When Peroxide Is the Best Solution
Panelists discuss the various types of patients who may benefit from using Clear Care Cleaning and Disinfecting Solution.
Arthur B. Epstein, OD, FAAO: Previously, we discussed the clinical benefits of hydrogen peroxide for contact lenses, specifically Clear Care solution (Alcon). We know Clear Care solution is safe and effective, with activity against bacterial1 and fungal2 biofilms, and it has low rates of corneal infiltrates and corneal staining.3-5 Let’s discuss how these benefits drive our lens care recommendations in clinical practice.
ALLERGIES AND EYE DRYNESS
Dr. Epstein: Dr. Townsend, you practice in Canyon, Texas, one of the most allergen-laden places in the universe. What do you recommend to your patients who are allergic or have sensitivities?
William D. Townsend, OD: I recommend Clear Care solution to those patients because of its cleaning and disinfecting efficacy. I also find that people who have allergies in general may be more likely to develop a sensitivity to the components in multipurpose solutions, so Clear Care solution is a good choice for them.
Dr. Epstein: Dr. Lievens, would you agree with Dr. Townsend’s recommendation?
Christopher W. Lievens, OD, MS: Absolutely. Clear Care solution isn’t just for patients with allergies. I tend to shift patients who have allergies and contact lens dryness to Clear Care solution, as well.
Dr. Epstein: Thanks, Dr. Lievens. Very interesting. What’s your rationale for recommending Clear Care solution for patients complaining of dryness symptoms?
Dr. Lievens: Clear Care solution’s surfactant Pluronic 17R4 provides benefits not seen in previous hydrogen peroxide systems. Pluronic 17R4 removes lipid and cholesterol deposits from the lenses,6 enhancing comfort and maintaining clear vision. I’ve found that clinically it can make a huge difference for these patients.
Dr. Epstein: Dr. Sindt, how important is the surfactant for a patient with contact lens dryness?
Christine W. Sindt, OD, FAAO: The drier a patient’s contact lens is, the more the surfactant matters. Typically, if a patient complains of contact lens-related dryness, I recommend a multipurpose solution that has a highly effective surfactant. I observe how the patient reacts to that before I switch him to a hydrogen peroxide system. It’s important to match the lens care solution to the patient’s needs.
Dr. Epstein: That’s a great point, Dr. Sindt. We sometimes forget that surfactants have intrinsic wetting properties. Perhaps more importantly, understanding how different lens care products work helps us ensure that we’re recommending the right product to best meet the patient’s needs. Dr. Brujic, I know you have a very successful contact lens practice. Do you have a usual protocol for lens care?
Mile Brujic, OD: Today’s multipurpose disinfecting solutions are so highly advanced that, for most patients, I initially recommend one of them. If a patient is sensitive to it or has ocular allergy symptoms, I recommend Clear Care solution.
Dr. Epstein: What is your rationale for recommending Clear Care solution for your allergy patients?
Dr. Brujic: When we look at contact lenses worn by someone with ocular allergy, we see the signs of these “active” eyes. The eyes are tearing and producing mucus, which tends to adhere to the lenses more readily. I find that Clear Care solution is ideal for keeping these contact lenses clean.
Dr. Epstein: Disinfection certainly is peroxide’s strong suit, but Clear Care solution also has a reputation for cleaning. Aside from the surfactant additives that aid in cleaning, do you consider peroxide an effective cleaning solution in and of itself, Dr. Brujic?
Dr. Brujic: Absolutely. That’s one of the reasons I recommend Clear Care solution for patients who have seasonal allergies and also for those who have giant papillary conjunctivitis (GPC) and can’t wear daily disposable lenses. Clear Care solution is a phenomenal choice for these patients. We know the disinfection efficacy is high, and when patients return for follow-up, their lenses are usually clean.
Dr. Epstein: That’s a great point. We don’t talk about GPC as much any more, but I remember when it was rampant. Peroxide was our go-to solution.
Dr. Brujic: With its high level of efficacy and low level of corneal staining, Clear Care solution is a product that I know will perform reliably.
Dr. Epstein: There has been noise about contact lens-related corneal infiltrates of late, so I’m going to open this question to all of you. If your patient has a history of corneal infiltrates and you’re concerned about recurrence, what do you recommend?
Loretta B. Szczotka-Flynn, OD, PhD, FAAO (Dipl): Infiltrates, which can occur regardless of the lens care product used, are usually caused by bacteria introduced by the patient.
Dr. Sindt: I’m more likely to recommend a peroxide-based system for these patients. A recent case-control study failed to find any significant association between peroxide use and infiltrates.8
Dr. Townsend: I’ve also found that patients who top off their solutions may develop corneal infiltrates. This is rarely a problem with patients who use a peroxide system, but it can happen.
Dr. Lievens: I believe many infiltrates are lid-disease related not at all solution-induced.
Dr. Epstein: I absolutely agree, Dr. Lievens. I think a large majority of patients are responding to the presence of Staph rather than this being caused directly by lenses or lens care products.
Switching gears: Are there other patients to whom you would routinely recommend a peroxide cleaning and disinfecting system?
Dr. Szczotka-Flynn: Clear Care solution is a great problem-solver in my practice. I recommend a significant number of therapeutic contact lenses, especially piggyback contact lenses, and because it’s approved for both GP and soft lenses, it’s an excellent choice for efficacy and convenience in these patients.
I also use Clear Care solution if I suspect a patient isn’t following good hygiene practices, if a patient has had an ocular contact lens complication in the past or if I’m concerned about high levels of contamination for any reason.
Dr. Epstein: Are there any patients for whom you would not recommend a peroxide system?
Dr. Szczotka-Flynn: I usually don’t recommend peroxide for occasional contact lens wearers, because the peroxide becomes neutralized to a nonpreserved state, and certain organisms may survive and grow over time. Those patients should use a multipurpose solution.
Dr. Epstein: That’s a great point and it should be emphasized that noncompliance is not limited to any one system or any one product.
MANY PATIENTS BENEFIT
Dr. Epstein: You’ve made it easy to sum things up into a few valuable clinical pearls. You have identified a number of specific patient types who are excellent candidates for Clear Care solution. Most notably, the patients who have ocular allergies, including contact lens dryness, will benefit from this highly effective hydrogen peroxide system. I think our colleagues will find your insights very helpful. Thank you for sharing them. CLS
Dr. Epstein is a consultant/advisor to Alcon, NiCox, Tear Science and Valeant Pharmaceuticals. He has received research support from Alcon. He is a lecturer for Alcon and VSP.
Dr. Brujic has been an advisor to Alcon, Allergan, Eyemaginations, NiCox, Transitions, TelScreen, VMaxVision and Vistakon. He has received reserach support from Alcon and VMaxVision. He has lectured for Allergan and Bausch + Lomb.
Dr. Lievens has received research funding from Alcon, Allergan, Eyegate and Merck. He has received lecture honoraria from Alcon, Transitions and Zeiss.
Dr. Sindt is a consultant/advisor to Alcon and Vistakon, and has received research support from Alcon.
Dr. Szczotka-Flynn She has received research support from Alcon, CooperVision and Vistakon.
Dr. Townsend is an advisor to Alcon, TearScience and Valeant. He has received research support from Odyssey and TearLab.
1. Szczotka-Flynn LB, Imamura Y, Chandra J, et al. Increased resistance of contact lens-related bacterial biofilms to antimicrobial activity of soft contact lens care solutions. Cornea 2009;28;918-926.
2. Retuerto MA, Szczotka-Flynn L, Ho D, Mukherjee P, Ghannoum MA, Efficacy of care solutions against contact lens-associated Fusarium biofilms. Optom Vis Sci 2012;89:382-391.
3. Diec J, Evans VE, Naduvilath TJ. Performance of Polyquad, PHMB and Peroxide Solutions With Silicone Hydrogel Lenses. Poster presented at: Annual Meeting of the Association for Research in Vision and Ophthalmology; May 7, 2009; Ft. Lauderdale, FL. E-abstract 5683/D942.
4. Carnt NA, Evans VE, Naduvilath TJ, et al. Contact lens-related adverse events and the silicone hydrogel lenses and daily wear care system used. Arch Ophthalmol 2009;127:1616-1623.
5. Diec J, Evans VE, Tilia D, Naduvilath T, Holden BA, Lazon de la Jara P. Comparison of ocular comfort, vision, and SICS during silicone hydrogel contact lens daily wear. Eye Contact Lens 2012;38:2-6.
6. Lorentz H, Heynen M, Tran H, Jones L. Using an in vitro model of lipid deposition to assess the efficiency of hydrogen peroxide solutions to remove lipid from various contact lens materials. Curr Eye Res 2012;37:777-786.
7. Keir N, Woods CA, Dumbleton K, Jones L. Clinical performance of different care systems with silicone hydrogel contact lenses. Cont Lens Anterior Eye 2010;33:189-195.
8. Chalmers RL, Keay L, McNally J, Kern J. Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates. Optom Vis Sci 2012;89:316-325.