A Clear Advantage
Learn why Clear Care Cleaning and Disinfecting Solution is the go-to peroxide system for these practitioners.
Arthur B. Epstein, OD, FAAO: As eyecare professionals, we know it’s imperative that we have a full complement of products to care for our patients. During this discussion, we’ve focused on our choices for contact lens care. We agree that most patients do well with a multipurpose solution, but in certain circumstances, only a hydrogen peroxide system will do — for patients with ocular sensitivities, such as allergy or dryness, for example — and our go-to peroxide system is Clear Care Cleaning and Disinfecting Solution (Alcon). I think it would be helpful to our colleagues if we discuss what differentiates Clear Care solution from other peroxide systems.
Dr. Epstein: One of the hottest topics in contact lens care is the issue of biofilms. We know that some microorganisms become effectively more virulent and resistant to disinfection by producing protective biofilms. Dr. Szczotka-Flynn, tell us about your work in this area.
Loretta B. Szczotka-Flynn, OD, PhD, FAAO (Dipl): After determining that all clinical and reference strains of Pseudomonas aeruginosa, Serratia marcescens and Staphylococcus aureus form biofilms on contact lenses, my colleagues and I evaluated disinfection efficacy on these biofilms using an in vitro model we developed.1 Compared to MPS systems — the only peroxide system tested, Clear Care — was effective against all three strains. In a similar fungal biofilm study, we also found that both peroxide systems tested were effective against biofilms from both Fusarium oxysporum and Fusarium solani.2 These results differ from those of the FDA-mandated planktonic testing performed on free-floating organisms. In those experiments, all disinfectants perform well, but when we look at resistant biofilms, we find distinct differences in efficacy inhibiting biofilm growth.
William D. Townsend, OD: That is groundbreaking work.
Dr. Epstein: Eventually, we’ll have standards that better reflect what we see in the clinical environment, but until then, it’s important to recognize these differences, because we deal with biofilm-forming organisms more often in practice.
Dr. Epstein: Peroxide has a strong reputation for cleaning. What is its mechanism of action when used for contact lenses?
Dr. Szczotka-Flynn: Peroxide breaks down the organic substrates and protein bonds.
Mile Brujic, OD: The excellent cleaning properties provided by Clear Care are one of the key reasons I choose it for patients who have ocular allergies or papillary hypertrophy if they don’t have a daily disposable lens option. Clear Care solution, which has an added surfactant, is a good choice for these patients. We know the disinfection efficacy is high, and we see the effects of its cleaning efficacy clinically when we examine worn lenses.
Christine W. Sindt, OD, FAAO: The surfactant cleaner, Pluronic 17R4, is an important differentiating factor between Clear Care solution and the other peroxide products, including store brands. Pluronic 17R4 reduces surface tension to help remove contaminants and maintain surface wettability.3
Christopher W. Lievens, OD, MS: I’ve found the wettability is a definite benefit for contact lens wearers who experience contact lens-related dryness.
Dr. Epstein: Dr. Sindt alluded to store-brand products, and I admit that patients using products I don’t specifically recommend is one of my pet peeves. Years of experience confirm that these patients often get less than they bargain for. Dr. Sindt, what are your concerns regarding store brands?
Dr. Sindt: We know store-brand products may say they are similar to branded products, but “inactive” ingredients may change how a product works and interacts with certain individuals.
Dr. Epstein: That’s an important point. There may be significant formulation differences that affect synergies between individual product components. This can make a huge difference in the performance of products that appear to be similar, and we’re dealing with the eyes, among the most sensitive and fragile tissues in the body.
Dr. Sindt: The purity of the peroxide is important.
Dr. Epstein: The key for practitioners is not to assume that our patients are using the specific products we recommended — especially today where store-brand packaging frequently mimics branded products. We need to consistently reinforce our preferences and make sure patients understand why a store-brand product is unacceptable.
Dr. Brujic: The best approach is to clearly define what we want patients to use. For a patient in whom peroxide is in his best interest, I utilize Clear Care solution as a first choice.
SAFETY AND SIMPLICITY
Dr. Epstein: The various hydrogen peroxide products use different neutralization strategies. Dr. Brujic, why do you prefer Clear Care solution’s platinum catalyst disc?
Dr. Brujic: In our clinics, we try to simplify things as much as possible for patients, and the platinum disc system is simple. Patients place their lenses in the cage, rinse with Clear Care solution for 5 seconds, fill the vial, place the cage in the vial, tighten the cap and store for 6 hours. They don’t have to worry about adding anything else to neutralize the solution.
Dr. Epstein: I agree. Simple also helps ensure compliance. Some other disinfecting systems use catalase tablets to neutralize the peroxide, which is an additional step.
Dr. Lievens: One of the benefits of the platinum-coated disc is that its neutralizing effect is consistent. Also, because the platinum disc is part of the case, patients don’t have to be concerned about running out of neutralizing agent.
Dr. Sindt: Another advantage of Clear Care solution’s platinum disc system is that patients receive a new case with each purchase, which eliminates worries about case hygiene.
Dr. Epstein: That’s a great point. It also minimizes the risk of biofilms and other contaminants collecting in the case.
Dr. Lievens: When we talk about hydrogen peroxide lens care, I think patients and practitioners are most concerned about neutralization, especially after hearing stories of patients who have accidentally put unneutralized hydrogen peroxide in their eyes. We have some science looking at residual peroxide levels in a platinum disc system.4,5 Clear Care solution has been formulated responsibly, so that the residual peroxide is less than 60 ppm, well below the threshold for ocular awareness.6
Dr. Epstein: Before we close, I’d like to mention two additional benefits that we often don’t think about. First, Clear Care solution is indicated for use with soft contact lenses and gas permeable lenses. However, with GP lenses, a digital rubbing step must be performed before the lenses are placed in the dome basket holder.
ESSENCE OF EMPOWERMENT
Dr. Epstein: When I speak at meetings, I start by telling the audience, “My hope is not only that you learn something today but that you take home something to communicate to your patients, because communicating knowledge is the essence of empowerment and really bonds patient and clinician.” I hope this roundtable provides insights that will help you better communicate with your patients, enabling them to better partner with you to ensure comfortable, healthy and safe contact lens wear. CLS
Dr. Epstein is a consultant/advisor to Alcon, NiCox, Tear Science and Valeant Pharmaceuticals. He has received research support from Alcon. He is a lecturer for Alcon and VSP.
Dr. Brujic has been an advisor to Alcon, Allergan, Eyemaginations, NiCox, Transitions, TelScreen, VMaxVision and Vistakon. He has received research support from Alcon and VMaxVision. He has lectured for Allergan and Bausch + Lomb.
Dr. Lievens has received research funding from Alcon, Allergan, Eyegate and Merck. He has received lecture honoraria from Alcon, Transitions and Zeiss.
Dr. Sindt is a consultant/advisor to Alcon and Vistakon, and has received research support from Alcon.
Dr. Szczotka-Flynn She has received research support from Alcon, CooperVision and Vistakon.
Dr. Townsend is an advisor to Alcon, TearScience and Valeant. He has received research support from Odyssey and TearLab.
1. Szczotka-Flynn LB, Imamura Y, Chandra J, et al. Increased resistance of contact lens-related bacterial biofilms to antimicrobial activity of soft contact lens care solutions. Cornea. 2009;28;918-926.
2. Retuerto MA, Szczotka-Flynn L, Ho D, Mukherjee P, Ghannoum MA, Efficacy of care solutions against contact lens-associated Fusarium biofilms. Optom Vis Sci. 2012;89:382-391.
3. Keir N, Woods CA, Dumbleton K, Jones L. Clinical performance of different care systems with silicone hydrogel contact lenses. Cont Lens Anterior Eye. 2010;33:189-195.
4. Kaplan EN, Gundel RE, Sosale A, Sack R. Residual hydrogen peroxide as a function of platinum disc age. CLAO. 1992;18:149-154.
5. Ngo W, Heynen M, et al. Impact of protein and lipid on neutralization times of hydrogen peroxide care regimens. Eye Contact Lens. 2009;35(6):282-6.
6. Paugh JR, Brennan NA, Efron N. Ocular response to hydrogen peroxide. Am J Optom Physiol Opt. 1988;65(2):91-98.