Contact Lens Care & Compliance
Resolving GP Surface-Wetting Problems CSI Style
By Michael A. Ward, MMSC, FAAO
A 61-year-old woman was referred for contact lens evaluation because her lenses were “cloudy in the bifocal part.” She also complained of general fogging that worsened as the day progressed.
The patient is an attorney and an avid tennis player. She wears crescent-segmented GP bifocal lenses, which had been fitted elsewhere about 18 months ago. She said the fogging problem began about a year ago.
She was using Boston Cleaner (Bausch + Lomb [B+L]) and Opti-Free GP Multi-Purpose Solution (Alcon) for disinfection. She was also using TheraTears Lubricant Eye Drops (Advanced Vision Research) four to five times per day and Latisse (bimatoprost ophthalmic solution 0.03%; Allergan) at night.
The patient's lenses were heavily coated and hydrophobic. I noted extensive makeup and debris in the tear film in addition to meibomian gland dysfunction (MGD). Contact lens-corrected vision was 20/20 OU at distance and J3 and J4 at near. Lens movement, centration, and seg positioning were good.
The patient's problem appeared to stem from environmental contamination of her lenses, most likely from eye area cosmetics and skin moisturizers. After cleaning her lenses with Progent (Menicon) in the office, the patient's near vision immediately improved to J1+.
The patient had been using a moisturizing bar soap and an eye makeup remover that contains mineral oil and cocoa butter. I explained that oil-based products have the potential to contaminate the hands, face, and lenses, causing cloudy lenses and fogging.
I instructed the patient to avoid oil-based cosmetics (discontinuing makeup was not an option), to switch from the oil-based cleanser to a commercial eyelid cleaner/lid scrub, and I cautioned her to keep makeup away from the lid margin. I also instructed her on proper eyelid hygiene and the use of hot compresses, and I emphasized the importance of thorough lens care.
The patient's new care regimen includes: Optimum by Lobob Extra Strength Cleaner (Lobob Laboratories Inc.), hydrogen peroxide disinfection with Clear Care (Alcon), and morning lens wetting with Boston Simplus Multi-Action Solution (B+L).
She returned three weeks later for follow up and reported good comfort and vision and resolution of the lens wetting issues.
These instructions worked well for this patient, but they may not work in all GP-coating situations. Troubleshooting such problems requires some detective work. We could call it “CSI Lens Care.” Other remedies may include:
• Avoid liquid soaps with lanolin, oils, and other moisturizers.
• Lid hygiene, hot compresses, diet (increase omega-3s and decrease omega-6s), and medications, if necessary, to treat MGD.
• Frequent use of preservativefree artificial tears to dilute the impact of tear debris; avoid the use of preserved tear products.
As a general rule, I do not prescribe multipurpose (MPS) GP care products without adding a daily cleaner. In my experience, MPS-GP products simply cannot clean lens surfaces as well as separate daily lens cleaners can.
For new lenses, laboratory cleaners such as Boston Laboratory Lens Cleaner (B+L) may be necessary to remove manufacturing residue. Plasma treatment along with wet shipment may increase surface wetting. Occasionally, however, a new lens just needs to be replaced because of manufacturing quality issues. CLS
|Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and director, Emory Contact Lens Service. He is also an advisor to B+L and Alcon. You can reach him at email@example.com.|