Article

ONLINE PHOTO DIAGNOSIS

By LUCIANO BASTOS

GP Lens Care, Maintenance, and Compliance

This image shows a GP lens fitted in June 2018 that has not been properly maintained. This patient has mild-to-moderate myopia and astigmatism. She has worn GPs since 1990 and has been refit with new GPs every two years, but this was the first time that she has encountered problems with her lenses. She reported blurry vision.

Our first guess was that there was a technical problem with her lenses, maybe from cutting or polishing them or even with the material. However, we had not experienced issues like this in other patients wearing lenses of the same material.

We could not imagine that the patient, as a long-term GP lens wearer, was not complying with proper care, cleaning, and maintenance of her new lenses.1 But, we asked her whether she had changed the multipurpose solution and whether she was cleaning the lenses after removal. It was a surprise to learn that, for some unknown reason, she was not cleaning her lenses after removal. She wears her lenses for 15 to 16 hours a day and reported that she was only cleaning them in the morning prior to application.

We always instruct patients to clean their GPs and sclerals immediately after removal, as this helps prevent mucin deposits from the tear film on the lens surface. This patient applies mascara and eye liner daily. In her case, she was not only failing to prevent the mucin deposits, she was also leaving makeup residue on the lens surface.

Management of the Case

The lenses were sent to the lab manufacturer for a mechanical and chemical cleaning. We received them clean and crystal clear. Figure 2 shows the same lenses after a proper cleaning by the lab.

Figure 2. GP fluorescein patterns after a proper cleaning.

We reviewed the cleaning and maintenance of GP lenses with the patient. We were sure that the problem was caused by failure to perform proper lens care aggravated by heavy use of makeup.

The care regimen that we recommended included the following steps.

After removal:

  • Wash and dry both hands.
  • Remove the lenses.
  • Apply diluted neutral-pH liquid soap on the lens.
  • Rub the lens in the palm of the contralateral hand.
  • Rinse the lens with nonpreserved saline solution.
  • Repeat the rub process with the multipurpose GP solution.
  • Store the lens in the clean GP case.

Prior to application:

  • Wash and dry both hands.
  • Inspect the lens for any dirt or defects on the lens surface and for any edge damage.
  • Clean and disinfect the lenses using the GP multipurpose solution.
  • Apply the lenses.

Conclusion

In this case, we identified the problem after reviewing the lens care regimen with the patient. It was not clear why the patient failed to perform the correct care. We suspect that she simply did not think that it could lead to blurry vision.

It is important to always provide verbal and written instructions to patients prior to contact lens dispensing. We also have a strict rule of only dispensing lenses to first-time patients after providing training on contact lens maintenance, application, and removal.

Another important aspect is that no matter how much experience patients have with contact lens wear, we need to ask them how they are cleaning and disinfecting their lenses. We also recommend that patients come in for follow up annually or at least every 18 months even if there is no problem with lens wear. We alert patients that prevention follow ups are much safer compared to corrective follow ups.

Practitioners and technicians3 should make every effort to protect their patients by giving them clear instructions and proper training. This ensures that we are providing contact lens patients the best possible visual acuity and ocular health.

References

  1. Moorfields Eye Hospital NHS Foundation Trust. Care of your rigid gas permeable contact lenses. Available at https://www.moorfields.nhs.uk/sites/default/files/%28final%29-rgp-contact-lenses.pdf . Accessed on Oct. 3, 2018.
  2. Ward MA. Contact Lens Care & Compliance – GP Contact Lens Care Pearls. Contact Lens Spectrum. 2012 Oct;27:23. Available at https://www.clspectrum.com/issues/2012/october-2012/contact-lens-care-compliance . Accessed on Oct. 3, 2018.
  3. Gas Permeable Lens Institute. Staff Training Materials. Available at https://www.gpli.info/staff-training . Accessed on Oct. 3, 2018.

Luciano Bastos is the director and clinical instructor of specialty contact lenses at the Instituto de Olhos Dr. Saul Bastos (IOSB) and is the director and specialty lens consultant of Ultralentes, a small laboratory specializing in GP and scleral lens designs in Porto Alegre, RS, Brazil.