Contact Lens Care

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Contact Lens Care David S. Wing, BSP, MS Ken Gellatly, OD Date of Revision: November 2014

Contact Lenses Introduction

Contact lenses can correct refractory errors associated with hyperopia (farsightedness), myopia (near-sightedness), astigmatism (related to shape of eye or cornea), presbyopia (age-related decline in acuity of near objects) and aphakia (reduced near and far vision related to absence of lens). Contact lenses are foreign bodies that sit on a tear cushion and do not actually make contact with the eye as implied by their name. As tears constantly bathe the cornea, supplying oxygen, contact lenses act as physical barriers, producing progressive hypoxia and edema. Whether clinical symptoms result depends on duration of wear, adherence to the care regimen, lens materials, lens design and fit. Contact lenses offer many advantages over eyeglasses:1,2 An entire field of view in focus Natural appearance

No fogging from temperature changes, perspiration or weather No annoying reflections and peripheral obstructions

Types of Contact Lenses

The 2 major types of contact lenses are rigid gas-permeable (RGP) and soft. Lenses are worn according to various replacement schedules: conventional (1 year or more), planned replacement (lenses replaced every 2 weeks, every month or every 3 months) or daily (brand new soft lenses inserted every day). Table 1 compares some of the important features of RGP and soft lenses.

Rigid Gas-Permeable Lenses

RGP lenses combine the optical qualities and durability of PMMA (polymethyl methacrylate, the original hard lens, which is now obsolete) with the oxygen permeability and comfort of soft lenses.3 RGP lenses have a sufficiently high oxygen permeability to prevent clinically observable corneal edema with normal wear. Hence, better long-term visual acuity and, in general, fewer complications are achieved than with either PMMA or soft lenses. RGP lenses have replaced the original PMMA lenses as the standard of care for hard lenses.

Soft Lenses

Soft lenses are made of a flexible polymeric material, usually hydroxyethyl methacrylate (HEMA), with a high capacity for water absorption.4,5 Their main advantage over RGP lenses is increased comfort. This is due to their flexibility (which increases with increasing water content), soft thin edges and hydrophilic nature. Unfortunately, these lenses have an open matrix which concentrates tear film lipoproteins, ophthalmic preparations, environmental pollutants, chemical vapors, oil and dust from fingers, cosmetics and some contact lens solution preservatives, all of which can lead to ocular irritation. Soft lens materials also tend to develop lens deposits (accumulation of proteins and lipids), a risk factor for the development of microbial keratitis, more rapidly than RGP lens materials.

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Silicone hydrogels are the new gold standard in soft contact lenses and should eventually make old (conventional) hydrogels obsolete. Silicone hydrogels are simply a much better polymer with increased oxygen permeability compared to conventional hydrogels. By reducing drying tendencies, addition of silicone to hydrogels has enabled longer wear times, even in more arid climates. Silicone hydrogels also adsorb less protein;6 when used with nonpreserved care solutions, they may be the safest choice7 though a study found no decrease in the risk of microbial keratitis.8 Table 1: Comparative Features of Rigid Gas-Permeable (RGP) and Soft Contact Lenses Characteristics

Soft Lenses

RGP Lenses

Composition

HEMA is the most common polymer; its combination with silicone (silicone hydrogel) will become the standard of care

PMMA/silicone, fluorosilicone acrylate

Water content

29–85% (hydrophilic); silicone hydrogels are made of hydrophobic material but have a hydrophilic surface treatment

≤2% (hydrophobic)

Life expectancy of lens

1 day to 1 year

5 years (unless lost earlier)

Solution requirements

Only soft lens solutions

Only RGP solutions

Visual acuity

Good

Excellent

Initial cost

Similar

Similar

Maintenance cost

More

Less

Gas permeability

Less

More

Initial comfort

Most comfortable

Intermediate

Adaptability (days until new lenses feel comfortable)

<1

5–10

Long-term comfort

Intermediate

Most comfortable

Daily wear time (hours)

>12

>12

Extended wear (days)

≤7 (hydrogels)

≤7

Strength

Fragile

Strong

Accumulation of deposits from tear film

Most susceptible

Least susceptible

Effect of humidity

Easily affected

Minimally affected

≤30 (silicone hydrogels)

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Characteristics

Soft Lenses

RGP Lenses

Risk of microbial contamination

Greatest

Slight

Abbreviations: HEMA = hydroxyethyl methacrylate; PMMA = polymethyl methacrylate; RGP = rigid gas-permeable

Combination RGP/Soft Lenses

In combination lenses, an RGP centre is fused to a heme skirt which provides the great optics of RGP with the comfort of HEMA. The combination is indicated for keratoconus and other corneal dystrophies. Soft lens solutions are used with these combination lenses.

Wear Schedules

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In the conventional wearing schedule, lenses are replaced at an interval of approximately 1 year. Due to adherence problems (e.g., inadequate cleaning, disinfection and rinsing, reuse of old solutions, poor hygiene, using lenses for a longer time than recommended), planned replacement programs (PRPs) were developed. In a PRP, lenses are worn on a daily basis (although PRPs can also include extended-wear lenses) and disposed of at fixed intervals (e.g., every 2 weeks, monthly or quarterly) as determined by the eye care professional. Advantages of PRPs include: More frequent insertion of a new, sterile lens

Lower cost because of reduced need for solutions (multipurpose solutions can replace single-purpose solutions) Improved vision (from more frequent replacement)

Improved comfort (deposits are reduced, which increases lens wettability and reduces dryness) Improved adherence (from increased monitoring)

More convenience (multipurpose solutions can be used, in association with increased monitoring)

Fewer complaint-related office visits (reduction in giant papillary conjunctivitis, acute red eye and infective or inflammatory keratitis) Fewer problems associated with lost lenses (wearer has immediate access to a new set of lenses) or damaged lenses (wearer has no need to keep an old spare pair of lenses on hand).

In addition to supplied lenses, a disposable system that includes solutions and storage cases that are replaced at regular intervals may decrease the risk of ocular infections. Daily disposables are sterile soft lenses that are opened fresh each day, worn and then disposed of in the evening. These lenses, which require no regular solutions for daily care, offer advantages for wearers who may have adherence problems with one of the other wear schedules.11 Extended wear is defined as continuous use of a contact lens for 24 hours or more. The lenses are usually soft; however, RGP lenses are increasingly being used in extended-wear schedules. Early uncontrolled trials suggested that the rate of serious complications was not excessive and many wearers adopted extended-wear schedules. However, extended wear of contact lenses was eventually implicated in promoting microbial keratitis.12 The most likely causes are increased protein accumulation, decreased flushing of bacteria during sleep and decreased immunologic activity during sleep. To decrease the frequency of infection, the US Food and Drug Administration (FDA) recommended that extended-wear soft lenses be worn for a maximum of 7 days before removal for cleaning or disposal.13 Due to their greater oxygen permeability, silicone hydrogels can be worn up to 30 days.

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Contact Lens Care

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Goals of Contact Lens Care Optimize vision

Promote lens longevity and comfort

Minimize complications such as eye irritation and infection

Patient Assessment

Use the following questions and answers to identify potential problems and aid in appropriate and timely referral to eye care professionals.

What type of contact lenses are you wearing?

The lens type (RGP or soft) determines the care regimen. Solutions for either lens type from the same manufacturer can likely be interchanged. Advise patients to consult their eye care professional for confirmation.

Do you have any of the following symptoms:

Pain when inserting or wearing the lenses or after wearing them? Burning that causes excessive tearing? Inability to keep your eyes open?

Severe or persistent haze, fog or halos while wearing the lenses? Redness, irritation or itching? Poor vision?

These symptoms may be due to poor lens fit, damaged lenses, improper handling, microbial conjunctivitis, solution or lens intolerance, ocular or systemic disease or improper lens care. Painful lid swelling and photophobia may be due to over wear. Advise patients to discontinue lens wear and consult their eye care professional if any of these symptoms occur.14

How long have you worn lenses?

Most contact lens wearers experience mild discomfort during the first few days while the eyes adapt. Since it may not be obvious at first which problems are significant, advise wearers to contact their eye care professional.

What medications are you taking?

Advise patients to consult an eye care professional before using any ophthalmic preparation with their lenses in place. Almost any ophthalmic product that is not specifically designed for use with contact lenses will cause temporary discomfort. Numerous systemic medications can alter eye dynamics sufficiently to warrant therapeutic intervention. Sedatives (including alcohol), hypnotics, antihistamines and muscle relaxants can affect the eyelid, producing incomplete blinking or a decreased rate of blinking. Antihistamines, anticholinergics, tricyclic antidepressants and diuretics can decrease tear volume, leading to significant discomfort. See Table 2 and Table 3.15,16,17,18,19,20,21 Table 2: Interactions between Contact Lenses and Systemic Drugs

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Drug

Effect on Lenses

Oral contraceptives22,23

Lens intolerance (increased sensitivity and awareness of lenses because of corneal and lid swelling from estrogen, and altered tear composition resulting in decreased lubricating ability of tears)

Antihistamines24,25

Decrease in blink rate (blinking is required to maintain hydration in soft lens wearers and helps supply oxygen to the cornea in RGP lens wearers)

Hypnotics

Sedatives Muscle relaxants

Incomplete blinking

Anticholinergics

Decreased tear volume (leading to irritation and deposits in soft lens wearers, and corneal drying in RGP lens wearers)

Antihistamines Maprotiline

Tricyclic antidepressants26,27 Propoxyphene28

Adherence of soft lens due to decreased tear volume

Isotretinoin29

Itching and decreased wear time in soft lens wearers

ASA30

Ocular irritation and redness in soft lens wearers

Dopamine

Discoloration of soft lenses

Nitrofurantoin

Phenazopyridine Rifampin31,32

Sulfasalazine33 Tetracycline

Abbreviations: RGP = rigid gas-permeable

Table 3: Interactions between Soft Contact Lenses and Ophthalmic Products Ophthalmic Agent

Effect on Soft Lenses

Phenylephrine

Dark discoloration of lens with repeated use

Benzalkonium chloride (preservative)

Can concentrate in soft lenses and cause ocular toxicity

Fluorescein,34

Can concentrate in soft lenses and cause staining

Tetrahydrozoline

rose bengal (diagnostic ophthalmic dyes)

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recommend?

Knowledge of the disinfection method makes it possible to reinforce the instructions of the eye care professional and prevent wearers from using solutions not designed for their method of disinfection. There are 2 forms of chemical disinfection: oxidizing agents (hydrogen peroxide) and disinfecting agents (e.g., polyquaternium-1, polyaminopropylbiguanide, polyhexanide, alkyltriethanolammonium chloride and sorbic acid).

What products do you use for the care of your lenses?

Eye care professionals recommend specific products for lenses. Pharmacists can identify and correct inappropriate substitution of products. Refer the wearer to an eye care professional if there is any confusion or uncertainty regarding which solutions to use. Patients often omit the disinfecting step by simply use a rinsing solution (unless they are using an appropriate multipurpose solution).

Describe how you use your lens care products.

To ensure wearers adhere to prescribed care, ask them to describe their care regimen (Figure 1). Nonadherence is the greatest threat to eye comfort and lens life. Inadequate cleaning and disinfection cause about 50% of all problems associated with contact lenses. ,

Figure 1: Steps for Proper Care of Contact Lenses

a

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There may be variations to these generic regimens (e.g., an enzyme cleaner may not be required in a planned replacement program).

b

With multipurpose solutions, 2 or more functions (usually cleaning and disinfecting, but may include rinsing and storing) are combined in 1 formulation.

What measures do you take before reinsertion after the lens has been dropped?

Unfortunately, wearers often pick up the lens and promptly reinsert it along with whatever the lens has collected. Rinse RGP lenses with an aerosol saline solution, or reclean with soaking/wetting solution; rinse soft lenses with an appropriate rinsing solution before reinserting.

Prevention of Complications

Taking proper care of contact lenses is crucial in maintaining optimal eye health. The ideal contact lens care system would be economical, easy to use, free of side effects and would maintain all types of contact lenses in a clean and sterile state. While such a system does not exist, newer systems combined with improved contact lens technology (e.g., daily disposables, improvements in oxygen permeability, multipurpose solutions) and adherence-enhancing programs (e.g., PRPs) have brought the standard of practice closer to the ideal.35,36 Figure 1 outlines the steps required to maintain contact lenses. Nonadherence with proper lens care, reportedly affecting as many 50–99% of contact lens wearers, is the greatest threat to eye health and lens life.37 Common forms of nonadherence include inadequate cleaning or rinsing before disinfection, and economizing by using old solutions and old cases. Solution contamination (e.g., topping up old contaminated solution containers rather than replacing them), inadequate lens disinfection, manipulation of the lens in the eye and poor hygiene increase the exposure of the eye to pathogens, which can lead to microbial keratitis and corneal ulcers.38,39,40

Contact Lens Solutions

For product selection consult Compendium of Products for Minor Ailments. Contact Lens Products: Contact Lens Solutions for Soft and Rigid Gas-Permeable Lenses, Rigid Gas-Permeable Contact Lens Cleaning Systems, Soft Contact Lens Cleaning Chemical Systems, Soft Contact Lens Hydrogen Peroxide Cleaning Systems and Soft Contact Lens Thermal Cleaning Systems.

General Principles

When contact lenses are purchased, the eye care professional usually gives the wearer a starter kit containing a complete lens care system.41 Once the sample kit is finished, wearers tend to replace their solutions with the same brand if the solutions have been compatible with the eye. Otherwise, a different set of solutions is recommended by the eye care professional on a trial basis. This trial-and-error scenario is repeated until the effect of the solutions on the corneal epithelium, as viewed by a biomicroscope, is considered acceptable by the eye care professional. Advise wearers to always use solutions from a single manufacturer unless otherwise instructed by their eye care professional. Manufacturers formulate each component of a care regimen to be compatible with each of the other components. The effect of substituting even one solution from a different manufacturer is not predictable, even if it has the same active ingredients in the same concentration. In addition, all solutions that are recommended by an eye care professional will have been found to be compatible with the wearer. Unpreserved aerosol saline is the only product that can be substituted by the wearer for all lens types.42

Cleaning Solutions

The most important step in the proper care of all contact lenses is cleaning, which optimizes visual acuity, comfort, eye health and lens life.43 Debris from numerous sources collects on the lens from the moment of insertion. The

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longer the interval between cleanings, the greater the risk of complications such as blurred vision, ocular discomfort, local allergic reactions, ocular infection or blindness. The two main types of cleaning solutions are surfactants (which remove loose debris) and protein cleaners (which remove embedded protein). Protein cleaners are primarily used for soft lenses.

Surfactants Since many contact lens contaminants are not water soluble, rinsing is inadequate.44 Surfactants emulsify and suspend organisms and other debris, reducing contamination and facilitating disinfection (the presence of debris can inactivate disinfectants). Proper cleaning and rinsing can remove more than 99.9% of the contaminants prior to disinfection.43 Daily surfactant cleaning is similar for soft and RGP lenses. For soft lenses, preservatives that do not concentrate in the lens (e.g., polyquaternium-1) are used. Immediately after lens removal, a few drops of solution are applied to each lens surface. The lenses are cleaned in the palm of the hand using the index finger in a circular motion for 30–60 seconds. An alternative method involves vigorous friction rubbing between the thumb and forefinger for 30–60 seconds. The surfactant is then thoroughly rinsed off with a rinsing solution before disinfection. A surfactant cleaner is used before an enzyme cleaner, since it acts on the lipids that may hide protein deposits, making the enzyme cleaner more effective. Surfactants must be thoroughly rinsed off the lens and hands to minimize the risk of chemical keratoconjunctivitis, stinging, allergic reactions, conjunctival hyperemia and eyelid edema.44 Unorthodox cleaners include toothpaste, baking soda, laundry detergent, hair shampoo and skin cleaners.45 These nonsterile products can damage lenses and are not recommended.

Protein Cleaners With soft lens use, protein accumulates from the first day of wear and may produce decreased visual acuity, ulcerative keratitis and giant papillary conjunctivitis (GPC), an inflammation of the lining of the upper eyelid thought to be an allergic reaction to protein deposits.46 Symptoms of GPC include redness of the upper eyelid along with multiple white bumps, mucous discharge and blurred vision. In addition, Pseudomonas aeruginosa adheres more readily if a soft lens has a mucin or protein and mucin coating.47 This bacterium has been implicated in causing microbial keratitis or corneal ulcers, with possible visual impairment. The incidence of corneal ulcers can be reduced significantly with weekly enzyme cleaning. The global acceptance of disposable soft lenses has made enzyme cleaning almost obsolete for soft lenses; for RGP lenses, enzyme cleaning is optional and is generally redundant when surfactants are properly used. Most enzyme cleaners contain papain, pancreatin or subtilisin. Enzymes remove protein deposits by catalyzing the natural breakdown of debris into simple compounds, which become softer and easier to remove by cleaning or rinsing. The lens must be rubbed to effectively remove the broken-down protein molecules. Enzymes generally require 6–12 hours to work. As a rule, dissolve enzyme tablets only in sterile saline, although subtilisin can be dropped into hydrogen peroxide during disinfection.48 The use of enzymes does not obviate the need for daily surfactant cleaning since enzymes cannot remove nonprotein deposits. A surfactant removes the nonprotein debris and enables the enzyme to exert its effect. Optimal lens cleaning involves the daily use of a surfactant followed by weekly enzyme cleaner.46

Disinfecting Solutions A disinfectant actively kills microorganisms on lenses, while a preservative maintains the sterility of a solution.49 Some compounds can be used for both purposes. Most disinfecting solutions for soft lenses contain disinfectants and preservatives. Some also contain surfactants but in a lower concentration than in cleaning solutions, so disinfecting still requires a separate step.

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Chemical Disinfection There are 2 basic forms of chemical disinfection solutions for soft lenses: oxidizing agents (hydrogen peroxide) and disinfecting agents (e.g., polyquaternium-1, polyaminopropylbiguanide and alkyltriethanolammonium chloride). Benzalkonium chloride (BAC) and chlorobutanol are used in solutions for RGP lenses only, because they are adsorbed by the HEMA polymer in soft lenses, with subsequent rapid release causing ocular tissue damage.49 Multipurpose solutions for RGP lenses may be more effective against Acanthamoeba than multipurpose solutions for soft lenses.50 Chemical disinfection of soft lenses is similar to the soaking process for RGP lenses, as the lenses are soaked or stored overnight in a chemical disinfecting solution.51 All soft lenses can be chemically disinfected with the appropriate solution. After disinfection, soft lenses must be thoroughly rinsed with at least 25 mL of rinsing solution (usually normal saline or a multipurpose solution) before lenses are inserted into the eye. With RGP lenses, saline or the disinfecting solution itself is used for rinsing. Water (e.g., tap, bottled, distilled) is not recommended for any lens because of potential accumulation of minerals in the lens and possible microbial contamination.51,52 Hydrogen peroxide was one of the more popular chemical disinfectants for soft lenses, but use fell to less than 10% of chemical disinfection systems due to the advent of more convenient multipurpose solutions.53,54 However, when used properly, hydrogen peroxide is the most effective chemical disinfectant and produces the mildest ocular response when properly neutralized. Consequently, its use has since increased. Oxidizing agents are inherently unstable and, in the presence of organic debris, form free radicals that attach to debris and disperse it.55 Their effervescence is a secondary means of removing debris from the lens matrix. Following disinfection, hydrogen peroxide is neutralized by a platinum catalyst, sodium pyruvate, catalase, thiosulfite, or by rinsing and dilution. These systems are either “one-step” (where neutralization occurs automatically) or “two-step” (where the wearer initiates neutralization). The “two-step” system may be superior for Acanthamoeba.56 Despite its strong cleaning action, all hydrogen peroxide manufacturers recommend the adjunctive use of daily cleaners and weekly enzyme cleaners. Hydrogen peroxide does not affect the tints of contact lenses, although hydrogen peroxide first aid products may cause tints to fade. Hydrogen peroxide first aid products are not designed for ophthalmic use and may contain impurities, stabilizers and other additives that irritate ocular tissue.57,58

Wetting and Rewetting Solutions Accessory solutions provide wetting/rewetting, lubrication and cushioning functions in various combinations.59 Wetting/rewetting agents are artificial tears preserved with chemicals that are compatible with soft lenses. Lubrication and cushioning actions are imparted by viscosity agents, large colloidal molecules (e.g., hydroxypropylcellulose, sodium hyaluronate) that increase resistance to flow, holding the tears in the eyes and reducing the drying-out effect of solutions. They produce a cushioning and lubricant effect between the lens and eyelid and between the lens and cornea. Unlike wetting solutions without added viscosity agents, lubricants do not enhance the flow of tears over the cornea. Wearers of silicone hydrogels who are suffering from dryness benefit from lubricants but comforting effects seldom last longer than 1–2 hours, even with increasing viscosity.60 Solutions in this class have all 3 properties to varying degrees. Since the clinical significance of these differences is unknown, their uses are interchangeable.

Soft Lenses Soft lenses tend to dry out throughout the day, especially in a dry or polluted environment, leading to dry eye symptoms in up to 75% of soft lens wearers.61 Additional risk factors for dry eye include the use of diuretics or hormones (e.g., oral contraceptives), lack of adequate tearing (e.g., due to age), certain conditions (e.g., rheumatoid arthritis and to a lesser extent hypertension), air conditioning and low humidity. Rewetting solutions can be used to relieve dryness, but limit use to 1 drop every 4–5 hours. More frequent use can result in red, irritated eyes and a foreign body sensation. No one product is consistently superior to any other, although unpreserved solutions are generally recommended because they minimize the potential for allergic reactions.

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Lubricants have not been found to be significantly superior to saline.61 Artificial tears that are not specifically formulated for contact lenses should not be used for rewetting soft lenses because most contain preservatives (e.g., BAC) that can accumulate in the lens matrix. A new type of wetting drop that includes a mild cleaner has proven successful in improving comfort and vision.62

RGP Lenses RGP lenses require wetting to reduce the foreign body sensation upon insertion.63 The mucin layer of the tear film contains highly hydrated polysaccharides that wet the lens. However, this deposition can take up to 15 minutes to develop, during which time the wearer experiences discomfort. A wetting and cushioning solution minimizes the transitional discomfort until the eyes adjust. The solution is applied to the concave side of the lens immediately before insertion. Wetting agents reduce surface tension between tears and the contact lens or between tears and the cornea, allowing tears to spread evenly. Although natural saliva has excellent wetting properties, it contains many potential pathogens and should never be used as a wetting agent.

Saline Saline is available in preserved or unpreserved formulations (unit dose or multi-dose).64 Preserved saline minimizes the risk of contamination during repeated use. Unpreserved unit-dose saline eliminates potential sensitivity reactions to preservatives. However, microbial contamination can occur if the solution stands for longer than 1 hour or if it is used improperly. Multi-dose aerosol nonpreserved saline is equally effective in preventing sensitivity reactions and remains sterile for the life of the product. Before each use of aerosol saline, dispense and discard a small amount of saline, since the saline inside the mechanism is open to the outside environment and may be contaminated.65

Multipurpose Solutions

An eye care professional may recommend as many as 5 single-purpose products or as few as 1 all-purpose product. To increase convenience, many products combine 2 or more functions in a single solution.66,67Although some researchers suggest that cleaning is compromised with the use of multipurpose solutions, clinical evaluations of multipurpose products for both soft and RGP lenses have shown they improve adherence and exhibit acceptable cleaning efficacy, leading to their wide acceptance. Some of them even disinfect at a rate faster than their recommended time.68 Initial positive results with no-rub formulations69,70 were countered by other studies with varying results leading to more cautious recommendations.71,72 Since then, many studies73,74,75,76,77 and a literature review78 have all recommended the reinstitution of rubbing as more effective than not rubbing. Two separate outbreaks (Acanthamoeba and Fusarium) of keratitis were traced to multipurpose solutions.79 The increase in the use of multipurpose solutions has paralleled the increase in use of silicone hydrogels.80 There has also been an increase in corneal staining and low-grade infiltrates, 2 measures of solution-related toxicity. To minimize the risk of these complications, recommended options include low-impact lens/multipurpose solution combinations, daily disposable lenses or hydrogen peroxide disinfection.

Lens Cases Store contact lenses in their cases, completely covered by disinfecting solution.81 If they dry out, the lens shape can temporarily change, rendering the lens useless until it can regain its original shape. Storage cases must be maintained with the same vigilance as lenses, since a dirty case will nullify the previous steps taken in the care of contact lenses. Keep storage cases clean by routine (at least monthly) boiling in water for 10 minutes. The lens case must be allowed to cool for 30–45 minutes before lenses are placed in it. If the case is not cleaned by boiling at least once a month, replace it monthly. Even if it is cleaned properly on a regular basis, replace it every 3 months. Fortunately, lens case replacement is being incorporated into PRPs. Replace the soaking solution daily. Flush the case of old solution and air-dry it before adding new solution.82 About 40% of bacterial eye infections

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among contact lens wearers can be attributed to carrying cases. Lens case care was the only area of improvement in an adherence study.83

Monitoring of Therapy

Pharmacists can help contact lens wearers optimize lens care by providing information on the many systemic and ophthalmic medications that can affect contact lenses by altering eye shape, affecting the blink reflex, altering tear volume and composition, concentrating in the lens or discoloring the lens (Table 2 and Table 3). Inform the wearer that drug-lens interactions are possible and can negatively affect the success of contact lens wear. Advise all wearers to maintain a current list of their medications, and show it to their eye care professional.

Resource Tips

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American Optometric Association. Available from: www.aoa.org. British Contact Lens Association. Available from: www.bcla.org.uk. Canadian Association of Optometrists. Available from: www.opto.ca. Contact Lens Association of Ophthalmologists. Available from: www.clao.org.

Suggested Readings

Donshik PC, Ehlers WH, Anderson LD et al. Strategies to better engage, educate, and empower patient compliance and safe lens wear: compliance: what we know, what we do not know, and what we need to know. Eye Contact Lens 2007;33:430-3. Foulks GN. Prolonging contact lens wear and making contact lens wear safer. Am J Ophthalmol 2006;141:369-73. Suchecki JK, Donshik P, Ehlers WH. Contact lens complications. Ophthalmol Clin North Am 2003;16:471-84. Szczotka-Flynn LB, Pearlman E, Ghannoum M. Microbial contamination of contact lenses, lens care solutions and their accessories: a literature review. Eye Contact Lens 2010;36:116-29. Woods CA, Jones DA, Jones LW et al. A seven year survey of the contact lens prescribing habits of Canadian optometrists. Optom Vis Sci 2007;84:505-10.

References 1. Alberta Association of Optometrists. Contact lenses. Available from: www.optometrists.ab.ca/contact-lenses. Accessed December 8, 2011. 2. Contact Lens Manufacturers Association. Wouldn't you rather wear contacts than glasses? Available from: www.contactlenses.org/clsglasses.htm. Accessed December 8, 2011. 3. Contact lenses now. Drug Ther Bull 1988;26:39-40. 4. Lum VJ, Lyle WM. Chemical components of contact lens solutions. Can J Optom 1981;43:136-51. 5. Mandell RB. Contact lens practice. 3rd ed. Springfield: Thomas; 1981. p. 495-518. 6. Santos L, Rodrigues D, Lira M et al. The influence of surface treatment on hydrophobicity, protein adsorption and microbial colonisation of silicone hydrogel contact lenses. Cont Lens Anterior Eye 2007;30:183-8. 7. Robertson DM, Petroll WM, Jester JV et al. The role of contact lens type, oxygen transmission, and care-related solutions in mediating epithelial homeostasis and pseudomonas binding to corneal cells: an overview. Eye Contact Lens 2007;33:394-8. 8. Dart JK, Radford CF, Minassian D et al. Risk factors for microbial keratitis with contemporary contact lenses: a

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Contact Lenses and Cosmetics — What You Need to Know

People who wear contact lenses have to be very careful when using cosmetics and other products. Some products (such as mascara or sprays) can irritate the eyes if they get on or under the lenses. To avoid eye problems, choose products carefully and use them safely.

How to use cosmetics safely:

Before handling your lenses, wash your hands and fingers well with soap and water to remove any product that could irritate your eyes (examples—perfume, cologne, lotion, suntan oil, nail polish and remover). Do not apply cosmetics if your eyes are swollen, red or infected.

Apply cosmetics, nail polish, hand creams and perfumes after inserting lenses. Remove lenses before removing makeup.

Apply eye makeup lightly and remove it daily. Use oil-free and fragrance-free eye makeup.

Use a good quality “water-resistant” mascara that does not flake off. Avoid “waterproof” mascara, which likely contains oils. Choose cream eye shadow instead of powder.

Make sure anyone giving you advice on cosmetics knows that you wear contact lenses.

Never use another person's eye makeup. It may contain bacteria that are dangerous to your eyes. Remove your lenses before using hair dye, bleach, perm lotion or medicated shampoo.

Protect your eyes and your lenses when using spray products (such as deodorant or hair spray). Close your eyes when you spray, then walk away from the area. Use pump sprays if possible. If spray particles get on your lenses, you may have to replace them. If you have to remove your lenses temporarily while wearing makeup, you can avoid smearing your makeup by tilting your head to one side after putting your lenses back in. This makes the tears run to the side.

CPhA assumes no responsibility for or liability in connection with the use of this information. For clinical use only and not intended for for use by patients. Once printed there is no quarantee the information is up-to-date. [Printed on: 03-03-2016 05:34 AM] RxTx, Compendium of Therapeutics for Minor Ailments © Canadian Pharmacists Association, 2016. All rights reserved

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