CONTACT LENS CARE & COMPLIANCE
MAINTAINING COMFORTABLE GP LENS WEAR
MICHAEL A. WARD, MMSC, FAAO
Crisp vision and good comfort with GP lenses are intimately associated with clean and smooth lens surfaces. As part of Contact Lens Spectrum’s GP lens issue, I offer the following points to maximize success with GP lenses.
• Always wash hands before handling contact lenses. Use mild, basic soap, and avoid antibacterial, deodorant, fragranced, or moisturizing liquid soaps; many liquid soaps have moisturizers that can contaminate your lenses during handling.
• Digital cleaning (rub and rinse) is a must to maintain good comfort and vision. Inadequate surface cleaning results in irregular, hydrophobic surfaces that attract debris, creating a debris-attachment cycle that further decreases vision and comfort and limits wearing time.
• Abrasive cleaners with strong surfactants are especially good at removing attached proteins. Non-abrasive, solvent-type cleaners are good at removing oils and organics. Thorough rinsing is necessary after using daily cleaners and before disinfection to prevent ocular irritation.
• Extra-strength daily cleaners are exceedingly good at removing oils and makeup from both soft and GP lens surfaces.
• Hydrogen peroxide disinfection works well to mitigate protein buildup on GP lenses. Never store a spare set of contact lenses with neutralized solution in these vials due to lack of preservation.
• Other stronger cleaners are only available in a practitioner’s office and/or recommended for use on a less frequent basis (e.g., biweekly). These are often very effective at removing manufacturing residues on new GP lenses.
• Scleral lenses up to ~16.5mm may be treated with a stronger cleaner by utilizing a case intended for large-diameter sclerals. However, be sure to remove the platinum disc from the lens holder before cleaning the lenses.
• Proteolytic enzymes may be used to treat GP lenses. Papain is no longer available, but pancreatin and Subtilisin A are available in liquid form that may be added to GP storage solutions. Be sure to rinse after use.
• Plasma treatment is a very effective cleaning method to remove any remaining residues, such as oils and waxes, that result from the manufacturing process. Benefits of plasma treatment are lost if lenses become dry (statically charged). Even when lenses are kept wet, the surface effect will eventually wear off.
• When fitting piggyback lenses (GP lenses over soft lenses in a tandem fashion), it is very important that GP lens solutions do not come into contact with the soft lenses. To avoid this, use GP lens cleaner on GPs only, and then rinse and store the GP lens in soft lens disinfecting solution. Only use soft lens care products to wet GP lenses when placing them onto a soft lens.
• Scleral lenses are just large GP lenses. Therefore, any approved GP lens care product may theoretically be used to clean, store, and disinfect scleral lenses. However, the fluid placed into the lens reservoir during application onto the eye should only be isotonic, nonpreserved, sterile saline. We use only unit-dose, nonpreserved, sterile saline. To clean scleral lenses, simply use a GP daily cleaner. Then, rinse thoroughly and disinfect overnight with a peroxide-based product. Finally, rinse and fill the lenses in the morning using a unit-dose saline ampule.
• GP lenses (diagnostic lenses as well as a patient’s spare GPs) should be stored dry for long-term storage. Use daily cleaner and disinfect prior to reuse.
• All lens storage cases should be emptied, rinsed, wiped, and air-dried between uses. 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 email@example.com.