The presentation I have made and uploaded provides you with an in-depth insight into the care and maintenance aspects of soft contact lens wear and use. The author does not assume responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. No copyright infringement, or plagiarism intended. Amrit Pokharel

1. Amrit Pokharel

2. Outline of the presentation
 Why care for contact lenses?
 Deposit and types
 Lens care regimen
 Components of lens care solution
 Functions
 Steps in lens care and maintenance
 Types of disinfectants
 Do-s and Don‟t-s

3. Purpose of Care and
Maintenance
 Failure to prescribe proper lens care regimen
 Failure of compliance
 Reduced comfort
 Reduced vision
 Increased risk of contamination---complications/
infections
 Dissatisfied patients
 Coverging to Failure of CL wear

4. Outline of the presentation
 .
 Deposits and Types
 .
.
.
.
.
.

5. Deposits and Types
 “…Any lens surface coating or matrix
formation which is not flushed or rinsed from a
lens by tears during blinking”
 Types of deposits:
 External
 Eye make-up, air pollutants, etc.
 Internal
 Tear components-protein, lipid, mucin, etc

6. Contact lens Deposits
 How do deposits form on contact lens surface?
 Interaction between lens and content of tears
 Evaporation of tears leaves residue on lens
 Lens chemistry attracts tear film constituents( proteins,
lipids, mucin, calcium)

7. How do protein deposits get
denatured?

8. Lipid deposits

9. Jelly
Bumps

11. Purpose of Care and
maintenance
 Clean lenses:
 To prevent/minimize deposits
 To maintain hydration and wettability
 To provide comfort and clear vision
 To prevent or reduce the risk of ocular
infection/inflammation

12. Deposit complications
 Reduced visual acuity
 Lens dryness- proteins repel water and the
lens may dry up more easily
 Irritation and reduced comfort shortened
wear time
 Cause allergic response
 Micro-organism‟s attachment to deposits may
cause eye infection

14. Outline of the presentation
 .
 .
 .Lens care regimen
 Components of lens care solution
 Functions
 Steps in lens care and maintenance
 Types of disinfectants
 Do-s and Don‟t-s

17. Components of Care and
Maintenance
 Daily cleaner
 Rinsing solution
 Disinfecting solution
 Protein removers
 Lubricating/rewetting
solution
 Lens storage case

18. Compliance Vs Non-
Compliance
 Simple system and Instruction
 Bettercompliance
 Easy convenient
 Complicated System
Confusion
Non-compliance
Lens wear complications

19. Essential Steps of Care and
Maintenance
 Cleaning
 Rinsing
 Disinfecting
 Extra Steps
 Protein Removal
 Lubricating/Rewetting

20. Daily cleaning and/or
rinsing removes majority
of Micro-organisms

21. Essential Steps of Care and
Maintenance
 Cleaning
 .
 .
 .

22. Daily cleaner- Functions
 To remove
 Loosely bound foreign matter
 Cell
debris
 Mucus, lipid , protein
 Cosmetic or other surface contamination
 Majority of micro-organisms

23. Daily cleaner Composition
 Surfactants
 Buffers
 Osmolality adjusting agents
 Preservatives
 Water

24. Surfactant Cleaners
 Remove deposits by
 Interactingwith deposits
 Displacing deposits from lens surface
 Emulsify oils and lipids
 Destroy/dislodge micro-organisms
 Prepare lens for rinsing and disinfection

25. Daily cleaner procedures
 Wash the hand
 Place the lens in the palm of the hand
 Place 2-3 drops of cleaner on each lens
surface
 Rub with forefinger for about 10-15 sec per
side using to and fro and circular action
 Rolling the fore-finger in both directions
 Clean lens periphery
 Rinse well

26. Daily Lens Care Procedure

27. Hand washing
 Reduced bio-burden
 With water-based
soaps
 Often forgotten step

28. Rubbing the lens
 10-15 sec on each
side
 To and fro action
 Removal of
environmental and
protein deposits
 Reduces risks of
infection

29. Consumer‟s perception of No
Rub
 Simply put the lens into the case after removal
 No digital cleaning, No rinsing
 Simple, carefree, convenient lens care
 Reduced usage of lens care solution

30. Essential steps of Care and
Maintenance
 .
 Rinsing
 .
 .

31. Rinsing
 Wash off loosened
debris
 Decrease risk of
deposit related
problems

32. Essential steps of Care and
Maintenance
 .
 .
 Disinfecting
 .

33. Disinfecting system
 Kill or Deactivate potentially pathogenic
organisms including
 Bacteria
 Fungi
 Viruses
 Amoebae
 Maintains lens hydration—
stable parameters

34. Disinfection
 Store the lens for at
least 4 hours in
FRESH solution
 Decrease the risk of
infections

35. Types of Disinfection
 Heat
 ThermalUnit
 Microwave
 Chemical
 Oxidative
 Hydrogen Peroxide
 Chlorine
 Cold chemicals
 Various disinfectants

36. Thermal Disinfection
 Original form of disinfection- discontinued in
the market
 Procedures
 Clean and rinse lenses
 Place lenses in fresh saline in lens case
 Heat to 70-80 deg for 10-12 min
 After heat cycle, allow lenses to cool before use

37. Thermal disinfection
 Advantages  Disadvantages
 Short disinfection  Incompatible with
cycle times some lenses, eg.
 Highly effective High water content;
antimicrobial action may cause
 Low risk or allergic
discolouration and
reactions deformation
 Increased protein
deposits( cook the
protein) and causes
allergy
 Suitable power may
not be always

38. Chemical
Disinfection

39. Chemical Disinfection
 Disinfection achieved by the presence of
preservatives
 Thimerosal, Chlorhexidine, Sorbic acid
 Disinfection depends on the concentration and
type of preservative
 Preservatives are potential irritants though rare

40. Chemical Disinfection
 Actions vary in modes:
 Cellmembrane disruption- Benzalkonium chloride
 Enzyme Inhibition-Thimerosal
 Protein Coagulation-EDTA
 Cold chemicals
 Thimerosal,
Chlorhexidine, Sorbic acid, ATAC,
Isopropyl alcohol, Polyquad, Dymed,
Phenylmercuric nitrate

41. Modern Chemical Disinfectants
 Used in Mutipurpose (All-in-one ) solutions:
 Polyaminopropyl biguanide (PABA, PHMB)
 Quaternary-ammonia (Poyquad) & Aldox

42. Multipurpose solutions
 Single bottle of solution for cleaning, rinsing,
disinfecting and removing protein
 Advantages
 Simple,convenient, easy transport
 Enhanced safety due to lower toxicity and
complications
 Does not cause protein denaturation
 Improved compliance
 Disadvantage
 Small incidence of mild sensitivity reactions

43. Hydrogen peroxide
 Advantages  Disadvantages
 Preservative free-  Inflexible
theoretically less neutralisation time(
allergy lens must be fully
 Effective disinfection neutralised before
use)
 H202 concentration
decreased rapidly
(3% to 1% in <10
min)- decreased
anti-microbial
efficacy

44. Hydrogen peroxide step
systems

45. Hydrogen peroxide step
systems

46. Antimicrobial efficacy
 A battery of tests is carried out to make out the
anti-microbial efficacy of disinfecting solutions:
 One million (6 log units or 106) microorganisms
(CFUs) permillilitre are added to the test solution)
 The USP Preservative Effectiveness test requires
a solution to decrease microorganisms by 3 log
units ( or 1000) after 14 days and no subsequent
regrowth for a further 14 days.

47. Antimicrobial efficacy
 A battery of tests is carried out to make out the
anti-microbial efficacy of disinfecting solutions:
 To pass as a disinfectant FDA‟s Office of Medical
Devices imposes two additional requirements on
an agent:
 At least 14 days, the original solution is rechallenged
by a 105 CFU/mL inoculum and the solution must
again cause a 3-log reduction in micro-organisms over
the following 14 days
 The solution must be fungistatic to yeasts and fungi
during the 28-day test.

48. Lens care regimen and deposit
types
 Protein deposits  Lipid deposits
 Chemical  Thermal disinfection
disinfection  Avoid chlorhexidine-
 Hydrogen peroxide because it increases
is preferred surface
 Proteolytic enzyme hydrophobicity and
weekly allows lipid adhesion
 If thermal is  Enzyme cleaning
necessary, low heat with a lipase
 Advise non-ionic  Avoid FDA Group I
and low water and II materials
content material

49. Lens care regimen and deposit
types
 Calcium deposits  Calculi
 Thermal disinfection  Lipid solvent cleaner
 Hydrogen peroxide(  Lipase-containing
low pH dissolves enzyme
calcium)  In-eye lubricants in
 Proteolytic enzyme EW lenses and
may help clean more
 Avoid tight fitting frequently
lenses  Tears with
 Prescribe glyceryl potassium
methyl methacrylate deficiency worsen
(CSI) material calculi problem so

50. Lens care regimen and deposit
types
 Rust spots  Discoloured lenses
 Consider thermal  Discard the lens as
disinfection far as possible
 Smokers usually get
 Hydrogen peroxide lenses discoloured
disinfection systems due to nicotine
may make them less interactions
obvious  Usually a/w protein
deposits so consider
the steps for the
protein deposit
management

51. Lens care regimen and Dry
eyes
 Dry-eyed patients  Dry-eyed patients
 Dilute the saline by  Use in-eye
20-50% with boiled lubricants frequently
distilled water. This  Re-soak the pair for
temporarily 15-30 min during the
increases the water day
content of the lens  Cosider protein
which is then slowly removal frequently
released onto the as protein deposits
eyes. are usual.
 Avoid thermal  Refit with low water,
disinfection as far as non-ionic materials.

52. Choice of Lens Care System
SCL Heat MPS Hydrogen
Peroxide
Group I √√√
Group II
Group III
Group IV
Bleaches colour in cosmetic contact

53. Recommendations
 Discard solution everyday
 Rub and rinse step is essential with
combination solution
 Keep nozzle closed
 Narrow openings
 Clean and rinse well
 Soak for recommended time

54. Essentials steps of Care and
Maintenance
 .
 .
 .
 Extra steps- Protein Removal

55. Protein Removers
 Effectively remove protein deposits
 Have NO effect on most other deposits
 React by breaking protein molecules
 For heavy depositors

56. Protein removal procedure
 Use regularly after daily wear and rinsing step
 Lenses should be soaked in enzyme, dissolve
in solution/saline for 15 min or overnight
depending on the manufacturer
 Lenses should be thoroughly rubbed and
rinsed again afterwards

57. Essentials steps of Care and
Maintenance
 .
 .
 .
 Extra steps
- Lubricating/ Rewetting

58. Rewetting or Lubricating Drops
 Alleviating signs of dryness and discomfort
 Flushing irritation particles from eye and CL
 Rehydrating lens

59. Care for Lens Cases
 Scrub with tooth brush using cleaning solution
weekly
 Rinse with saline or disinfecting solution
 Air dry upside down
 Replace case regularly

63.  Wash your hands
before handling
contact lenses
 Check the position
of lenses before
insertion

64.  Cosmetics/Make-
ups
 Put contact lenses
in
 After applying hair
products like
hairspray
 Before applying
cosmetics especially
eye makeup

65.  Instruction for makeup
 Insert the lenses before applying makeup
 Remove the lenses before taking makeup off

66.  Avoid harmful or Irritating Fumes while the
Lenses Are On

67.  Do Rinse the Lenses
 Always before inserting the lens and after
removing it from the eye
 Rinse the lens with contact lens solutions
suggested by contact lens
practitioners/optometrists

68.  Clean and change the solution in the case
daily
 Keep the contact lenses either in your eyes or
in your lens case

70.  Do not let hair spray
or other cosmetic
aerosols come in
contact with the
lenses
 Avoid Long and
Dirty Nails

71.  Do not swim with contact lenses if yes with
swimming goggles only

72.  Don‟t sleep with contact lenses
 Remove the lenses before going to sleep
 Your cornea may not get the necessary oxygen*
while asleep
*Continuous wear lenses or Extended wear lenses with
High Dk can be used upon practitioner‟s
recommendations

73.  The following have interactions potentially
hazardous to CL wear:
 Tetracycline
 Rifampin
 Preserved products
 Aspirin
 Antihypertensives
 Tricyclicantidepressants
 Antihistamines
 Anticholinergics

74. Additional Tips for Hygienic CL
Wear
 Do not mix solution types and brands
 Never soak/store lenses in saline or tap water
 Don‟t put solutions and lens case in the toilet
or refrigerator
 Don‟t touch the tip of any contact lens solution
 Don‟t use any topical eye drops while wearing.

75. Immediate contact with ECP
 If the eyes get red and irritated or if you feel
any pain remove the lenses and contact eye
care practitioner

76. How to avoid infection
 Deposits can be avoided by maintaining a
good lens care regimen
 Cleaning
 Disinfection
 Following the instruction
 Shorter is better-Disposables, small packs of
solution (120 ml or 360 ml rather than 500 ml)

77. Why disposable?
 More comfortable
 Healthy
 More hygienic
 Convenience of spare pair at hand
 Longer wearing time
 Contact lenses related infection and
complication are on the low in disposables.

79. Methods
 Fifty consecutively presenting patients form
each of two teaching clinics who had
presented for routine after-care examinations,
and had undergone at least two previous after-
care visits were surveyed in the study.
 The contact lens teaching clinics were at the
Queensland Institute of Technology and the
University of Melbourne.
 Carried out by the students under the
supervision of optometrists.

80. Methods
 Patients in this survey had been wearing
contact lenses for an average of 2.6 years(
range 0.25 to 8 years). Most wore lenses 7
days per week and 8 to 14 hours per day.
 Only patients wearing daily wear lenses were
included; 82% wore soft lenses and and 18
wore hard lenses Lens Distribution
soft lenses
Hard Lenses
18%
82
%

83. Strategies to bolster compliance
 Strategies to improve patient compliance must
address these basic causes, and are usually
considered in four classes:
1) Education, so that the availability of correct
information is maximized.
2) Improved communication techniques, so that
information is provided in a brief, clearly
categorised and specific way( usually using
more than one medium to emphasize the
importance of key areas. Use of visuals is
instrumental

84. Strategies to bolster compliance
 Strategies to improve patient compliance must
address these basic causes, and are usually
considered in four classes:
3) Organisational procedures, so that the
cost, complexity and nature of recommended
care systems are tailored to the specific needs of
individual patients. The example could be the use
of an MPS which aims to promote patient
compliance.
4) Behavioural modifications: The use of verbal or
written commitments by contact lens patients.

85. How to enhance compliance?
 Educate staff and the patient
o Simple written and verbal instructions
o Reinforce few key points many times
o Practical demonstration/visuals
 Review lens care at every visit
 Keep patients coming back for more
o Compliance packs/offers
o Recall system
o Regular contact through mailers

86. Summary
 Minimal adverse reactions achieved by:
 Clean, well-fitted lenses
 Adequate physiological performance
 Appropriate choice of care system
 Regular monitoring of patients
 Patient compliances

87. References:
 F. Stapleton, A. J. Phillips and G. A. Hopkins.
Chapter 4 „ Drugs and solutions in contact lens
practice and related microbiology‟ in Contact
Lenses, 4th Edition, Butterworth
Heinemann, 1997
 IACLE Contact Lens Course, Module 5, 1ST
Edition, The International Association of
Contact Lens Educators, 2000

88. References:
 Shovlin J: Systemic Medications and their
interaction with soft contact lenses. Int Contact
Lens Clin 17: 250, 1990
 Kristine D. OD, Lakshman N. Physical
Properties of Soft Contact Lens
Solutions.Optometry and Vision Science
2007;85:122-128
 Edward S. Bennet and Barry A. Weismann,
Clinical Contact Lens Practice text book,