lens case reports
A Sure-fire Way to Remove GP Protein Buildup
BY 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 lenses.
For 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 (Figure 1).
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 SynergEyes, Inc.