For anyone interested in minimizing contact lens-induced complications in their practice, notably from poor compliance with lens care, this is a must watch webinar.

Some of the highlights included:

1)  There is a well-established relationship between poor contact lens and case hygiene and adverse ocular events.

2)  Four cases of Acanthamoeba keratitis – all occurring in the same clinic within a 12-month period – were described along with diagnosis and management. Possible etiologies included habitual tap water use, hot tub, and showering with lenses.

Recommendations included the following:

• Even though solution manufacturers have outlined in more detail the risk of non-sterile water contamination of contact lenses and cases, patients may not read the fine print and it is important for optometrists to proactively educate and re-educate.
• Confocal microscopy – used in these cases to diagnose Acanthamoeba keratitis – has the advantages of being quicker, non-invasive, with superior efficacy than other methods. As this testing is often limited to hospital or referral. Settings, it is important to find the one nearest you.

3)  A fifth case was presented for which a patient – fit into custom soft toric lenses – had a history of topping off her solution in the case. She reported with pain, photophobia, redness, lid swelling and discharge. Her culture came back as Pseudomonas. She was managed with fortified antibiotics and resolved with minimal scarring.

4)  Increased risk of contact lens-associated infection occurs via:

• Poor handwashing
• Overnight wear
• Lens and case bioburden
• Infrequent case replacement
• Topping off solutions
• Poor case cleaning

5)  A disconnect exists for both patients and practitioners:

• In a survey of 162 contact lens wearers (1): 86% believed they were compliant but only 34% actually were compliant; and 80% of lens wearers reported being aware of risk factors, but ignored
• Contact lens wearers are often not aware of the specific contact lens care system they are prescribed or that they are using. Contact lens wearers are often not aware of the steps for cleaning and disinfection for lenses, cases, and replacement schedule. (2)

6)  Recent Standards for Care and Disinfection

• 2018 International Organization for Standardization (ISO) 19979:2018(E) publication
• Technical Report: Guidelines for Handling of Multipatient Contact Lenses in the Clinical Setting (3)
• In-Office Disinfection of Multi-Patient Use Diagnostic Contact Lenses. This is a laminated card available from the GP Lens Institute (see Focus on Resources).

Disinfection Protocol: GP Lenses

• Rub all lenses after use with a daily surfactant cleaner
• Minimum 3-hour soak in non-neutralized ophthalmic grade 3% hydrogen peroxide
• Rinse thoroughly with sterile saline or multipurpose solution and store dry
• Reclean and rinse before application

Disinfection Protocol: Soft and Hybrid Lenses

• Rub all lenses after use with a daily surfactant cleaner
• Inspect lenses for any damage
• Minimum 3-hour soak in non-neutralized ophthalmic grade 3% hydrogen peroxide
• After 3-hour soak, solution should be neutralized according to manufacturer’s guidelines
• After neutralization, lens should be rinsed with sterile saline or multipurpose solution
• Transfer lens with sterile cotton swab or contact lens tweezers
• Store lens in container with multipurpose contact lens solution

7)  Contact Lenses in Academia Solutions Study (CLASS) 2022 Survey

• The goal of this study was to understand current cleaning & disinfection practices for multi-patient use diagnostic lenses at the schools and colleges of optometry
• Investigators sent a survey link and received responses from each of 25 ASCO Schools and Colleges in North America.
• The results were presented at the Annual Meeting of the American Academy of Optometry in San Diego.(4)
• The results found that, for the most, the contact lens faculty were following the ISO guidelines.

Some recommendations made included:

• With so many lenses used in a laboratory or academic setting, consider using silicone ice cube trays which will help keep lenses organized while having good compatibility with hydrogen peroxide
• Post the guidelines where visible to doctors, interns, and staff, to improve compliance
• Ensure that hydrogen peroxide, trays, neutralizing cases, gloves, sterile saline, and MPS are readily available and well stocked
• Suggestions to manufacturers: waterproof diagnostic lens labels, laser etching of diagnostic lenses for identification purposes, and supply multiple of most commonly used lenses

References:

1.  Yee A, Walsh K, Schulze M, Jones L. The impact of behavior and care system compliance on reusable soft contact lens complications. Cont Lens Ant Eye 2021;44:101432.

2.  Bui TH, Cavanagh HD, Robertson DM. Patient compliance during contact lens wear: perception, awareness, and behavior. Eye Contact Lens 2010;36(6):334-339.

3.  Sindt C, Bennett E, Szczotka-Flynn L, Sclafani L, Barnett M. Technical Report: Guidelines for Handling of Multipatient Contact Lenses in the Clinical Setting. Optom Vis Sci. 2020;97:544-548.

4.  Steele KR, Man MK, Sicks LA, Rueff E, Satjawatcharaphong P. Educator Awareness of and Adherence to ISO Standards for Multipatient Use Diagnostic Contact Lens Disinfection. Poster presented at the Annual Meeting of the American Academy of Optometry, October, 2022, San Diego, CA.