Soft Contact Lens Solutions Lecture 2017

1 2/1/17 1 So( Contact lens Solu3ons & Pa3ent Instruc3on Maria K. Walker, OD, MS, FAAO February 2, 2017 Terminology CL: Contact lenses SCL: So( Contact Lenses HEMA: Hydrogel ( Contact Lenses) SiHy: Silicone Hydrogel ( Contact Lenses) MPS: Mul3- purpose solu3on 2016 Distribu3on of CL FiSng JJ Nichols. Contact lens 2017. 2/1/17 2 2016 Distribu3on of CL FiSng JJ Nichols. Contact lens 2017. Pa3ent Educa3on Very important to the success of CL wear Noncompliance and lack of knowledge are primary causes of SCL adverse events Four (prac33oner) factors contribute to pa3ent noncompliance 1. Poor instruc3on 2.))

2 No instruc3on 3. Poor example 4. Overloading pa3ent with informa3on at dispense Pa3ent Educa3on Applica3on of lenses: Washing and drying hands Opening blister pack Determining lens inversion (taco test) Actually apply lenses (several acceptable methods) Can demonstrate if a CL wearer Can have staff do this, but be sure they are well trained Adequate ligh3ng and mirrors Set up a good example in your office! 2/1/17 3 Taco Test Pa3ent Educa3on Removal of lenses: Hand washing! Floa3ng lenses prior to removal if 3ght Youtube, Pa3ent Educa3on lens Cleaning: Most important educa5onal step!

3 Pa3ents will be most compliant if their cleaning system is simple and innexpensive Rub and rinse analogy Proper management of CL cases 2/1/17 4 Pa3ent Educa3on Increasing wear 3me gradually for adapta3on NO Tap EVER EVER with so( lenses! Avoid swimming and showering Not as much of concern with daily disposable Generally daily and monthly are easier for pa3ents to remember proper replacement 1st and 15th replacement for bi- weekly lens Deposits Mucin balls 2/1/17 5 2/1/17 6 Pa3ent Educa3on ALWAYS give new CL wearers wrihen instruc3on Cosme3cs & Contact Lenses Makeup Suntan lo3ons A(er- shave lo3on Shampoo Oils / creams Acne medica3ons Accutane 2/1/17 7 2/1/17 8 2/1/17 9 History of SCL Care Solu3ons 1971.))

4 First Hydrogel Solu3ons Mid 1980s MPS evolved Introduc3on of polyaminopropyl biguanide and polyquaternium- 1 (preserva3ves) August 15, 2010: FDA guidance recommends manufacturers remove no- rub from bohles. Heat uncommon now Original chemical disinfectants SCL Solu3on Components Disinfectants Preserva3ves (Chela3ng agents) Surfactants Lubrica3ng agents WeSng Agents (minor components): Tonicity, pH/buffers, stabilizers 2/1/17 10 2/1/17 11 Preserva5ve Toxicity Preserva5ve Toxicity 2/1/17 12 Preserva3ve Toxicity 2002 study on corneal staining in hydrogel lens wearers 500 full 3me wearers, 20 clinical sites Any staining present in at least one eye: Moderate/severe staining: 8% No correla3on to care system Steps of SCL Disinfec3on Physical (rubbing, rinsing) vs.

5 Chemical (soak 3me) Chemical: Myristamidopropyl dimethylamine (Aldox) An3- fungal and an3- amoebic ac3vity Polyquaternium- 1 (Polyquad) Also binds cell membrane Polyhexamethylene biguanide (Dymed, TrisChem) Binds (- )phospholipids in cell membranes. (problem?) Hydrogen peroxide (3% = 30,000ppm) Very toxic at 3% Neutralized to <100ppm 2/1/17 13 H2O2 solu5ons Commonly used when pa5ents have preserva5ve sensi5vity Kills bacteria and fungi 3% used (30,000ppm) Pla5num catalyst or catalase neutralizer Leaves the lenses in a non- preserved solu5on aMer neutraliza5on Advanced Cleaning Systems 2/1/17 14