Specialty contact lenses (CLs) are great for treating a variety of patients (Harthan et al, 2017). While recent material advances have made specialty CLs safer than ever (Harthan et al, 2017), wearing them, especially scleral lenses, brings about additional considerations.
Caring for specialty CLs involves many of the same tasks as caring for soft CLs (e.g., good hand hygiene, following care system directions, reporting for regular eye exams, etc). However, there are three tips that are particularly important for specialty CL wearers that I like to discuss with my patients (Robertson and Cavanagh, 2011; Zimmerman and Marks, 2014).
1. Carry Care Products
I always tell my specialty CL wearers to carry their care products with them throughout the day. This is especially important for scleral lens wearers who experience midday fogging. The mechanism of midday fogging is currently unknown, but it may result from tear film components or a poor fitting scleral lens.
Midday fogging is typically treated by removing the lenses, cleaning them, and reapplyng them with fresh saline (Walker et al, 2016), a task that cannot be completed without having the proper tools on hand. Having care products handy could also be helpful for removing irritating dust or debris that is trapped under or on a specialty CL.
2. Discard Old Care Products
I always educate my patients that old care products could harbor potentially vision-threatening pathogens (Panthi et al, 2009; Wu et al, 2010). One study provided convincing evidence that using CL cases that were older than 6 months was a risk factor for developing microbial keratitis (Stapleton et al, 2012).
Although there is no firm timeline for discarding cases, the preponderance of the data suggests that wearers should do this at least every 3 months (Stapleton et al, 2012; Panthi et al, 2014). With that said, I generally tell my patients to replace their case every time they open a new care solution bottle. Similarly, there is evidence that CL application and removal devices can support microbial growth (Logan and Perrigin, 2017); therefore, I recommend to my patients that they should regularly clean their devices and replace them at least every 3 months.
3. Saline Choice Matters
I always educate my patients about the differences between tap water, preserved saline, and non-preserved saline. I highlight that tap water should be avoided while caring for CLs unless specifically indicated by the care system’s manufacturer, because tap water may contain unwanted pathogenic microorganisms (e.g., Acanthamoeba) (Vesaluoma et al, 1995; Choo et al, 2005). If the care regimen involves directly applying saline solution to the eyes (e.g., scleral lens wearers), I further educate patients that they should select nonpreserved saline over preserved saline because the preserved saline contains molecules that could lead to eye irritation (Sweeney et al, 1999; Pucker et al, 2016).
Don’t Let Them Forget
Convincing patients to maintain good care and compliance habits is a constant challenge, as CL complications are relatively rare (Davidson et al, 1980). Nevertheless, I believe that it is our duty to continually remind our patients about the importance of good CL care habits, especially those that they frequently fail to correctly complete. CLS
For references, please visit www.clspectrum.com/references and click on document #SE2017.