contact lens care
Taking a Closer Look at Hydrogen Peroxide Products
In my last column, I discussed the characteristics of hydrogen peroxide disinfection and its mechanism of action. This month I will highlight the various products available at the present time.
Then and Now
Experienced practitioners remember the days of two-step hydrogen peroxide systems. Two separate bottles of solution were required: one H2O2 bottle to disinfect the lenses and the second to neutralize the H2O2, thus preventing peroxide keratitis.
All of today's systems are one-step; that is, the disinfection and neutralization (with either a catalytic disc or catalase tablet) occur simultaneously.
AOSept (CIBA Vision), the original one-step system, debuted in the United States in 1982. This three-bottle system combines a potent daily cleaner with H2O2 disinfection. MiraFlow, its isopropyl alcohol-based daily cleaner, emulsifies lipids as well as provides some disinfection. The third bottle, Softwear saline, is for rinsing off Miraflow before disinfection. Neutralization, performed with a platinum-coated plastic disc, takes six hours. Once disinfected, patients can safely store lenses for 30 days. Along with UltraCare, it provides the most thorough cleaning/disinfection available. Despite this, its market share is decreasing. One reason: CIBA no longer gives sample care kits to practitioners.
UltraCare (Advanced Medical Optics, 1986) is a three-bottle system: Lens Plus Daily Cleaner, Lens Plus Sterile Saline (to rinse off the daily cleaner) and hydrogen peroxide. An advantage to this system is the presence of a wetting agent (hydroxypropyl methylcellulose, HPMC) in the neutralization tablet. It is recommended that the lens not be rinsed prior to insertion to take advantage of the built-in lubricant. The catalase tablet also includes cyanocobalamin (vitamin B12), which creates a pink hue just before total neutralization (six hours) to indicate that the tablet was placed into the solution. Maximum storage time is seven days.
Clear Care (CIBA Vision, 2001) system combines a cleaner, Pluronic 17R4, and H2O2 in one bottle. With a five-second rinse, it's FDA-approved for no rub. It has a six-hour neutralization period and is approved for 30 days of storage. It's the only H2O2 system indicated by the FDA for silicone hydrogel lenses. Another advantage: samples are provided to practitioners.
Sauflon One-Step (Sauflon USA, January 2006) is the newest offering. A one-bottle peroxide system, Sauflon One-Step contains a built-in cleaner and has no-rub approval with a five-second per side (20 seconds total) rinse prior to disinfection.
It has two advantages. First, it's the only one-bottle H2O2 system with a rewetting agent, important for dry eye patients. Second, Sauflon is provided only to practitioners, not to retailers. This may improve patient brand loyalty and compliance, as well as provide income to the practice. Samples are banked, based on retail size purchases. Neutralization with the catalytic disc takes six hours; storage time shouldn't exceed 24 hours before re-disinfecting.
Dr. Gromacki is a Diplomate in Cornea and Contact Lenses in the American Academy of Optometry. She has a specialty contact lens and post-surgical co-management practice as part of a multi-subspecialty ophthalmology group in Ann Arbor, MI.