There are over 40 million contact lens wearers in the United States, and as many as 2.7 million drop outs each year.1 Patients discontinue contact lens wear for a variety of reasons including discomfort, inconvenience, reduced vision and eye irritation. And, it’s no surprise that solutions play a role in exacerbating or relieving contact lens problems. When starter kits are dispensed, patients frequently run out of solution before they return to their eye care practitioner and when they purchase a replacement solution for their lenses, it is often not what was initially prescribed. As doctors weigh the role of multipurpose vs. hydrogen peroxide solutions, it is time for practices to expand their services to offer portion-controlled products for their patients.
Introducing Peroxide Disinfection Lens Systems
While well tolerated by the eye, multipurpose solutions are not always effective in eliminating the pathogens that lead to ocular infections. The two major contact lens-related microbial keratitis outbreaks stem from Acanthamoeba (a genus of free-living protozoa) and Fusarium (a genus of filamentous fungi) and have resulted in two multipurpose solution recalls.
Surfactant cleaning is ineffective at removing Acanthamoeba trophozoites and cysts from the contact lens surface.2 One step peroxide is regarded as the most effective disinfection solution.3 Hydrogen peroxide penetrates the matrix of silicone lenses and other hydrogel materials, expanding the lens matrix and oxidizing the microbes within. Hydrogen peroxide also penetrates the biofilm and breaks proteins and lipids bonds, removing debris from the lens.
Hydrogen peroxide showed the highest “kill rates” over multipurpose systems after four to six hours with an extremely low adverse response rate.4-6 Peroxide is preservative-free, making it ideal for patients with hypersensitivities and dry eyes.7 In fact, an effectively neutralized hydrogen peroxide system leaves no residual chemicals in the eye and doesn’t contribute to any existing eye irritation.3 Peroxide systems are therefore preferred for patients with any history of hypersensitivity, giant papillary conjunctivitis or past lens care product reactions.
Recently, and largely due to new literature, many doctors have started using hydrogen peroxide as a problem-solving system in response to contact lens wear complications or difficulty in contact lens wear such as sensitivity, discomfort or dryness. In our own practices, we have transitioned from using peroxide for problem-solving to initially prescribing peroxide disinfecting systems for all eligible patients. But, keep in mind that peroxide disinfecting systems are contraindicated in young children, part-time wearers and those who cannot soak their lenses for six hours at night.
Improving Patient Compliance
Patients often do not practice good contact lens hygiene, which greatly increases the risk of infection. A government-sponsored study reports that 30% of people using restrooms in various airports did not wash their hands, an unsanitary practice that is directly associated with increased risk for developing microbial keratitis.8
How can practitioners increase patient compliance with solutions? The first step is to prescribe solutions; however, do not hand out a solution starter kit. By only handing out a starter kit, the practitioner is setting up the patient for failure considering the average starter kit lasts no longer than one to two weeks. Once patients run out, they will visit a pharmacy to purchase more solution and are generally inclined to buy the brand on sale. This change in solution may lead to ocular discomfort, irritation and even infection.
A trip to the pharmacy can inadvertedly create other problems if the patient is given a discount coupon at checkout. A partnership—such as the collaboration between Walmart and 1-800-Contacts—encourages consumers to buy contacts, schedule eye examinations and eye care appointments with the partner companies. Another concern is the patient’s ability to place unlimited orders and bypass their yearly eye exams.9
The best and safest way of prescribing contact lens solutions is to provide a minimum of a full month’s supply. This will guarantee that the patient will not run out of solution before the next scheduled visit and will develop the habit of using all of the prescribed solution before ordering more of the same solution. Our own patients appreciate receiving a month’s supply of lenses and solution simultaneously.
Many companies package their contact lens solutions in one, three or six months divisions. One such example is Sauflon Pharmaceuticals, which offers a retail package that patients can purchase exclusively through the practitioner’s office. At our own practice, we use this product and give new patients a single bottle of Sauflon solution or a one month’s supply. Returning patients can then either buy their replacement solution from our office or take a direct order form to purchase products directly from the company.
Expanding Your Business Model
The idea of selling solutions as part of a contact lens practice is still foreign to some practitioners. But, it shoudn’t be! Many of us already offer retail size solutions to patients in order to control the type of solutions and solution-lens combinations used. By selling the prescribed solutions in your office, you can increase revenues by as much as $60 per patient per year—making solutions more profitable than contact lenses.
A Better Solution
Hydrogen peroxide disinfection with at least a month’s worth of solution can effectively help reduce dryness and redness, while increasing comfort for prolonged wear. In fact, hydrogen peroxide cleaning solutions have been shown to be more effective than multipurpose solutions in disinfecting contact lenses.10
1. Fonn D. Targeting contact lens induced dryness and discomfort: what properties will make lenses more comfortable. Optom Vis Sci. 2007 Apr:84(4):279-85.
2. Radford CF, Moodaley LCM, Porter R. Acanthamoeba keratitis in compliant users of a one-step hydrogen peroxicd contact lens disinfection system. Optometry Today. 1999 Aug;21-4.
3. Joslin C. Peroxide systems provide maximum disinfection efficacy. Cont Lens Spect. 2009 June;14.
4. Murphy J. Pick up the dropouts. Rev Optom. 2005 May(141):5:27-9.
5. Holden B. A report card on hydrogen peroxide for contact lens disinfection. CLAO. 1990 Jan-Mar;16(1 Suppl):S61-4.
6. Yurkiewicz S.Booster shots. Los Angeles Times. 2009, July.
7. Gromacki S. Hydrogen Peroxide Disinfection. Cont Lens Spect. 2006 Dec;19.
8. As many as 30% of travelers don’t wash hands after using public restrooms at airports. Available at: www.biology-online.org/articles/30_percent_travelers_wash.html. (Accessed September 2010).
9. Rex G, Sindt C, Townsend W, Ward M. Multipurpose infection solutions vs. hydrogen peroxide system. RCCL. 2008 Jan-Feb:144(1):26-30.
10. Shovlin JP. Acanthamoeba Update. Rev Optom. 2009 July;145(7):85.
Dr. Kline is the U.S. Director of Professional Affairs for Sauflon Pharmaceuticals. He is a fellow of the American Academy of Optometry with diplomate status in two sections: cornea, contacts and refractive technology and low vision.
Dr. Davis heads a team of optometrists, ophthalmologist and opticians in a private practice in Pembroke Pines, Fla. He is an adjunct clinical professor at Nova Southeastern College of Optometry and Pennsylvania College of Optometry.