Finding the Right Solution for Sensitive Patients
BY MARJORIE J. RAH, OD, PHD
Recently, a 55-year-old female and longtime GP contact lens wearer visited our practice complaining of lens discomfort. The discomfort was noticeable in both eyes, but was more pronounced in the left eye.
The patient wore her lenses an average of 12 hours per day. Table 1 details her original lens parameters.
Slit lamp examination was unremarkable in each eye. With fluorescein evaluation, both lenses were lid attached and significantly superiorly decentered with light central touch. Overall, both lenses appeared to show flat fitting relationships to the corneas. We ordered new lenses with the parameters in Table 2.
Two weeks after dispensing the new lenses, the patient returned for follow-up complaining of difficulty removing the lenses. She reported symptoms of slight irritation and a gritty feeling during the day. Rewetting drops hadn't made a noticeable difference.
The patient wore her lenses an average of eight to 10 hours per day and was still using her same care system. She didn't experience similar symptoms while wearing her spectacles.
Visual acuity with the lenses remained 20/20 in each eye with a plano over-refraction. Slit lamp examination was unremarkable with the exception of trace punctate stain in the right eye. The fluorescein pattern of each lens was closer to alignment centrally.
Although still lid attached, both lenses were better centered over the pupil on each eye. Because the fit appeared acceptable but she was still experiencing symptoms, we recommended a change in her care system. We advised her to use Clear Care (CIBA Vision) and unpreserved saline.
When the patient returned a week later she reported significant improvement in symptoms after changing care products.
A Similar Incident
Perhaps this isn't the most exciting case report of the year, but about two weeks after seeing that patient, we saw another patient who had been a soft lens wearer and wanted to try multifocal lenses. Due to her astigmatism, we selected a GP design.
When we applied the lenses to her eyes, she experienced sensitivity to the GP lens solution. It was of a much greater magnitude than the previous patient and she nearly decided to discontinue lens wear as a result. Upon resolution of this event, she resumed GP lens wear with Clear Care as her care system.
Benefits for GP Wearers
These cases demonstrate the benefit of using Clear Care as a viable alternative for GP contact lens care. As a hydrogen peroxide-based system, it's also preservative free and is therefore a good choice for patients who have solution hypersensitivities.
Many soft contact lens patients use the Clear Care system, but it's underutilized as a GP care system. CLS
Dr. Rah is an assistant professor at the New England College of Optometry where she works primarily in the Cornea and Contact Lens Service in patient care, teaching and research.