Soft Lens Care 

Kelsy R. Steele OD MS

Clinical Instructor and Researcher at The Ohio State University College of Optometry (US) 

Introduction

Soft contact lenses account for approximately 90% of contact lens fits worldwide. Soft lenses offer patients exceptional comfort and vision coupled with straightforward lens handling and care. But despite the overall ease of use associated with soft lenses, many patients struggle to maintain compliant lens care.

Utilization 

The use of daily disposable lenses continues to increase annually, in part due to the lower risk of infectious and inflammatory events and to better replacement compliance associated with their use when compared to planned-replacement lenses. While the call for “daily disposables for all!” has its merits, a complete conversion to daily disposable lenses in the soft lens market is not currently feasible. Budgetary concerns aside, there are many clinical, refractive, and cosmetic situations for which planned-replacement lenses are the most appropriate option. 

Lens Care and Handling

The recommendation of a contact lens disinfection solution may be almost as important as the selection of the lens itself. Various factors contribute to the overall patient experience with a disinfection protocol, including preservative sensitivities, ocular surface conditions, disinfection protocol compliance, and contact lens material, to name a few. Hydrogen peroxide-based solutions offer effective cleaning and disinfection without the addition of preservatives, and some studies have demonstrated lower risks of corneal staining and corneal infiltrative events with the use of hydrogen peroxide-based solutions when compared to multipurpose solutions.[1,2] Although hydrogen peroxide can be an ideal option for many planned-replacement lenses, this solution may be contraindicated with tinted or prosthetic lenses; in these cases, following the manufacturer-recommended guidelines is warranted. 

Proper contact lens storage case care and replacement can play an important role in the prevention of corneal inflammatory and infectious events. Up to 80% of lens storage cases exhibit contamination,[3] and the level of contamination is associated with increasing age of the case. Unsurprisingly, the use of older storage cases is associated with a higher risk of both corneal inflammatory and infectious events. Therefore, it is

recommended that patients replace contact lens storage cases every 1-3 months. Additionally, the best clinical practice for storage case cleaning includes rinsing the case with fresh solution, rubbing the lens wells with clean fingers, wiping the wells with a clean tissue or paper towel,

and air drying face down.[4]

Behaviors that expose contact lenses to water increase the risk of potentially serious corneal infections. Although soft contact lens wearers are less likely than gas permeable lens wearers are to expose their lenses to tap water in association with cleaning and storing, these practices are still reported. As many as 31% of soft lens wearers report ever using tap water to rinse their lenses; up to 15% report using tap water to store their lenses.[5] More common water exposure behaviors for soft lens wearers include swimming and showering. Contact lens contamination by water-borne pathogens can occur even without direct water contact; therefore, it is important to discuss these behaviors with all contact lens wearers. Additionally, practitioners should emphasize and model proper hand hygiene when handling contact lenses, which includes washing hands with antimicrobial soap and water followed by thoroughly drying hands with a clean towel or paper towel. 

Complications

There are a number of potential complications associated with contact lens wear, the most serious of which is microbial keratitis (MK). Contact lens wear is one of the most frequently reported risk factors in the development of MK. Specific contact lens behaviors, including poor lens case hygiene, poor hand hygiene, storing lenses in water, wearing lenses while swimming and showering, and disinfecting lenses with certain multipurpose solutions, are associated with an increased risk of developing MK. The most frequently encountered form of MK is bacterial in nature, and 20-50% of these cases are associated with contact lens wear. The Gram negative microbial species that are most commonly isolated with bacterial keratitis are Pseudomonas aeruginosa and Serratia marcescens, both of which are water-borne pathogens. Acanthamoeba species are also water-borne, and they are the causative organisms in protozoal keratitis. Acanthamoeba species have been isolated from a wide variety of water sources, including municipal water supplies, household taps, bottled water, air conditioning units, and eyewash stations. Contact lens wearers are particularly at risk for developing this form of keratitis, for as many as 96% of Acanthamoeba keratitis (AK) cases present in association with contact lens use.[6] Although AK is quite rare and progresses slowly, it is often initially misdiagnosed because it has a presentation that is similar to keratitis with bacterial, viral, or fungal etiologies. 

The Practitioner’s Role

Despite the poor compliance with contact lens care historically demonstrated by patients, specialty contact lens practitioners can influence patient behaviors with targeted education. There is discrepancy between what patients recall hearing and what providers report saying regarding contact lens education given by eye care providers. The Centers for Disease Control and Prevention recently reported that approximately 33% of contact lens-wearing patients do not remember hearing any of the items from a list of contact lens care recommendations at their most recent visit. This is in contrast to the nearly 40% of providers who report presenting all nine of the listed recommendations at regular checkups.[7] A previous study found that patients are more compliant with contact lens case hygiene when provided both verbal and written instructions versus verbal instructions alone.[8] Additionally, a study presented at the 2019 British Contact Lens Association meeting found that planned-replacement contact lens wearers demonstrated improved water contact behaviors after using a storage case that included a “no water” sticker when compared to a group who used a traditional case without the message.[9] In a recent article that explored the association of water exposure and contact lens-related disease, Arshad and colleagues stressed the importance of presenting an unequivocal message to patients concerning contact lens exposure to water of any kind. This is especially key in part because of the extensive water imagery included in contact lens packaging and marketing materials, which have the potential to cause patient confusion.10 Keeping all of this in mind, it is clear that it is important to utilize a variety of forms of patient education to get the message across, and repetition is key. 

Conclusion

Soft contact lenses can offer refractive, cosmetic, and customizable options to serve a broader patient population. By providing thorough, repetitive, and realistic care and handling instructions to soft lens wearers, practitioners can help to mitigate potentially serious contact lens-associated complications.

References

1. Lazon de la Jara P, Papas E, Diec J, Naduvilath T, et al. Effect of lens care systems on the clinical performance of a contact lens. Optom Vis Sci 2013;90:344-50.

2. Chalmers R, Wagner H, Mitchell G, et al. Age and other risk factors for corneal infiltrative and inflammatory events in young soft contact lens wearers from the Contact Lens Assessment in Youth (CLAY) Study. Invest Ophthalmol Vis Sci 2011;52:6690-96.

3. Szczotka-Flynn L, Pearlman E, & Ghannoum M. Microbial contamination of contact lenses, lens care solutions, and their accessories: a literature review. Eye Contact Lens 2010;36:116-129.

4. Wu Y, Zhu H, Willcox M, & Stapleton F. Removal of biofilm from contact lens storage cases. Invest Ophthalmol Vis Sci 2010;51:6329-33.

5. Zimmerman A, Richdale K, Mitchell G, et al. Water exposure is a common risk behavior among soft and gas-permeable contact lens wearers. Cornea 2017;36:995-1001.

6. McKelvie J, Alshiakhi M, Ziaei M, et al. The rising tide of Acanthamoeba keratitis in Auckland, New Zealand: a 7-year review of presentation, diagnosis and outcomes (2009-2016). Clin Exp Ophthalmol 2018;46:600-607.

7. Konne N, Collier S, Spangler J, Cope J, Healthy contact lens behaviors communicated by eye care providers and recalled by patients – United States, 2018. MMWR Morb Mortal Wkly Rep 2019;68:693-697.

8. Tilia D, Lazon de la Jara, Zhu, et al. The effect of compliance on contact lens case contamination. Optom Vis Sci 2014;91:262-271.

9. Arshad M, Carnt N, Tan J, et al. “The effect of ‘no water’ stickers on contact lens wearer’s contact behaviors” in Clinical conference & exhibition of British Contact Lens Association (BCLA), UK, May 2019.

 Kelsy Steele is a clinical instructor and researcher at The Ohio State University College of Optometry.

She completed a 2-year Cornea and Contact Lens Fellowship following her optometric education and she is currently working on a PhD in Vision Science.

Kelsy is involved in a variety of collaborative contact lens-focused research projects. She enjoys writing and lecturing on topics including contact lens-related hygiene and compliance, and corneal inflammatory and infectious conditions.