Contact Lens Care & Compliance
Maximizing Multipurpose Solutions
BY ANDREW D. PUCKER, OD, MS, FAAO
Each day, patients assault their soft contact lenses with a variety of contaminates that can include dirt, makeup, and/or microbes. In addition, with daily lens use, tear biomolecules (e.g., proteins and lipids) are deposited onto contact lenses (Butcko et al, 2007; Cho et al, 2009; Cheung et al, 2014). Deposits are a significant concern because they may promote ocular disease (e.g., papillary conjunctivitis), and they may result in reduced visual acuity as well as ocular discomfort (Brennan and Coles, 2000).
The majority of patients (74%) combat deposits and microbes by cleaning their contact lenses with multipurpose (chemical) lens care solutions (Nichols, 2015). Multipurpose solutions are designed to reduce harmful pathogens and are also intended to remove unwanted deposits and debris (Cho et al, 2009). Multipurpose solution care regimens have traditionally consisted of rub, rinse, and soak steps that are intended to occur directly after lens removal (Cho et al, 2009).
Nevertheless, many modern multipurpose solutions have been approved as “no rub” solutions, a change that manufacturers have made in an attempt to make contact lens care easier and to increase patient compliance (Cho et al, 2009). Patients also commonly practice “no rub” by simply neglecting to complete these steps.
Rubbing and Rinsing Facts
While “no rub” multipurpose solutions can effectively clean contact lenses (Rosenthal et al, 2003), the following evidence suggests that rubbing and rinsing lenses can greatly improve the overall effectiveness of these cleaners:
• Proper lens rinsing results in greater protein removal compared to not rinsing lenses (Pucker and Nichols, 2009).
• A short rinse step (2mL) is much less effective at removing microorganisms compared to longer (7.5mL and 12.5mL) rinse steps (Rosenthal et al, 2003).
• Rubbing can more effectively reduce contact lens deposits (makeup, protein, hand cream, lipids) compared to not rubbing (Cho et al, 2009; Tam et al, 2014).
• The highest number of surviving microbes (e.g., bacteria, fungi, and Acanthamoeba) were found when lenses were cleaned without a rub or rinse step; rinsing decreased the amount of microbes, while rubbing and rinsing further decreased the number of microbes (Kilvington and Lonnen, 2009; Zhu et al, 2011).
• Some multipurpose solutions are less effective at cleaning contact lenses dirtied with “organic soil” (Rosenthal et al, 2003).
• Deposits (proteins or lipids) are associated with increased clinical signs (e.g., solution-induced corneal staining) and reduced ocular comfort (Brennan and Coles, 2000; Zhao et al, 2010).
Reinforce Rubbing and Rinsing
Anyone can gloss over directions when it comes to mundane tasks; therefore, I urge you to personally educate your patients about the importance of both rubbing and rinsing their contact lenses. I also urge you to look for deposits during contact lens evaluations; excess deposits might be a sign of noncompliance. If noticed, ask your patients about their contact lens cleaning habits. When patients indicate that they have not been rubbing or rinsing, educate them that these extra steps could result in healthier eyes. You may also want to provide a handout on healthy contact lens habits so they have your instructions in writing.
For patients who have been rubbing and rinsing, consider switching to a different lens material, as deposit amounts are known to be material dependent (Pucker et al, 2010). CLS
For references, please visit www.clspectrum.com/references and click on document #242.
Dr. Pucker earned his OD and MS degrees from The Ohio State University. He is currently a senior research associate at The Ohio State University. He has also received research funding from Johnson & Johnson Vision Care. You can reach him at firstname.lastname@example.org.