May 2023
Column
The CASE Report
We are lagging behind in our specialty lens arena sometimes, compared to regular soft lens wear, when it comes to hygiene - while arguably, there should be more emphasis on lens care with specialty lenses, as we often are dealing with more challenging eyes and more complex lens systems. While the standard of care in the frequent-replacement soft lens arena is typically either to replace the lenses daily or to replace the lens case at least every 1-3 months (advice varies), it almost seems like different rules apply in the specialty lens arena. This may be in part because many lens wearers have been using their specialty lenses for decades. It may be our obligation and our duty to inform patients (better), as insights into (general) health care change, and insights into safe lens care have changed too - such as absolutely no tap water. And if you can't replace the lens itself regularly, at least replace the lens case regularly. See a couple of nasty cases below.

A Couple of Cases
The left picture above is courtesy of Andrew Bowden, an optometrist and specialty contact lens practitioner at Envision Optical (Gold Coast, Australia). It belongs to a 35-year-old male rigid corneal lens wearer. He presented complaining of bilateral red, irritated eyes for several weeks. The lenses are probably six years old, but the patient is not sure exactly which ones he is wearing currently, as he said he might have mixed them up with some old ones. Andews 'public service announcement' is: change your contact lens case every 1-2 months. And if there’s black mold in your case, maybe don’t wear your contacts. The main problem is that it may not be the mold causing the problem but all the other micro-organisms that we can't see with the naked eye. The top right picture was taken by Jillian Campbell, a specialty contact lenses practitioner from Richard Lindsay & Associates 'down under’ in Australia (Melbourne), and shows a case from a rigid corneal lens wearer who was asymptomatic and ‘never had an eye infection,’ in his own words. Possibly the lenses (and the case) are over two decades old. In the specialty lens arena, oxidizing agents (primarily hydrogen peroxide) often are used for their effective disinfecting properties. But their use does not exclude patients from needing to replace their lens case – as we see in the image on the bottom right by Michaella Meertens from Visser contactlenzen in the Netherlands of a scleral lens case from a patient with keratoplasty.
Handling of Multipatient Contact Lenses
Diagnostic Lens Disinfection Guidelines
A poster presented at the last American Academy of Optometry meeting by Kelsy Steele et al states that specialty contact lenses, such as corneal, scleral, hybrid, and specialty soft lenses, are often fit diagnostically in didactic, clinical, or laboratory settings and that proper cleaning and disinfection of these trial lenses is essential to minimize the risk of potentially sight-threatening infections. The 2020 technical report “Guidelines for Handling of Multipatient Contact Lenses in the Clinical Setting” was a joint publication by the American Academy of Optometry Section on Cornea, Contact Lenses and Refractive Technologies and The American Optometric Association Contact Lens & Cornea Section. The purpose of the study by Steele et al was to assess the current practice patterns for cleaning and disinfection of diagnostic lenses at the North American schools and colleges of optometry and to compare these practices to the published guidelines. The vast majority of participants reported performing a cleaning step before disinfection (97% GP, 95% scleral, 92% hybrid, 98% specialty soft) but were not necessarily following the ISO standard. Peroxide-based solutions were most frequently used for disinfection (ranging from 75%-83% for different lens types). No participants reported using tap water to rinse soft or hybrid lenses, but 4.1% and 2.6% reported using tap water to rinse corneal and scleral lenses, respectively. Of the educators, 14.5% reported being unaware of the ISO standards for in-office contact lens disinfection.
Infographic
The described guidelines for diagnostic lenses above are summarized in an infographic. These guidelines specify classify contact lenses into three categories for disinfection purposes. Soft contact lenses (hydrogel) include both silicone hydrogels and HEMA hydrogels. Rigid gas permeable lenses include corneal and scleral lenses. Hybrid contact lenses are composed of a rigid center attached to an outer “skirt” made of a soft lens material. Disinfecting Rigid Lenses: Use a commercially available hydrogen peroxide disinfecting solution currently approved for contact lenses. The 2018 ISO standard recommends a three-hour soak in non-neutralized ophthalmic-grade 3% hydrogen peroxide. Lenses are then rinsed with sterile saline or multi-purpose solution (MPS) and stored dry. Tap water and well water should be avoided at all times due to potential Acanthamoeba contamination. Soft and Hybrid Contact Lenses: follow the same hydrogen peroxide soaking instructions as listed above for rigid lenses. After the three-hour soak time, the solution should be neutralized according to manufacturer guidelines. After neutralization, the lens should be rinsed with saline or MPS and stored in MPS.
Orthokeratology
Multifocal Versus Conventional Ortho-k
Can we 'upgrade' from normal ortho-k to multifocal ortho-k? These two articles explore the possibility of using multifocal ortho-k versus conventional ortho-k. This first article in the Journal of Clinical Medicine by Loertscher, Backhouse, Phillips looks at this for myopia control purposes. They conclude that the efficacy of the novel multifocal ortho-k lens used in this study significantly reduced eye growth compared to conventional ortho-k lenses over an 18-month period. A paper by Michael Wyss in Optometry & Contact Lenses (article in German, abstract in English - open access) states that with the aging population, management of presbyopia with contact lenses has become increasingly important. The article explores the benefits of multifocal ortho-k design. Due to the wider multifocal back-surface design, the adaptation and modulation time until the stable final result is achieved takes about one week longer than with traditional ortho-k, and adequate patient care is of great importance. But in conclusion, he states that presbyopia should not be considered a contraindication in ortho-k lens wearers. The new multifocal designs work well in the long term and are in no way inferior to the well-known conventional presbyopia contact lens options.
Photo: Michael Wyss (Bern - Switzerland)
The 'Latest in Contact Lens Care for Scleral Lenses is a GPLI webinar by Susan Gromacki that was presented on March 21st. She looks at different rigid lens care options. Here are a few highlights. Digital rubbing is critical to success, removing almost all surface debris, which should then be rinsed off to make the disinfection process more effective. She describes both non-abrasive and abrasive cleaners; the latter is not recommended with lenses that have a surface coating. However, she looks at several extra-strength cleaners that would be effective. According to the US Food and Drug Administration, contact lenses should not be exposed to any water: tap, bottled, distilled, lake, or ocean. Want to learn more? See link below.
GPLI
Become a Member
The GPLI Eye Care Professional Membership is a new program that gives eye care practitioners access to premier resources to help you advance your specialty contact lens practice at a low annual fee. The membership supports the ongoing efforts of the GP Lens Institute, and member benefits include: free printed materials (US only), coding and billing module, staff module, building your practice with rigid lens multifocals, archived webinars, free quarterly COPE-approved webinars, bi-monthly member newsletter, access to recent cornea and contact lens residents symposium presentations, quarterly GPLI podcast (“GPLI Radio”), member directory, and more.
BCLA Clinical Conference 2023
The BCLA hosts the UK’s largest Clinical Conference and Exhibition dedicated to contact lenses and the anterior eye every two years. This highly regarded three-day event attracts more than 900 UK and international contact lens professionals, at all stages of their career.
I-site is an educational newsletter that is distributed on a monthly basis and provides an update on rigid gas permeable-related topics (scientific research, case reports and other publications worldwide). I-site is objective and non-political. Disclosure: I-site's editor Eef van der Worp, optometrist PhD FAAO FBCLA FIACLE FSLS, receives educational grants from a number of industry partners but is not related to any specific company.