contact lens care and compliance
GP Care: Some Common Myths
BY SUSAN J. GROMACKI, OD, MS, FAAO
My new technician desperately needed my assistance. She was performing a dispensing visit and needed to tell me something "important" before she sent the patient home. "He put his lens in his mouth!" she said. "Then he put it in his eye!" Her look of horror was priceless. I held back a grin, reassuring her I'd heard and seen this before. Longtime GP wearers are known for "unique" lens care habits developed during their polymethyl methacrylate (PMMA)-wearing days.
I asked her to educate him about the specifics of his care system and that saliva increases the risk for infection. But the patient had repeated this practice for 30 years with nary an eye infection. We were aware that he'd likely return to his lingual method of lens-wetting.
So, how serious is this and other noncompliant GP care habits and how can we educate our patients about their consequences? Let's review each misconception.
"I use baby shampoo or Windex for daily cleaning. It's cheaper and it works better than that stuff in the bottle." Using non-U.S. Food and Drug Administration (FDA)-approved liquids for cleaning lenses is hazardous, both to the eye and to the material. Any residue not completely rinsed from the lenses can be toxic to the anterior segment. It can also serve as a source for microorganism attachment and subsequent infection. Unlike PMMA, GP materials contain microscopic pores. A foreign solution can penetrate this matrix, causing changes to the lens structure. Windex, for example, will flatten the lens' base curve.
"I use my daily cleaner in the morning." This is much less effective than cleaning lenses upon removal. Deposits and surface debris loosen more easily if cleaned immediately after the lenses are removed. In addition, without having first removed any microbes with a digital cleaning step, the disinfecting solution has to work harder to penetrate debris and kill a comparatively increased load of pathogens.
A morning cleaning also eliminates enhanced wettability provided by an overnight soak. This may cause dry lenses and fogging. Patients assume this is due to dirty lenses and will repeatedly remove and reclean them, further prolonging surface drying.
"I keep my lenses extra clean by rinsing them with tap water prior to applying them in the morning." This completely negates the disinfection, not to mention the conditioning, provided by the overnight soak. Tap water contains pathogens, not the least of which is Acanthamoeba. The recent Acanthamoeba outbreak did, in fact, affect GP lens wearers. Prior to the outbreak, we told patients that rinsing cleaning solution from the lens with tap water was acceptable, as long as it was followed immediately by the recommended disinfecting soak. But now, with the exception of multipurpose GP solutions, an aerosol saline rinse is advised.
"I rub my lens between my thumb and forefinger to get it really clean." This cleans the lens unevenly and predisposes it to warpage and breakage. Advise patients to clean the anterior surface by placing the lens, convex down, in the palm of their opposite hand. Rub with the index finger in a linear motion, back and forth. Patients with a history of breakage should use their little finger. They may also place cleaning solution into the concave aspect of the lens, making a special effort to clean its posterior surface. If the patient still feels the lens isn't clean enough, he may use a cotton swab.
An Important Question
It's important to always ask your patients, "How do you clean your lenses from the time you start to the time you finish?" Their answers may surprise you. However, this will provide you with the opportunity to not only reinforce good compliance, but to also save your patient from a potential toxicity or infection. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #167.
Dr. Gromacki is a Diplomate in the Cornea and Contact Lens section of the American Academy of Optometry. She lives in West Point, New York.