing the patient was a –3.50D
myope. Within a week after initiating overnight lens wear, she was 20/20 uncorrected
throughout all her waking hours.
The patient was then lost to follow-up and reappeared back in
our practice two years later with chief complaints of decreased lens comfort and
a loss of her corneal reshaping effect. Despite her symptoms, she'd continued to
wear the lenses every night. Her uncorrected VAs at 2:00 pm were OD 20/40 and OS
20/30. Her corneas were clear and free of any staining, and her corneal maps showed
a significant loss of the corneal reshaping effect.
The patient reported that she was using the lens care regimen
we had suggested, the Alcon Unique pH solution. Examination of her CRT lenses clearly
revealed the problem in the form of a 4+ protein coating on the surfaces of both
years we've identified lens coatings as a major contributor to late onset loss of
corneal reshaping effect. To manage this, we generally suggest daily use of the
Alcon SupraClens liquid enzyme and/or periodic in-office treatment with the Progent
cleaner (Menicon Co., Ltd.) to rejuvenate the surfaces of these complex lens shapes.
We felt that this case presented the perfect opportunity to challenge the Progent
cleaner against the worst coated GP lenses we'd ever seen.
Seeing is Believing
Our experiment started by combining the two Progent solutions,
Progent A that contains sodium hypochlorite and Progent B that contains potassium
bromide. We then placed the patient's lenses into the solution for 30 minutes. What
emerged after a single cleaning astonished even us: Two perfectly rejuvenated lenses
We reinstructed the patient on proper lens care and handling techniques
and dispensed the Alcon SupraClens for daily enzyme cleaning. The patient wore the
cleaned lenses for two nights and her corneal reshaping effect returned to its previous
20/20 uncorrected VA throughout all her waking hours.
This case clearly illustrates something that we've known for a
number of years that the Menicon Progent cleaning system works extremely
well. Please note that because of the toxic nature of the solutions, the system
is currently for in-office use only and is not for use with soft contact lenses.
Patrick Caroline is an associate
professor of optometry at Pacific University and is an assistant professor of ophthalmology
at the Oregon Health Sciences University. He is also a consultant to Paragon Vision
Sciences and SynergEyes, Inc. Mark André is an associate professor of optometry
at Pacific University. He is also a consultant for Alcon Labs, CooperVision and
Contact Lens Spectrum, Issue: August 2006