Contact Lens Care & Compliance
GPC and GP Lens Care
By Michael A. Ward, MMSc, FAAO
A 61-year-old male GP lens wearer presented with complaints of excessive lens movement and clouding of his vision. He denied ocular itching, redness, and pain. He was currently wearing GP segmented bifocal contact lenses, which I had fitted approximately seven years prior. He had not returned for an ocular exam/contact lens evaluation in the last five years because he was "doing great." To care for his lenses he was using Boston Simplus (Bausch + Lomb), which he had switched to approximately one year ago.
The patient had a mild ptosis. Slit lamp evaluation of his superior tarsi revealed giant papillae along with thickening and injection of the palpebral conjunctiva (Figure 1), OD>OS.
Figure 1. Giant papillary conjunctivitis in a GP lens wearer.
Giant Papillary Conjunctivitis
Contact lens-associated giant papillary conjunctivitis (GPC) results from an immunologic reaction to the presence of a foreign body (lens) and the coating of the foreign body with tear proteins (lysozyme, lactoferrin, lipocalin, immunoglobulins), which may be denatured. Palpebral conjunctival thickening, redness, and excess mucous production may be present. Histopathologically, GPC patients exhibit one of the following abnormalities: mast cells in the conjunctival epithelium, and eosinophils and/or basophils in the epithelium or substantia propria. The frequency of GPC is greater and the onset and severity of clinical signs and symptoms are more pronounced among soft lens wearers than among rigid lens wearers.
Managing GP-Related GPC
The key to contact lens-associated GPC management is to keep the lenses clean. GP lenses attract denatured proteins, albeit to a lesser extent than soft lenses do. Lens deposits may adversely affect lens movement, comfort, and visual clarity as well as stimulate inflammatory cascades.
GP lens cleaners contain surfactants and/or solvents and abrasives. Solvent-type daily cleaners include Optimum Extra Strength Cleaner (Lobob Laboratories) and CVS Extra Strength Cleaner—its formulation mimics Miraflow (Ciba Vision), which is no longer available. Solvent-type cleaners are particularly good at removing oily films.
Abrasive daily cleaners include Boston Advance Cleaner (B+L) and Opti-Free Daily Cleaner (Alcon); such cleaners are best at removing harder protein and mineral deposits.
Initially manage GP-related GPC with lens discontinuation and topical anti-inflammatory medications. After clinical signs and symptoms have resolved, the following lens care regimen is recommended:
● Alternate use of Boston Advance Daily Cleaner (B+L) and Optimum Extra Strength Cleaner (Lobob) for daily lens cleaning.
● Disinfect lenses overnight in peroxide, either Oxysept (Abbott Medical Optics), or Clear Care (Ciba)
● Perform enzyme cleaning twice a week with either Ultrazyme [AMO] or Boston One Step Liquid Enzymatic Cleaner [B+L].
One-step multipurpose solutions such as Boston Simplus and Opti-Free GP (Alcon) are inadequate for keeping lenses clean for GPC patients. The surfactants in multipurpose solution products are necessarily mild because the solution goes directly onto the eye. The daily regimen of digital lens cleaning cannot be overstressed. In addition to his daily cleaning regimen, our patient will need to be followed monthly for a while, at which time we will use Progent (Menicon) to chemically clean his lenses in the office. CLS
Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. You can reach him at firstname.lastname@example.org.