Hot off the Press: New In-Office Contact Lens Disinfection Guidelines
By Melissa Barnett, OD
The utilization of diagnostic (a.k.a. trial) scleral lenses is routine. Practitioners commonly apply one or multiple scleral lenses during a diagnostic fitting. These lenses must be disinfected prior to storage and use on another patient, and there is the possibility of transferring potential pathogens from one patient to another when reusing diagnostic contact lenses on multiple patients in practice. These pathogens may be introduced into the system from one patient to another or may be transferred by the practitioner or staff during handling and storage or both. Pathogens can cause acute or chronic infection that can lead to significant ocular morbidity (temporary or permanent), including vision loss.
New “Guidelines for Handling of Multi-Patient Contact Lenses in the Clinical Setting” were created by the American Optometric Association’s (AOA) Contact Lens & Cornea Section and The American Academy of Optometry (AAO) Section on Cornea, Contact Lenses and Refractive Technologies. Standards from the 2018 International Organization for Standardization (ISO) 19979:2018(E) were applied.1 Clinically, practical standardized guidelines are necessary to assist prescribers in minimizing the risk of conveying infection through multiuse diagnostic contact lens use and reuse.
In these guidelines, contact lenses are divided into three categories for disinfection purposes. Soft contact lenses (hydrogel) include silicone hydrogels and hydroxyethyl methacrylate (HEMA) hydrogels. GP contact lenses include corneal and scleral lenses. Hybrid contact lenses (composite) are composed of a GP center attached to an outer “skirt” made of a soft contact lens material.
The guidelines recommend that all contact lenses should be rubbed with a daily surfactant cleaner according to the manufacturer instructions. The aim of daily cleaners is to clean, not disinfect, contact lenses. The cleaner removes particulate matter, deposits, and debris from contact lenses, ensuring more effective disinfection. Practitioners should use the daily cleaner to carefully rub the contact lens as instructed. Products such as multipurpose or saline solution may be used for rinsing off the daily cleaner.
Following cleaning, the diagnostic lens should be visually inspected for any damage or defects. If damaged, the lens should be discarded. Otherwise, contact lens disinfection is performed.
For disinfection of GP or polymethylmethacrylate (PMMA) lenses, it is advised to use a commercially available hydrogen peroxide contact lens disinfecting solution currently approved for contact lenses. The 2018 ISO Standard recommends a three-hour soak in non-neutralized ophthalmic-grade 3% hydrogen peroxide. Lenses are then rinsed with sterile saline or multipurpose solution and stored dry. Tap and well water should be avoided at all times due to the potential of contamination with Acanthamoeba, which is found in most municipal drinking water supplies.
If manufacturer guidelines are not clear, practitioners should seek guidance from the manufacturer on the criteria for discarding the diagnostic lens. Information such as the number of times that a diagnostic lens can be reused and/or the expiration date of the diagnostic lens after first use can be obtained from the manufacturer. The intention of these guidelines is to reduce the transfer of potential pathogens when reusing diagnostic contact lenses on multiple patients in practice.
The author would like to thank Drs. Christine Sindt, Ed Bennett, Loretta Szczotka-Flynn, and Louise Sclafani for their contributions to this publication.
1. American Optometric Association’s (AOA) Contact Lens and Cornea Section and American Academy of Optometry (AAO) Section on Cornea, Contact Lenses & Refractive Technologies. Guidelines for Handling of Multi-Patient Contact Lenses in the Clinical Setting. 2019 Oct. In process for publication.
Dr. Barnett is a principal optometrist at the University of California Davis Eye Center in Sacramento, specializing in anterior segment disease and specialty contact lenses. She is the past president of the Scleral Lens Education Society. She is an advisor to and/or has received honoraria or travel expenses from AccuLens, Alcon, Alden Optical, Allergan, Bausch + Lomb, Bruder, Contamac, CooperVision, EveryDay Contacts, Johnson & Johnson Vision, Ocusoft, Paragon Bioteck, RaayonNova, ScienceBased Health, Shire, SynergEyes, and Visioneering Technologies.