Check GP Lenses Before Treating Patients for Dry Eye
BY ANN LAURENZI-JONES, OD, FAAO
A 54-year-old female was recently referred to our contact lens clinic for a contact lens evaluation. She had worn GP lenses for several decades and reported that she was currently being treated for dry eye that developed in the past year. Her symptoms included irritation, burning, foreign body sensation, and redness. She had initially used artificial tears, then was placed on Restasis (Allergan) for the past six months with no improvement in her condition. She noted that her visual acuity seemed to be reduced and thought that it may be related to the dry eye. Her distance visual acuities were 20/25(-) OD and 20/30 OS.
Slit lamp evaluation showed that her lashes were clear of debris. The meibomian glands were normal, but the margins were moderately hyperemic. Her bul-bar conjunctiva showed 1+ injection OD and OS. The GP lenses were well-centered and moved well with the blink.
However, the lenses were severely coated with what appeared to be protein, more so in the periphery but also centrally. The lenses were two years old, and the patient reported that she wore them from the time she woke up until she went to bed.
Cleaning the Lenses
The patient removed the lenses, and I performed an in-office cleaning with Progent Protein Remover (Menicon), an intensive cleaning system for removing protein deposits. Progent contains two different solutions: Ampule A contains 5mL of sodium hypochlorite while Ampule B contains 5mL of potassium bromide. The two are mixed together in a receptacle where the lenses are suspended in solution for 30 minutes for maximum cleaning and disinfection. (Soaking the lenses for more than 30 minutes reportedly may discolor them, although I have never experienced this.) No abrasive cleaners, digital cleaning, or polishing are necessary, which is great for high-Dk and hyper-Dk materials. Progent is approved for use with all GP materials.
Examination of the patient's lenses post-soaking revealed that they were clear and free of the protein deposits. I cleaned and rinsed the lenses and returned them to the patient for trial. She noted an immediate improvement in comfort, and the visual acuity improved to 20/20(-) OU.
Progent is an excellent protein remover with potent disinfection properties that have successfully passed all U.S. FDA test standards. It has bactericidal and virucidal efficacy and is also effective against Acanthamoeba in both the trophozoite and cystic forms. You can obtain Progent from any U.S. lab that distributes Menicon products. Currently in the United States Progent is available for professional in-office use only, so you may need to set up a maintenance program for patients who are heavy protein depositors. A quarterly or monthly cleaning can keep patients comfortable and their lenses free of deposits.
At the two-week follow-up visit, my patient noted a dramatic improvement in comfort and a return to clear vision. Her “dry eye” symptoms were also greatly improved. In this particular case, the deposits on the contact lenses were the real source of her ocular irritation. Proper cleaning and maintenance of her lenses will keep her free of irritation. CLS
Dr. Laurenzi-Jones currently has a staff position at NorthShore University Hospital in Glenbrook, Illinois.