Contact Lens Care & Compliance
Oily Contamination on GPs
BY MICHAEL A. WARD, MMSC, FAAO
A 61-year-old male presented with complaints of blurred vision in both eyes, which had started approximately two months earlier. He has successfully worn corneal GP lenses for many years. He described his vision as intermittently foggy, but sometimes he can “see around it.” Some days are better or worse, but the quality of his vision is generally deteriorating. He reports his uncorrected and spectacle-corrected vision upon waking to be unchanged, but he has keratoconus, so these comparisons have limited value. He wears his contact lenses most waking hours. His current lenses are two years old. He denies any pain, redness, or discharge.
His vision with contact lenses is 20/50-2 OD and 20/40-2 OS, which pinholed to 20/25+ OU. His lens-corrected visual acuities at his last visit five months prior were 20/25-1 OD and 20/20-2 OS. He has not changed his lens care products or routine and does not use eye drops. Slit lamp evaluation revealed a smeary and hydrophobic surface on his contact lenses. Upon further observation, his facial skin was noted to have an oily sheen. When asked, he stated that he is now wearing sunscreen everyday, which started about two months ago.
A simple clean and polish of his lenses resolved the issue immediately. I changed his lens care regimen from a two-part GP lens cleaner/conditioner to include a stronger lipolytic solvent along with daily peroxide disinfection.
Lens Care Suggestions
Environmental contamination of the skin and tear film from cosmetics, moisturizers, and lotions can be a problem for contact lens wearers. Below are some GP lens care suggestions (Ward, 2013; Ward, 2012).
• Always wash hands before handling contact lenses. Use mild, basic soap and avoid antibacterial, deodorant, scented, or moisturizing liquid soaps.
• Surface cleaning/debulking with digital rub and rinse is necessary for good comfort and vision. Inadequate surface cleaning results in irregular, hydrophobic surfaces that may create a debris attachment cycle, further leading to decreased vision, comfort, and wearing time.
• Do not apply oil-based moisturizers to the eyelids. Oils can spread along the skin and contaminate the tear film.
• Do not apply any makeup to the eyelid margin (shelf). This will contaminate the tear film.
• Abrasive cleaners are especially good at removing attached proteins. Non-abrasive, solvent-type cleaners are good at removing oils and organics.
• Alcohol-based extra strength daily cleaners are especially good at removing oils and makeup from soft and rigid lens surfaces. These are generic formulations of Ciba Vision’s original MiraFlow Extra Strength Daily Cleaner. They each contain isopropanol 15.7% with amphoteric 10 and poloxamer 407. The Miraflow brand name was purchased and is now attributed to one of the generic formulations. Other equivalents include Sereine Extra Strength Daily Cleaner (Optikem International), Sof/Pro2 (Lobob Laboratories), and Lens Fresh (Orion Vision Group).
• Hydrogen peroxide disinfection works well to mitigate protein buildup on GP contact lenses. Do not store a spare set of lenses in these vials due to lack of preservation.
• Boston Laboratory Lens Cleaner (Bausch + Lomb [B+L]) and Progent (Menicon) are very effective at removing manufacturing residues on new GP lenses.
• Proteolytic enzymes (e.g., Opti-Free SupraClens, Alcon; Boston One Step Liquid Enzymatic Cleaner, B+L) may be used to treat GP lenses. These are both in a liquid form that may be added directly to GP storage solutions.
• All lens storage cases should be emptied, rinsed, wiped, and air-dried between uses and replaced at least every three months. CLS
For references, please visit www.clspectrum.com/references and click on document #227.
Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. He is also a consultant or advisor to Alcon and B+L. You can reach him at email@example.com.