Eye care providers have struggled with, and often debated, the best practices for caring for multi-patient, reusable trial contact lenses. Disposable lenses are available in many parameters, obviating the need for reusable trial lenses in many cases. Nevertheless, we’re still called upon to care for trial lenses with the insurgence of scleral lens use. Using these lenses has forced us to take another look at in-office, multi-patient guidelines, especially in light of the COVID-19 pandemic.
An excellent summary of in-office handling of reusable trial lens suggestions is available using the standards from the International Organization for Standardization (ISO).1 In addition, the contact lens groups of the American Academy of Optometry and the American Optometric Association have updated guidelines for in-office disinfection of trial lenses.2
For those who haven’t already digested the main elements of the 2018 ISO guidelines, these pertinent key points might help you and your staff ensure minimal transmission risk of any infection to your patients, especially since office staff hygiene can be a significant factor in disease transmission.3
The ISO 19979 provides guidance to manufacturers for the development of information provided to eye care practitioners for the hygienic management of trial hydrogel, composite and rigid gas permeable contact lenses intended for multi-patient use.1,3 These documents are updated every five years. Within the guidelines, contact lenses are categorized by material and design, listed as rigid, soft or hybrid lenses.
Remember, our patients potentially are exposed to a wide variety of pathogens when subjected to reusable trial lenses in our office. The wide range of pathogens could include both gram-positive and gram-negative bacteria, fungi (mold and yeast), protozoa and several different viruses, whose survivability depends on lens material and variations in polymer differences.3
A vigorous rub and rinse of any lens surface will easily remove a good portion of any microbial contamination, along with most deposits, particulate and debris.3 Train staff and reinforce this important first step. Keep in mind that several disinfection methods depend on lens type and material. Remember, while the recommended steps do not sterilize, following them does more than simply sanitize lenses.
In order to ensure safety, employ a broad-spectrum disinfectant. Chemical disinfecting solutions have not been tested for HTLV-III/LAV efficacy, so oxidative systems seem to win the day.1 A three-hour, non-neutralizing soak in 3% hydrogen peroxide seems to be the most effective eradicator of pathogens and is recommended for all lenses. Soft and hybrid lenses should then be placed in a neutralizing case with fresh 3% hydrogen peroxide for a minimum of six hours, rinsed and then stored in a multi-purpose disinfecting solution and disinfected case.
Systems in Check
It’s key for eye care providers and staff to keep these things in mind:
- Ensure consistent handwashing with soap and water for at least 20 seconds and dry with clean paper towels for technicians, providers and patients.
- Carefully inspect each lens after cleaning with a vigorous rub and rinse.
- Always use approved rinses with sterile solution after disinfecting trial lenses.
- Avoid tap or well water exposure after disinfecting.
- Use clean, new cases for storage.
- Color-code bottles with stickers depending on in-office expiration.
- Repeat the disinfection cycle every three to six months even without use; if bottles are opened and not reused, repeat disinfection steps every month.
Be mindful to record the dates and number of clinic uses for every trial lens. Consult each manufacturer on their disposal recommendations after so many uses.
A special thank you to the many individuals who have worked tirelessly on the updated guidelines. Kudos to our eye care groups who have collaborated in such a collegial fashion.
1. ISO. Ophthalmic optics—contact lenses—Hygienic management of multi-patient use trial contact lenses. www.iso.org/standard/67859.html. March 2018. Accessed April 6, 2020.
2. AAO, AOA. In-office disinfection of multi-patient use diagnostic contact lenses. files.constantcontact.com/fd2dfe10101/b82a6f1b-8373-42f9-9a25-72ff50af9d64.pdf. March 17, 2020. Accessed April 6, 2020.
3. The AOA Health Policy Institute. Disinfection of multi-patient contact lenses in the clinical setting. www.aoa.org/documents/HPI/HPI_Report_Disinfection of Multipatient CLs in the Clinical Setting_2018.pdf. October 2018. Accessed April 6, 2020.