Gaining clarity in contact lens care

Full contact lens compliance is rare. Just 15% of contact lens wearers complete every step in caring for and cleaning their lenses.¹
 
Although lenses may seem clean to patients, we know that sub-microscopically there can be debris and microorganisms left on the lens that the human eye cannot see, particularly when it comes to specialty lenses. 
 
Caring for contact lenses is as important as wearing the correct contact lenses. Unclean lenses impact vision, are uncomfortable to wear, can affect eye health and can undo all the efforts put into achieving an optimal lens fit.
 
Add to this that contact lens solutions differ in their composition, their mechanism of action and the concentration of the various agents, lens cleaning is not always simple. But it is absolutely vital and over time, non-compliance can lead to severe ocular complications. 
 
Our unique PROGENT formula is well-known and studied for its ability to intensively clean gas permeable (GP) lenses. Used in combination with our daily Unique pH™ solution, PROGENT is a solution for regular use, which removes debris from the lenses in just 30 minutes, making cleaning easier for the patient and protecting their eye health. 

A reminder of the risk of residues

Deposits on contact lenses are made up of tear film components such as proteins, lipids, mucin and calcium but other substances from the patient’s everyday routines can also contaminate lenses, including nicotine if they’re a smoker, or cosmetics, such as hand cream and make-up.^2-4
 
Lens contamination has proven to result in contact lens-related ocular pathology, including: 
 

• Papillary conjunctivitis 
• Contact lens induced acute red eye (CLARE)
• Corneal inflammatory events 
• Microbial adhesion
• Microbial keratitis^2,3

All these factors can ultimately impact the patient’s lens-wearing experience, ocular health and result in reduced vision.

Issues of improper cleaning

Emphasizing the importance of thorough contact lens care to patients right from the start and at every visit will help form good habits long-term. 
 
We know patient compliance will overcome the risks associated with deposits but achieving this can be a challenge.  
 
Poor hand hygiene is one of the top risk factors for microbial contamination of contact lenses, potentially leading to the development of microbial keratitis and corneal inflammatory events.⁵
 
Plus, wearers aren’t always using contact lenses for the correct duration. A report by the Centers for Disease Control and Prevention (CDC) found 82% of respondents to a national survey wore contact lenses for longer than recommended and half slept in their lenses. Such behavior has been found to raise the risk of eye infections by five times or more.⁶
 
Meanwhile, the lowest compliance has been found in the cleaning of lenses, particularly rubbing and rinsing, and cleaning lens cases,¹ which are also major contributors to eye infections. Symptoms include burning, itching, redness, irritation, the feeling of something beneath the lens and acute pain, which can go on to develop into more serious consequences.⁷

Taking care when cleaning specialty lenses 

When it comes to specialty lenses, the need to adhere to a thorough cleaning routine is particularly important.

 
Rigid gas permeable lenses are designed to last for extended periods, which can increase the risk of contamination if lenses aren’t cared for daily. The ideal cleaning routine is to use fresh multipurpose solution every day, including rubbing the lenses and soaking for the correct length of time. But wearers may miss a day of cleaning, they may not rub or soak the lenses for long enough, or they may skip rubbing completely. This creates a build-up of stubborn protein deposits and biofilm, which could impair vision quality and wear comfort, induce contact lens intolerance, and potentially cause corneal infection.

 
Specialty designs such as orthokeratology lenses also require greater attention. A study of eight worn orthokeratology lenses found deposits measuring up to 7.72µm thick.⁸ These deposits could be due in part to the reverse geometry back surface, which is designed to help reshape the cornea and correct the refractive error. But this shape is also prone to deposits invisible to the naked eye. 
 
Additionally, deposits may serve to increase bacterial retention on the lens surface, which can lead to infections such as keratitis caused by Pseudomonas aeruginosa, a pathogen which can be highly resistant to antibiotics.⁹
 
While there is a huge array of contact lens care solutions on the market, they vary greatly in terms of performance, efficacy and compatibility when it comes to the contact lens type and the wearer’s ability to follow a cleaning routine.   

The ideal contact lens care system

Kills ALL viable organisms:

• in lens case
• in solutions
• on contact lenses 

 
Removes ALL:

• dead organisms
• skin lipids (from eyelids)
• tear, finger and air-borne contaminants
• cosmetic residues
• lens care product residues and by-products

Our powerful pairing for sparkling specialty lenses

Daily cleaning with Unique pH™

For all contact lens users Unique pH™ is a multi-purpose solution developed specially for gas permeable (GP) lenses. Designed to remove dirt, lipids, protein deposits and debris, the solution disinfects lenses using antimicrobial agents, which destroy harmful microorganisms commonly found on the surfaces of lenses. 
 
At the same time, it conditions lenses by adjusting to the eye's natural tear pH to enhance the wettability and comfort of the lenses to provide a soothing effect while they’re being worn.  

Intensive cleaning with PROGENT 

Our PROGENT formula is unique – no other product on the market has its characteristics. To be used regularly, PROGENT offers fast, effective protection, compatible with all GP lenses. It removes protein deposits in just 30 minutes and has been proven to be extremely effective against bacteria, molds, yeasts, viruses and amoeba in just five minutes. 

 
PROGENT is widely recognized for its efficacy. A recent study which measured lens deposits on worn orthokeratology lenses using image analysis software found cleaning with PROGENT fully removed debris.⁷

Let’s clean up compliance

As contact lens technologies become more advanced and designs more complex, finding the right cleaning solution is vital to aiding patient compliance and protecting their eye health. 
 
No matter the product or whether prescribing a lens care system for a biweekly or monthly disposable lens, or a specialty soft or GP lens, the ideal solution should always meet the following criteria: 
 

• effective in disinfection, especially to those microorganisms known to cause adverse events
• nontoxic to the user
• compatible with the corneal epithelium and all lens materials
• able to maintain surface wettability and enhance comfort
• simple to use and quick to perform

 
Clean lenses provide vision, comfort and above all, safety. It’s our job to help wearers see the importance of consistent contact lens hygiene so they can preserve eye health now and for the future.

Author

Patricia Flores DO, MSc, PhD, FSLS

Global Professional Services, Specialty Lens Division at Menicon Co., Ltd

Dr. Patricia Flores works in Global Professional Services for the Specialty Lens Division at Menicon Co., Ltd. She is an optometrist with a PhD in Optics, Optometry and Vision from the Complutense University of Madrid, Spain. Her specialty is in the adaptation of contact lenses in diseases of the ocular surface.

References

1. Morgan PB, Efron N, Toshida H, et al. An international analysis of contact lens compliance. Cont Lens Anterior Eye 2011;34:223–228.
2. Jones L et al. (1996).  Spoilation and clinical performance of monthly vs. three monthly Group II disposable contact lenses.  Optom Vis Sci. 73(1): 16 – 21.
3. Jones L et al. (2000).  A comparative evaluation of IgA and lysozyme deposition on etafilcon & lotrafilcon contact lens materials.  Cont Lens & Ant Eye. 77(12)(Suppl.): 175.
4. Review of Cornea and Contact Lenses, 2011. Can cosmetics impact contact lens wear? Christine W. Sindt, accessed March 2023
5. Fonn et al. 2019. Hand hygiene is linked to microbial keratitis and corneal inflammatory events, Cont Lens Anterior Eye
6. CDC, newsroom, Nearly all contact lens wearers in national survey report risky eye care behaviors that can lead to eye infections, 2015. Accessed March 2023 
7. National Research Council (US) Working Group on Contact Lens Use Under Adverse Conditions. 1990 
8. Hiraoka T, Yoshimitsu M, Santodomingo Rubido J, Kondo H, Oshika T A novel quantitative evaluation of deposits adhered to worn orthokeratology contact lenses Jpn J Ophthalmol 2021 65 6 855 863
9. Choo JD, Holden BA, Papas EB, Willcox MD Adhesion of Pseudomonas aeruginosa to orthokeratology and alignment lenses Optom Vis Sci 2009 86 2 93 7