As we strive to enhance patient comfort and decrease risk of interactions, we utilize the best science and technology available to offer our patients the best possible outcome. We use the most sophisticated diagnostic equipment, the most advanced pharmaceuticals and the highest quality materials. Our patients expect us to be up-to-date on the latest in cutting edge technology and science and utilize these advancements to improve their eye care.
In 1999, we saw what is thought to be a great advancement in contact lens care— the introduction of silicone hydrogel lenses. Doctors immediately began upgrading patients to this superior material that was expected to minimize patient risk for contact lens-related interactions. Silicone hydrogel has been shown to decrease the rate of neovascularization and giant papillary conjunctivitis (GPC) vs. non-silicone lenses.1 However, a large number of patients developed moderate to severe corneal staining. There is also evidence that poor biocompatibility of some contact lens solutions combined with silicone hydrogel lenses was a factor.2 Most contact lens solutions were formulated prior to the advent of silicone hydrogel. And, it was found that using older technology multipurpose solutions containing PHMB contributed to corneal staining when used with certain silicone hydrogel lenses.3 With this information, we were strongly encouraged to switch our silicone hydrogel patients to non-PHMB regimens.
Silicone hydrogel lenses continue to post double-digit growth year after year and currently account for over half the contact lens sales in the U.S. The rapid and continued growth in prescribing this advanced material led to a new technology solution developed for biocompatibility with silicone hydrogel lenses. When compared to other multipurpose solutions combined with silicone hydrogel lenses, studies have shown that patients using OPTI-FREE® RepleniSH® MPDS had significantly less contact lens related interactions than other solutions tested.1 The Andrasko Grid further illustrates that most older technology multipurpose solutions (containing PHMB) cause a significant amount of corneal staining when combined with certain major brands of silicone hydrogel contact lenses vs. OPTI-FREE® RepleniSH®. Patients using private label solutions were found to have over twice the amount of interactions as patients using OPTI-FREE® RepleniSH® MPDS.1
While objective findings are essential to us as practitioners in our clinical evaluation, subjective response from our patients also plays a vital role in providing them with superior comprehensive care. There is a trend between the objective evaluation of corneal staining and patients’ subjective level of comfort. We have found that as staining increases, comfort decreases.4
The evidence is clear that in order for our patients to receive the greatest overall benefit from the most advanced science and technology, their contact lens solution must be upgraded at the same time as their contact lens material. Pairing a high- quality contact lens with the appropriate solution (that was specifically designed for optimal biocompatibility) provides our patients with the quality eye care that they want and expect from us. But surprisingly, a recent survey indicates that while 74% of patients are upgraded to silicone hydrogel lenses, only 12% of patients receive a recommendation to upgrade their solution.5
Our patients come to us with the expectation that we are the authority and want us to decide which options will offer the greatest benefit. Many patients are not aware that they can optimize their comfort by upgrading their solution.6
Practitioners make every effort to provide patients with care that meets the highest standard. Our patients want to leave our offices with the confidence that we have utilized our knowledge to make the best decisions for them. We should not disappoint our patients by falling short on our responsibility. It is important to prescribe the proper combination of contact lens material and solution to give our patients the best that science has to offer.
This column is sponsored by Alcon.
1. Forister J, Forister E, Yeung K, et al. Prevalence of contact lens related complications: UCLA contact lens study. Eye Contact Lens. 2009 Jul;35(4):176-80.
2. Epstein A.B. SPK with daily wear of silicone hydrogel lenses and MPS. Cont Lens Spect. 2002 Nov;17(11):30.
3. Jones L, MacDougall N, Sorbara LG. Asymptomatic corneal staining associated with the use of balafilcon silicone-hydrogel contact lenses disinfected with a polyaminopropyl biguanide-preserved care regimen. Optom Vis Sci. 2002 Dec;79(12):753-61.
4. Andrasko G. Ryan K. Corneal staining and comfort observed with traditional and silicone hydrogel lenses and multipurpose solution combinations. Optometry. 2008 Aug;79(8):444-54.
5. Decision Analysis Survey of 350 Optometrists. Alcon. August 2009.
6. Corbin GS, Bennett L, Espejo L, et. al. A multicenter investigation of OPTI-FREE® RepleniSH® multi-purpose disinfecting solution impact on soft contact lens patient comfort. Clin Ophthalmol. 2010 Feb 2;4:47-57.