Article

CONTACT LENS CARE & COMPLIANCE

HYDROGEN PEROXIDE AND THE OCULAR SURFACE

Because vision and comfort with contact lenses are intertwined, having a pristine ocular surface may not only enhance lens comfort, vision may also improve. Rao and Simpson (2016) established that there is an association between clarity of vision and ocular comfort. Vision under blurred conditions for both spatial blur and dioptric defocus was graded significantly different (p < 0.001) from clear viewing conditions (Rao and Simpson, 2016).

Contact lens dropout is a highly prevalent condition, even with advanced contact lens materials. The rate of contact lens dropout ranges from 15% to more than 20% (Pritchard et al, 1999; Young et al, 2002; Richdale et al, 2007; Rumpakis, 2010).

If vision, comfort, or both are not optimal with the current contact lens modality, consider a solution change. Recommendations include eliminating the care system by changing to a daily disposable lens or changing the care solution or care system (Nichols et al, 2013).

Hydrogen Peroxide Solutions

Hydrogen peroxide (H2O2) systems are an option for reusable contact lens wearers because they are easy-to-use, safe, comfortable, and efficacious (Nichols et al, 2019). H2O2 produces free radicals that act as oxidizing agents, which destroy microorganismal cell membranes and essential cell components, exerting a biocidal effect (Lowe and Brennan, 1987). Alternatively, multipurpose solutions (MPSs) disturb the microorganismal cell membrane structure and cause leakage of intercellular components via electrostatic interaction (Sindt, 2013).

With appropriately neutralized solution, the release of H2O2 does not carry the same risks as MPSs. Any residual H2O2 in or on the contact lens is quickly metabolized on the ocular surface, without any ocular symptoms (Chalmers and McNally, 1988; Chalmers, 1989; Chalmers, 1995).

Studies have demonstrated that MPSs give rise to significant staining and that H2O2 solutions result in minimal corneal staining (Lazon de la Jara et al, 2013; Andrasko, 2008; Andrasko and Ryen, 2007; Jones et al, 2002; and others. Full list available at www.clspectrum.com/references .). This indicates that staining may demonstrate compromised corneal epithelial barrier integrity.

Furthermore, the amount of staining with H2O2 is similar to that with saline in all contact lens materials (Lazon de la Jara et al, 2013; Andrasko, 2008; Andrasko and Ryen, 2007). Significant corneal staining occurs with MPSs, mainly in U.S. Food and Drug Administration group V (silicone hydrogel, SiHy) and group II (high-water-content and neutral) materials (Lazon de la Jara et al, 2013; Andrasko, 2008; Andrasko and Ryen, 2007; Jones et al, 2002; and others).

Additionally, by analyzing corneal epithelial cells and confocal microscopy with SiHy lenses, there is less staining and shedding of corneal epithelial cells using a one-step H2O2 system compared to polyhexamethylene biguanide-containing MPSs (Gorbet et al, 2014).

Additionally, fewer corneal infiltrative events (CIEs) occur with one-step H2O2 solutions compared to MPSs (Carnt et al, 2009). In a retrospective chart review of soft lens wearers, there was almost a three times greater risk for CIEs with MPS use in comparison to H2O2 solutions (Chalmers et al, 2011).

According to the Centers for Disease Control and Prevention lens care guidelines, only 13% of those who used MPSs were compliant, compared to 100% of those who used H2O2 solutions (Woods and Jones, 2019). And, of 6,739 patients, those who used a one-step H2O2 system compared to MPS users were more likely to comply with a practitioner’s lens care brand recommendation (79% versus 34%), four times more likely to use fresh solution for daily disinfection, and seven times more likely to replace the lens case as advised (Guthrie et al, 2016). CLS

For references, please visit www.clspectrum.com/references and click on document #284.