Contact Lens Handling & Maintenance Videos:
courtesy of MEH
courtesy of MEH
courtesy of SynergEyes
courtesy of SLES
Contact Lens Hygeine
Following the correct hygiene procedures is crucial to successful and safe contact lens wear. Comfort and performance will be affected if you extend the life of your lenses beyond the recommended replacement interval or if they are not cleaned and disinfected with the correct solutions. Wearing dirty or damaged lenses can put your eye health at risk. If you are in doubt about which solutions to use with your lenses then ask your eye care practitioner.
The aim of disinfecting and cleaning solutions is to reduce the number of microorganisms that accumulate on the lenses with wear, therefore minimising the risk of infection with contact lenses.
Contact Lens Handling – WASH YOUR HANDS!
Before handling contact lenses, wash your hands with an antibacterial soap, free from perfumes and moisturisers for at least 20 seconds. Rinse thoroughly to ensure there is no soap residue remaining on your fingers, then dry them with a lint free towel.
Contact Lens Maintenance – Stages of Cleaning
Contact lenses should ideally be cleaned with a cleaner then rinsed with saline, before soaking in a disinfecting solution. If the lenses are changed frequently (eg 2 weekly or monthly disposable) then an ‘all in one’ multipurpose solution, alone may suffice providing the lenses are given a rub and rinse with the solution before insertion and upon removal, before storage.
To minimise the risk of infection, the solution and lens case should be changed every month. Make sure you empty the lens case of solution after each use, clean and air-dry it, then replace with fresh solution each time the lenses need to be stored.
Types of Contact Lens Solutions
There are many types and brands of contact lens solution, each with different ingredients and for specific lens types. It’s important to use the solution recommended for your contact lenses at the time of your fitting and to read the instructions carefully.
Multipurpose (preserved) solutions such as Biotrue, Optifree or Quattro are the simplest and most convenient type of soft contact lens solutions, designed to clean, rub, rinse and store lenses. The minimum storage time to ensure adequate disinfection varies but is generally four to six hours. Occasionally some patients experience mild irritation when combining certain multipurpose solutions with certain soft lenses. If this is suspected, try an alternative solution with a different preservative and if the problem persists, see your eye care practitioner to change to a different lens design or preservative free system.
Hydrogen peroxide solutions provide a preservative free method of disinfection and are useful for people who are sensitive or allergic to preserved solutions. After disinfection, the hydrogen peroxide must be neutralised before contact lenses can be worn, otherwise it can cause a painful ‘chemical burn’ to the eye. This either requires a metallic disc which is incorporated in to the case (eg Easysept & Aosept), or a tablet which must be added to the solution (eg Ever Clean & Oxysept 1 step). The minimum storage time is usually around six hours. When hydrogen peroxide solution has been neutralised it will offer no resistance to microorganisms so contact lenses should not be stored for longer than one week in neutralised unpreserved solution. Another type of preservative free solutions contain sodium chlorite (eg Regard & Synergi). These solutions neutralise in contact with light and must be used with an opaque case. With all preservative free solutions it’s particularly important to follow the instructions to avoid problems.
If soft contact lenses are kept for longer than one month, they should also be cleaned with a cleaning solution such as I-clean and rinsed with saline before soaking to prevent a build up of deposits. Periodic use of a protein removal agent (see below) is also recommended if the lenses are not replaced frequently.
Custom tinted, printed and painted soft contact lenses should be cleaned, rinsed and soaked in the same way as clear lenses. Most all in one solutions are suitable for most of these lenses. Our suppliers recommend that Quattro works well with all types of prosthetic and cosmetic lenses. They have reported that occasionally other all in one solutions can cause colour changes in certain lenses. We have had conflicting advice from different laboratories on the compatibility of alcohol based cleaners and hydrogen peroxide systems with hand painted and printed lenses and therefore recommend that these should only be used after ensuring compatibility with the manufacturing laboratory.
Hybrid contact lenses should be cleaned in a similar fashion to soft contact lenses and most soft lens solutions can be used. Our recommendation is to use Quattro which is approved for use with both soft lenses and RGP’s. Alcohol and abrasive cleaners are best avoided, especially with the coated SynergEyes lenses. Hydrogen peroxide solutions provide an alternative for patients with preservative allergies, though in some patients the tear chemistry may react with the hydrogen peroxide to cause a permanent white ring at the junction of the rigid center and soft skirt. This ring does not affect vision or comfort.
RGP contact lenses should be cleaned with a cleaner (such as I-clean or Boston cleaner) in the palm of one hand by rubbing gently with the little finger of the other hand for 20 seconds. The lens should then be rinsed under a stream of saline or conditioning solution (NOT water or boiled water).
After cleaning, lenses should be stored in fresh conditioning solution (eg Boston Conditioning or Blink Total Care). The main purpose of conditioning solutions, also known as wetting and soaking solutions is to disinfect the lens and wet the surface to provide a cushion on insertion.
Recently ‘all in one’ RGP solutions (such as Avizor GP, Menicare Plus, Menicare Pure and Boston Simplus) have become more popular. As with the soft lens all in one solutions it is essential to rub and rinse lenses before and after wear and because RGP lenses tend to be worn in excess of 6 months, these solutions should ideally be complemented with RGP cleaners and protein removal agents as with conditioning solutions.
There are not many preservative free RGP solutions on the market, soft lens preservative free solutions such as those above (eg Ever Clean) can be used.
Orthokeratology lenses are rigid gas permeable contact lenses and should be maintained in the same manner described above. To keep matters simple in the early stages of ortho-k we usually recommend an all in one RGP solution such as Avizor GP or Menicare Plus (or Ever Clean as a preservative free alternative). It is essential to rub and rinse ortho-k lenses with the solution before and after wear and to store lenses in fresh solution each day.
After a short period, we recommend introducing a daily cleaner such as I-clean (see above) and a protein removal agent such as progent (see below) to keep the lenses as clean as possible. Abrasive cleaners such as Boston cleaner should be avoided.
Scleral contact lenses should be maintained in the same manner as RGP lenses. Abrasive cleaners such as Boston are best avoided with surface treated lenses, therefore our first choice cleaner is i-clean which should be rinsed off thoroughly with saline. Scleral lenses can be stored dry, but most suppliers recommend they should be soaked overnight in an RGP solution for improved wettability and comfort. Before insertion they must be rinsed thoroughly and filled with unpreserved sterile saline (eg Avizor or Amidose vials).
Protein removers (such as Ultrazyme, Amiclair and Avizor enzyme) contain enzymes which break down the bonds between protein molecules, enabling them to be rinsed away from the lens. They can be used with RGP or soft lenses, though are not usually required with disposable lenses. Protein removal is only effective on active proteins and should therefore be done regularly (usually once a week). The protein removal tablet should be dissolved in saline or multipurpose solution and the lenses soaked for several hours. It is essential to clean the lenses thoroughly before and after protein removal and to rinse them carefully with multipurpose solution or saline before wear.
Progent is different from conventional enzymatic cleaners and is only for use with RGP lenses. It contains two parts A & B, which when mixed together produce a chemical reaction resulting in the removal of protein deposits and other debris which has stuck to the lens. The lenses should be cleaned and rinsed thoroughly before and after soaking and should only be left in the progent solution for 30 minutes. Menicon recommend Progent should be used once a week.
Ever Clean is a hydrogen peroxide cleaning system that comes with a two layer tablet for neutralisation. The tablet contains a protein removing agent that improves the cleaning of deposits adhered to the lens.
Ocular lubricants, comfort and re-wetting drops should be unpreserved or marked as suitable for use with contact lenses on the eye. Many eye drops are not suitable for use with contact lenses. If in doubt check with your eye care practitioner before using them.
Saline solutions are useful for rinsing contact lenses but should not be used for storing lenses. No other solutions, including any type of water, or saliva, should come into contact with your contact lenses or storage case.
Contact lenses & Swimming
The BCLA (British Contact Lens Association) advice for contact lens wearers is: ‘to not wear contact lenses for swimming – or in hot tubs or whilst showering or participating in water sports – unless wearing tight-fitting goggles over the top. After swimming – or if lenses are removed and stored whilst swimming – contact lenses should be cleaned and disinfected in fresh solution before putting them back on the eyes. The BCLA recommendation is that regular swimmers talk to their eyecare practitioner about being fitted with daily disposable lenses for use with goggles whilst swimming. Wearers of daily disposable contact lenses should always discard them immediately after swimming.’
How to tell if a soft contact lens is inside out
Hold the contact lens on the tip of your dry finger. If the lens turns slightly in at the edges it’s the correct way around – if the edges turn slightly out and the lens looks unusually flat it’s inside out. A lens that’s inside out will generally feel slightly uncomfortable on the eye and will move more than usual.
Infection and contact lenses
Good hygiene and not wearing your lenses overnight are the most important factors in minimising the risk of infection. Poor hygiene increases the chance of an infection by four times. Sleeping in contact lenses overnight also increases the risk by about four times and should always be avoided if you’re unwell. Daily disposable lenses have a low rate of serious infection.
Occasionally you may experience mild discomfort or redness with your lenses. If discomfort is caused by a dirty, dusty or damaged lens, or by the lens being inside out, symptoms will usually improve when the lens is removed.
More serious problems such as corneal infection, affecting the clear tissue at the front of the eye are very unusual but can cause irritation, pain, redness, watery eyes or discharge. The eyes may also be sensitive to light and vision may be blurred. In almost all cases of infection, removing the contact lens does not relieve the symptoms. If you are suffering from these symptoms you must make an URGENT appointment to see your contact lens specialist or go to the nearest Eye Hospital A&E.