Great Chemistry versus No Rub: Education and Compliance
BY HARRY N. SNYDER, OD
Evidence of the complications of noncompliance with contact lens solutions reached a new height with the recent Fusarium keratitis outbreak this past year. This has been heightened by the more recent Acanthamoeba keratitis outbreak that is still under investigation by the Centers for Disease Control and Prevention. These events raise questions about our current standards and whether they are safe enough. The term "no-rub" that has prominently appeared on the packaging of many lens care solutions may have contributed to the confusion over what steps to take to achieve healthy contact lens wear.
No-rub Solution Complications
Before the development of multipurpose solutions, multi-step systems (clean, rinse, store/disinfect) were common to maintain eye health. Practitioners encouraged contact lens wearers to follow rubbing regimens to care for their lenses.
While the risk for these and other infections may be rare, other negative (and possible toxic) results can occur with no-rub solutions. These include inflamed eyelids, red/dry eyes, corneal irritation and conjunctivitis.
It remains necessary to instill in patients the need for proper contact lens care, especially with silicone hydrogel lenses. This material in particular is especially prone to greater lipid deposition, which needs rubbing for removal.
Pearls for Successful Lens Wear
I find it beneficial to prescribe the same lens care solution to all of my patients. This can eliminate one variable when evaluating contact lens success as well as help me identify whether a patient is having a solution-related problem or whether he's noncompliant.
It's especially important to reiterate proper lens care to patients who wear soft contact lenses. I educate and re-educate them on how to rub their lenses. For these patients, I treat the multipurpose solution regimen like any other prescription and provide the following step-by-step instructions:
- Wash and dry hands thoroughly with a non-lanolin based soap. Clean each lens in the palm of one hand using the appropriate solution, gently rubbing the lens with one finger of the other hand in a lateral (back-and-forth) motion for eight seconds. Then turn the lens over and repeat on the other side. I demonstrate this on patients' palms so they get a sense of how much finger pressure to put on the contact lens.
- Store lenses in a clean contact lens case with fresh solution for a minimum of four hours.
- The next day, give the lenses a gentle rub before applying.
I also advise patients to replace their lens case every one to two months because the case is commonly implicated in bacterial infections.
I find it useful in my practice to sell a one-year supply that includes both contact lenses and solution. This not only saves compliant patients money, but also takes patients out of the market, meaning less of a chance for them to purchase generic brands or other lens care solutions from store shelves. It also lessens the chance of patients switching solutions.
It's also important to keep in mind that not all contact lens care solutions are the same. Different solutions have unique properties to hydrate, moisturize and disinfect contact lenses. Recognizing these differences and paying attention to how certain care solutions interact with certain lens materials is critical to helping your patients achieve healthy contact lens wear. CLS
Dr. Snyder is the founding partner of Northern Virginia Doctors of Optometry where he has practiced for more than 30 years. He has served as a clinical investigator in contact lens studies and his specialties include contact lenses and difficult-to-fit contact lens patients, geriatrics, low vision and the comanagement of laser vision correction.