As eye care practitioners, we evolve into better clinicians over time. This process is influenced by the continual influx of new information that we continuously incorporate into our exam room. So, what should we do in light of recent FDA research?
FDA-sponsored research found that, in in vitro testing over time, uptake of polyhexamethylene biguanide (PHMB) into certain lenses affects the PHMB concentration in a multipurpose solution and reduces its residual biocidal efficacy against both Staphylococcus aureus and Fusarium solani in as little as six hours.1,2 If the FDA is currently considering revisions to contact lens product testing and regimens, this should certainly motivate us to review our office protocol as well.
Our patients often think that all lens care systems will ultimately work the same. We may sometimes agree. But even solutions with the same surfactants can work differently for different patients.
Disinfecting lens care options can be broken into several categories, including multipurpose solutions preserved with or without PHMB, and peroxide-based systems. Knowing that certain lens/solution interactions might be no more biocompatible than others, it is important that we consider how we make these decisions. Consider corneal staining as one example. Certain lens/solution combinations result in greater amounts of solution induced corneal staining (SICS) than others.3
It is important to understand that SICS results from the release of the disinfectant after lens insertion from the lens into the tear film.4 Larger areas of SICS represent greater amounts or certain concentrations being released, which may indicate more uptake of disinfectant by the lens. The FDA reported that the uptake is responsible for affecting the PHMB concentration in the solutions and decreasing the resulting antimicrobial and antifungal activity remaining in the solution; moreover, the resultant staining can signify a break in the barrier function, which is essential in protecting the cornea from microbial entry.1,2,5,6
Patients may believe that all contact lens solutions are the same, and they may not know that many “store brand” multipurpose contact lens solutions are made with different ingredients, like PHMB, than other branded solutions on store shelves.
It is important that we take the time to educate our contact lens patients on the differences and make firm recommendations. In a recent survey, 95% of doctors claimed to always give contact lens patients a solution sample; however, only 31% of patients reported receiving a specific recommendation for which product to use.7
Be very deliberate in your instructions. We suggest that you clearly reiterate when handing over a trial kit that this is the solution you want your patient to use. In fact, take the next step and tear the label off the box and ask them to put it in their wallet or purse, so they know exactly what to buy when they go to the store. This is a very direct approach in which the patient is clear on your instructions.
Enlist a well-trained staff member to repeat your directive. Doctor recommendations that are echoed by the staff are the ones most remembered and practiced. It is crucial that everyone in the office understands and believes that lens care choice and compliance are critical in the comfort and success of the wearer.
As eye care professionals, you are in the position to influence the behavior of your patients. Keep your patients committed to contact lens wear. Stress the lenses and lens care solution that will ensure a successful lens wearing experience.
1. Shoff ME, Lucas AD, Brown JN, et al. The effects of contact lens materials on a multipurpose contact lens solution disinfection activity against Staphylococcus aureus. Eye Contact Lens. 2012 Nov;38(6):368-73.
2. Clavet CR, Chaput MP, Silverman MD, et al. Impact of contact lens materials on multipurpose contact lens solution disinfection activity against Fusarium solani. Eye Contact Lens. 2012 Nov;38(6):379-84.
3. Andrasko G. Andrasko corneal staining grid. Available at: http://staininggrid.com. Accessed February 25, 2013.
4. 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;79:753-61.
5. Chuang EY, Li DQ, Bian F, et al. Effects of contact lens multipurpose
solutions on human corneal epithelial survival and barrier function. Eye Contact Lens 2008;34:281-6.
6. Dutot M, Reveneau E, Pauloin T, et al. Multipurpose solutions and contact
lens: Modulation of cytotoxicity and apoptosis on the ocular surface.
7. Alcon data on file, 2012.
Dr. Lievens is Associate Professor and Chief of Staff of the Eye Center at Southern College of Optometry.
Dr. Brimer is in private practice in Wilmington, NC and is the owner of Crystal Vision Services, an ophthalmic consulting company.
© 2013 Novartis 5/13 OPM13066AE