Professional Documents
Culture Documents
Contact Lens Care & Maintenance
Contact Lens Care & Maintenance
Version:
2012.May.10
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Published in Australia by
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CONTRIBUTORS
5L1-6
WHAT IS CONTACT LENS CARE?
SOFT
SOFT CONTACT
CONTACT LENSES
LENSES
5L1-7
WHAT IS CONTACT LENS CARE?
SILICONE
SILICONE HYDROGEL
HYDROGEL CONTACT
CONTACT LENSES
LENSES
5L1-8
WHAT IS CONTACT LENS CARE?
GP
GP LENS
LENS CASES
CASES
5L1-9
WHAT IS CONTACT LENS CARE?
LENS
LENS CASES:
CASES: SCL
SCL
5L1-10
THE IDEAL CONTACT LENS
CARE SYSTEM: AA BROAD
BROAD VIEW
VIEW
5L1-11
THE IDEAL CONTACT LENS
CARE SYSTEM: AA NARROWER
NARROWER VIEW
VIEW
5L1-13
CONTACT LENS CARE
FDA HYDROPHOBIC LENS GROUPS
(Stone [2007])
5L1-14
THE IDEAL CONTACT LENS
CARE SYSTEM
5L1-15
FACTORS
FACTORS ALTERING
ALTERING PERCEPTIONS
PERCEPTIONS OF
OF
LENS
LENS CARE
CARE
5L1-16
DEFINITION OF CL DEPOSITS
5L1-17
WHAT HAPPENS WHEN LENS
CARE IS IGNORED
Deposited CLs
5L1-19
CLARE: Contact Lens-induced Acute Red Eye
5L1-20
Microbial adhesion to CLs
S. aureus P. aeruginosa
Corneal infiltrate
5L1-22
Reduced vision with soiled CLs
E F D E
often more ‘revealing’)
P R U Z U R
Z H U V P V N F
E N D F U Z E D N E Z F U
P R U D E N V H Z F V Z F H E N U D R P
Assess with
high & low contrast
Snellen charts
5L1-23
CONTACT LENS CARE
THE CURRENT SITUATION
5L1-24
CONTACT LENS CARE
THE COST
5L1-25
WORLD CONTACT LENS MARKET
2010
International CL Markets 2010
Morgan et al., 2011
Country Rigid OK DDs Other DW Soft SiHy DW Soft EW
5L1-26
WORLD CONTACT LENS MARKET
THE FUTURE
• Evolution of CL materials
5L1-27
WORLD CONTACT LENS MARKET
THE FUTURE
5L1-28
WORLD CONTACT LENS MARKET
THE FUTURE
5L1-29
WORLD CONTACT LENS MARKET
THE FUTURE
5L1-30
WORLD CONTACT LENS MARKET
THE FUTURE
5L1-31
CONTACT LENS CARE
DEPOSITS
5L1-32
CONTACT LENS CARE
IN THE DISPOSABLE LENS ERA
SUMMARY
• The need for lens care remains unchanged
• Disposable CLs do not need protein removal
– if protein deposits prove to be a problem,
review frequency of disposal
• DDs = the answer for many but not all wearers
• LCP performance likely to
• The perceptions surrounding the importance of lens
care are FALSE
5L1-33
CONTACT LENS CARE
THE MAIN STEPS
5L1-34
CONTACT LENS CARE
HAND CLEANING
5L1-35
CONTACT LENS CARE
LENS CLEANING
5L1-36
CONTACT LENS CLEANING
RUB or NO RUB?
NO RUB
Why?
• Rinsing alone does not detach adherent/penetrating fungi
• Micro-organisms are not the only ‘concern’
– other lens contaminants also require removal
finger-borne contaminants (lens handling)
– inevitable surface deposition needs to be contained
– a clean lens is usually more comfortable
• Lens wettability is enhanced
(see review by Butcko et al., 2007)
5L1-37
CONTACT LENS CARE
LENS CLEANING continued…
continued…
5L1-38
CONTACT LENS CARE
LENS CLEANING continued…
continued…
5L1-39
CONTACT LENS CARE
LENS RINSING
5L1-40
CONTACT LENS CARE
LENS RINSING continued…
continued…
5L1-41
CONTACT LENS CARE
LENS RINSING
5L1-43
CONTACT LENS CARE
SALINE SOLUTIONS
(Carney et al., 1990)
5L1-44
CONTACT LENS CARE
ANTIMICROBIAL ACTIVITY
After Wikipedia @ 2009-Apr-23
Levels of efficacy:
5L1-45
ANTIMICROBIAL AGENTS
MODES OF ACTION
5L1-46
CONTACT LENS CARE
PRESERVATIVE CHARACTERISTICS
5L1-47
CONTACT LENS CARE
DISINFECTION: TARGETS
Ocular pathogens:
• Bacteria
S. aureus P. aeruginosa
• Viruses
• Protozoans
• Fungi
Acanthamoeba sp. Hyphae of fungus
• Spore forms of any of the above
5L1-48
CONTACT LENS CARE
DISINFECTION: NEED
5L1-49
CONTACT LENS CARE
CHARACTERISTICS
CHARACTERISTICS OF
OF A
A DISINFECTANT
DISINFECTANT
5L1-50
CONTACT LENS CARE
DISINFECTION: D-VALUE
106
0
0 10 20 30 40 50 60 70 80 90 100
TIME (Min)
5L1-51
CONTACT LENS CARE
DISINFECTION: D-VALUE
106
0
0 10 20 30 40 50 60 70 80 90 100
TIME (Min) [Linear Scale]
5L1-52
CONTACT LENS CARE
FACTORS AFFECTING DISINFECTION
5L1-53
CONTACT LENS CARE
DISINFECTION: STANDARDS
• Bacteria:
– Pseudomonas aeruginosa ATCC 9027
– Serratia marcescens ATCC 13880
– Staphylococcus aureus ATCC 6538
Note: Currently (2011), Acanthamoeba spp. are not featured in the Test Panel. Therefore,
there is no mandated requirement that a solution or product needs to meet in regard to
Acanthamoeba spp. This may change following discussions between 2008 & 2010
5L1-54
CONTACT LENS CARE
DISINFECTION: CRITERIA
5L1-55
CONTACT LENS CARE
DISINFECTION: CRITERIA continued
continued…
5L1-56
CONTACT LENS CARE
DISINFECTION METHODS
• Chemical
- cold chemical
- various disinfectants
5L1-57
CONTACT LENS CARE
A BALANCE: EFFICACY vs TOXICITY
5L1-58
CONTACT LENS CARE
ADVERSE REACTION TO A LCP
SYMPTOMS SIGNS
5L1-59
CONTACT LENS CARE
STORAGE
STORAGE &
& CONDITIONING
CONDITIONING SOLUTIONS
SOLUTIONS
• After cleaning & rinsing low CFU count is further by the disinfectant
in S&C
5L1-60
CONTACT LENS CARE
WETTING SOLUTIONS
• GP CLs only
• Solution is applied to GP CLs immediately before insertion
• Solution contains:
– surfactants
lens surface tension & lens wettability
– viscosity-increasing agent(s)
cushions lens on insertion & lens lubricity
comfort on insertion
• Preserved unless unit-dose (single-dose)
• Rôle largely overtaken by S&C solutions or MPSs
• Few products available currently
5L1-61
CONTACT LENS CARE
PROTEIN REMOVAL
5L1-62
CONTACT LENS CARE
PROTEIN REMOVAL: THE #1 TARGET
To remove a protein, it
must be hydrolyzed
For lysozyme, the
four S–S bonds must
be cleaved (broken) to
allow an ‘unraveling’ of
the protein chain
5L1-63
CONTACT LENS CARE
PROTEIN REMOVAL
5L1-64
CONTACT LENS CARE
PUT SIMPLY
5L1-65
CONTACT LENS CARE
RE-WETTING DROPS/LUBRICANTS
In-eye products:
•Soothe dry, irritated, tired, or sensitive eyes
•Preservative-free (unit-dose) or low-irritant preservative
•Alleviate discomfort insufficiently lubricious tears
– or insufficient tear volume
•Alleviate dryness towards end of CL wear
•Rehydrate CLs in situ
•Flush/clean debris from lens surfaces & eye
tear protein denaturation & surface deposition
•Viscous fluid envelope cushions CLs in situ
5L1-66
CONTACT LENS CARE
RE-WETTING DROPS/LUBRICANTS
5L1-67
CONTACT LENS CARE
RE-WETTING DROPS/LUBRICANTS
5L1-68
CONTACT LENS CARE
LUBRICANTS: DO THEY WORK?
“Neither lubricant tested was found to be significantly
superior to saline” (Efron et al., 1990)
5L1-69
CONTACT LENS CARE
RE-WETTING DROPS/LUBRICANTS
5L1-70
CONTACT LENS CARE
CONTACT LENS CARE EPHEMERA
Many gadgets, ‘innovations’, novel ideas,
resurrection of old ideas, etc. appear regularly,
few survive. The reasons for failure include:
5L1-71
CONTACT LENS CARE
COMPLIANCE
5L1-72
CONTACT LENS CARE
NON-COMPLIANCE
Non-Compliance:
• Failure to return for after-care
• Not adhering to prescribed CL wearing schedule
life of CLs >recommended
• Failure to understand the requirements for, or significance of,
the various lens care steps
• Skipping the cleaning and/or disinfection steps
• Using quantities of LCPs than recommended
• Poor general hygiene
• Failure to clean or replace lens case (Woods et al., 2010)
• Not following manufacturers’ instructions (lenses, LCPs)
5L1-73
CONTACT LENS CARE
NON-COMPLIANCE
– 60% - 85%
5L1-74
CONTACT LENS CARE
NON-COMPLIANCE
5L1-75
CONTACT LENS CARE
FACTORS AFFECTING COMPLIANCE
Positively:
• Patient education
• Practitioner attitudes & communication skills
• Use & supply of clear, illustrated instructions
• Simplicity of the lens care system
• Review procedures at every opportunity
5L1-76
CONTACT LENS CARE
FACTORS AFFECTING COMPLIANCE
Negatively:
• Poor or no education from the practitioner
– failure of patient/practitioner ‘partnership’
• Being <30 & using CLs for cosmesis or convenience
• Being 10-30 or >50 or with more than 2 years of lens-
wearing experience
• Differing advice from different practices
• Being a risk taker
5L1-77
CONTACT LENS CARE
FACTORS AFFECTING COMPLIANCE
(after Shannon,1987)
Negatively:
• Complexity of the procedures recommended
5L1-78
CONTACT LENS CARE
FACTORS AFFECTING COMPLIANCE
Negatively:
• Wearer ‘discovering’ a more ‘convenient’ way or an ‘easier’ way
• Laziness
• Erroneous information provided by well-intentioned, ‘helpful’
friends
• Following instructions correctly for different, irrelevant, LCP
and/or CLs
• The awe-struck wearer who is afraid to question the practitioner
or confirm what they think they heard
• Inappropriate practitioner attitudes that act as barriers to
communication
5L1-79
CONTACT LENS CARE
FACTORS
FACTORS NOT
NOT AFFECTING
AFFECTING COMPLIANCE
COMPLIANCE
• Shannon (1987):
– age (other studies suggest age is a factor)
– wearer’s sex
– occupation
– perception of threat or consequence of disease
– race
– highest education level achieved
– socio-economic group
5L1-80
CONTACT LENS CARE
OTHER COMPLIANCE ISSUES
5L1-81
CONTACT LENS CARE
OTHER COMPLIANCE ISSUES
5L1-82
CONTACT LENS CARE
OTHER COMPLIANCE ISSUES continued…
continued…
5L1-83
CONTACT LENS CARE
FDA RECOMMENDATIONS 2010
• Rub & rinse CLs as directed by your eye care professional (ECP)
• Do not ‘top-up’ (top-off) solutions in your case. Always discard all of the
leftover solution after each use. Never reuse any lens solution
• Clean, rinse, & air-dry your lens case (upside-down) each time CLs
removed
• Do not expose your CLs to water: tap, bottled, distilled, lake, ocean, etc.
5L1-84
CONTACT LENS CARE
LENS STORAGE & LENS CASE CARE
5L1-85
CONTACT LENS CARE
LENS CASE BIOFILM SCHEMATIC
Generalized micro-organism
More mature form
x)
atri
x
ri m
at mer
m ly
Planktonic cells de
i r po
r
a a
c ch ellul
ly sa trac
x
po (e o
Ex
Sessile cells
Micro-colony Macro-colony Macro-colony Substrate (e.g. lens case)
Attachment Phase Growth Phase Maturation Release & Dissemination Phase
Reversible then
Colonization (If conditions are favourable)
irreversible
Seconds Seconds - Minutes Hours - Days Hours - Days Days - Months
5L1-86
CONTACT LENS CARE
COMPLIANCE & LENS CASE CARE
5L1-87
CONTACT LENS CARE
LENS CASE CARE
• Rinsing alone is incapable of removing adherent organisms
• Hot water & air-drying bacterial contamination
• Recommendations:
– water temperatures >70°C, or…
– unneutralized peroxide for >20 min, or…
– bleach (sodium hypochlorite [NaOCl]) for >20 min
and…
– periodic scrubbing with dishwashing detergent, bleach, or
peroxide & water using a stiff brush to disrupt any biofilm
established inside the case & lid, & case/lid screw threads
5L1-88
CONTACT LENS CARE
LENS CASE: RECOMMENDATIONS
5L1-89
CONTACT LENS CARE
LENS CASE CARE: OTHER ISSUES
• The supply of new lens case with each bottle of solution has met with
limited success
– some CL wearers are ‘collectors’. Each new case becomes part of a
‘collection’ of unused cases thwarting the original intention
– ‘collecting’ is encouraged by cases that are well-designed, attractive, & well
finished
– conversely, cases made as low-cost, disposable items may be perceived
poorly. Functionally, they may also be inadequate, e.g. they might leak
• The cost of complex cases, e.g. vented peroxide cases, may make the
cost of frequent disposability prohibitive
5L1-90
CONTACT LENS CARE
LENS
LENS CASE
CASE CARE:
CARE: OTHER
OTHER ISSUES
ISSUES
5L1-91
CONTACT LENS CARE
WEAR MODALITY & LENS TYPE
5L1-92
CONTACT LENS CARE
WEAR MODALITY & LENS TYPE
5L1-93
CONTACT LENS CARE
WEAR MODALITY & LENS CARE
5L1-94
CONTACT LENS CARE
SELECTING A CARE REGIMEN
5L1-95
CONTACT LENS CARE
LEGAL ISSUES
5L1-96
CONTACT LENS CARE
SILICONE HYDROGELS 0
After a decade of development, silicone hydrogel CLs (a.k.a. siloxane
hydrogels, SiHy CLs) were launched in 1999
5L1-97
CONTACT LENS CARE
SILICONE HYDROGELS 1
• The reports exposed an unmet need for SiHy LCPs if the ‘problems’
reported were to be addressed adequately
• Subsequently, LCPs targeting SiHy CLs were released
• Throughout this saga, hydrogen peroxide’s status as the yardstick
against which other LCPs should be measured, was confirmed, even
when used with SiHy CLs
• For practitioners, it was also a salutatory lesson on how easy it is to
jump to logical but erroneous conclusions when inadequate ‘research’
(or no research) in undertaken
• Industry’s seizure of the obvious but ultimately hollow marketing
opportunities, also provided a valuable lesson
5L1-98
CONTACT LENS CARE
TO RUB OR NOT TO RUB
• The benefits of CL cleaning by rubbing have been detailed already & have been
long understood
• The Fusarium spp. & Acanthamoeba spp. events of 2005-2007 revealed several
potential problems compounded by the usual compliance issues
• The down-side of the wide acceptance & promotion of a ‘No Rub’ approach
became apparent
• All stakeholders, many of whom never supported ‘No Rub’, now agree that
rubbing is required
• Erasing the entrenched ‘No Rub’ culture will take time & effort by all, especially
practitioners
– omitting rubbing is the easiest form of ‘non-compliance’
• Regulation & approval of Patient Instruction inserts is an obvious next step
– differing regulations around the world are unhelpful
5L1-99
CONTACT LENS CARE
TINTED LENSES
5L1-100
CONTACT LENS CARE
LONG-TERM STORAGE OF CLs
5L1-102
CONTACT LENS CARE
LONG-TERM STORAGE OF CLs
• An alternative is to use unneutralized 3% peroxide in a new,
vented case with 3-monthly (a conservative figure) scheduled
solution changes
– the same provisos detailed previously apply, especially
ensuring the new solution bathes the insides of the case
completely
– current peroxide solutions are well stabilized and can easily
perform this task (a vented case still required)
longer storage is possible & safe but scheduling longer
intervals is more difficult
obviously, CLs require thorough neutralization & rinsing
before further use
• In summary: Discard the CLs – it’s the easiest solution
5L1-103
CONTACT LENS CARE
IN-OFFICE (TRIAL SET) DISINFECTION
• Similar to all other long-term storage
– problems for GP & hydrogel lenses are similar
– a CL practice must set the standard for infection control
• Disposable CLs have problem significantly. However, not all trial
CLs are disposable & GP CLs are unlikely to be disposable in the
foreseeable future
• If trial CLs can be disinfected thermally, this is preferred
– prions are not inactivated by heat used in this context
– any CLs used on a known CJD/vCJD case should be
destroyed
– undiagnosed CJD cases are a risk
there are no known cases of CL-mediated CJD – yet!
5L1-104
CONTACT LENS CARE
IN-OFFICE (TRIAL SET) DISINFECTION
• Alternatives include:
– peroxide storage in a vented lens case with scheduled 3-monthly solution
changes
as neutralization takes time, and is required before reuse, it must be
scheduled immediately before any relevant appointment. The latter
can not always be anticipated
– storage in a MPS with 2-weekly solution changes as described previously.
As none of these solutions are especially strong disinfectants, thorough
cleaning & rinsing before storage, and documentation of the steps taken
are mandatory
as the vial/case/container is likely to be reused many times,
consideration of case hygiene/replacement and/or biofilm formation
are also required
• Although obvious, the need for the case/vial lids to remain on
& sealed needs to be emphasized to all staff in the practice
5L1-105
CONTACT LENS CARE
SUMMARY
5L1-106
GP LENS CARE
PRODUCT
PRODUCT UPDATES
UPDATES
IACLE also invites users of its resources to help it evolve and improve them
5L1-108
IACLE INDUSTRY SPONSORS
5L1-109
5L1-110
ALL
REFERENCES
USED
5L1-112
Davis LJ (1995). Lens hygiene and care system contamination of asymptomatic rigid gas permeable lens wearers . ICLC.
22: 217 – 221.
Dumbleton KA et al. (2010). Relationship between compliance with lens replacement and contact lens-related problems in
silicone hydrogel wearers. Poster Amer Acad Optom Annual Meeting, San Francisco Nov 2010 .
Efron N et al., (1990). Do in-eye lubricants for contact lens wearers really work? CL Ant Eye. 5: 14 - 19.
Epstein AB (2002) . SPK with daily wear of silicone hydrogel lenses and MPS. CL Spectrum. 17(11): 30.
Gleason WJ (1999). Contact Lens Regulations and Compliance. CL Spectrum. May or visit:
http://www.clspectrum.com/article.aspx?article=&loc=archive%5C1999%5Cmay%5C0599034.htm
Hickson-Curran SB et al. (2010). Making the case for daily disposable contact lenses: patient non-compliance with
storage case hygiene and replacement. Poster Amer Acad Optom Annual Meeting, San Francisco Nov 2010 .
Hind HW (1979). Contact lens solutions: Yesterday, Today, and Tomorrow. CL Forum. 4(100): 17 – 27.
Houang E et al. (2001). Microbial keratitis in Hong Kong: relationship to climate, environment and contact-lens
disinfection. Trans R Soc Trop Med Hyg. 95: 361 - 367.
Houlsby RD et al. (1984). Microbiological evaluation of soft contact lens disinfecting solutions. J Am Optom Assoc. 55(3):
205 – 211.
Jones L, Senchyna M (2007). Soft contact lens solutions review: Part 1 - components of
modern care regimens. Optometry in Practice 8: 45 - 56.
Kilvington S (2000). Through a glass darkly – Contact lenses and personal hygiene. Microbiol Today. 27(5): 66 – 69.
Ky W et al. (1998). Clinical survey of lens care in contact lens patients. 24(4): 216 – 219 & comment 194.
Lakkis C et al. (2010) reported in Sivak A (2010), ARVO 2010 Part 2 available at:
http://www.siliconehydrogels.org/meeting_synopsis/index.asp (accessed on 2010-Dec-22).
Larragoiti ND et al. (1994). A comparative study of techniques for decreasing contact lens storage case contamination . J
Am Optom Assoc. 65(3): 161 – 163.
Leluan P et al. (1991). Amoebic and bacterial contamination of contact lens storage cases. Contactologia 13: 137 – 141.
Mayers M et al. (2010). Compliance and contamination in contact lens wear. Poster Amer Acad Optom Annual Meeting,
San Francisco Nov 2010 .
McGeehon M (1988). Guidelines to handling problem patients. CL Forum. 13(4): 23 – 28.
McMonnies CW (1988). Is there a way through the maintenance minefield? J BCLA. 12 (Science Meeting): 26 – 31.
5L1-113
Morgan PB et al. (2011). International Contact Lens Prescribing in 2010. CL Spectrum. January 2011. Available at:
http://www.clspectrum.com/article.aspx?article=105084
Peterson R et al. (2010). Impact of a rub and rinse on solution-induced corneal staining. Optom Vis Sci. 87: 1030 – 1036.
Powell CH et al. (2010). ARVO Fort Lauderdale, May 2010. Synopsis by Sivak A Oct 2010 Meeting Synopsis on the
silicone hydrogels website (www.siliconehydrogels.org)
Radford CF et al. (1993). Contact lens hygiene compliance in a university population. J BCLA. 16(3): 105 – 111.
Seal D et al. (1999). Acanthamoeba keratitis in Scotland: Risk factors of contact lens wearers. Cont Lens Ant Eye. 22(2):
58 - 68.
Schwartz CA (1987). What’s on their minds when they don’t comply? Review Optom. 130: 49.
Shannon BJ (1987). Don’t quit with the fit. CL Forum. 12: 46 – 48.
Shih KL et al. (1985). The microbial benefit of cleaning and rinsing contact lenses. ICLC. 12(4): 235 – 242.
Shih KL et al. (1991). Disinfecting activities of non-peroxide soft contact lens cold disinfection solutions. CLAO J. 17(3):
165 – 168.
Sokol JL et al. 1990. A study of patient compliance in a contact lens wearing population. CLAO J. 16(3): 209 – 213.
Stapleton F et al. (1995a). Epidemiology of Pseudomonas aeruginosa keratitis in contact lens wearers. Epidemiol Infect.
114(3): 395 – 402.
Stone R (1988). Why contact lens groups? CL Spectrum. 3: 38 - 41.
Sweeney DF et al. (1992). Contamination of 500 ml bottles of unpreserved saline. Clin Exp Optom. 75(2): 67 – 75.
Tonge et al. (2001). Contact lens care: Part 6: - Comfort drops, artificial tears and dry-eye therapies. Optician 222(5817):
27 – 33.
Turner FD et al. (1993). Compliance and contact lens care: A new assessment method. Optom Vis Sci. 70(12): 998 –
1004.
Wilson LA et al. (1990). Microbial contamination of contact lens storage cases and solutions. Am J Ophthalmol. 110: 193
- 198.
Wilson LA et al. (1991). Comparative Efficacies of Soft Contact Lens Disinfectant Solutions Against Microbial Films in
Lens Cases. Arch Ophthalmol 109: 1155 – 1157.
Woods CA et al. (2010). Compliance with lens care and contact lens case care and replacement. Poster Amer Acad
Optom Annual Meeting, San Francisco Nov 2010 .
5L1-114
CONTACT LENS CARE
PRESERVATION STANDARDS
ISO 14730: Preservative Efficacy Test (tests effectiveness up to 30 days, no CLs involved,
microbial re-challenge @ 14 days, tests for initial efficacy & shelf-life. Test is basis of 30-day
lens storage)
Test Panel (TP) of Organisms (inoculum 1 X 10 7 to X 108 CFU/mL):
• Fungi:
5L1-115
CONTACT LENS CARE
PRESERVATION CRITERIA
ISO 14730: Performance Requirement (inoculum 107 to 108)
Bacteria A preservative acts as a
• At 14 days & before re-challenge LCP ‘defence system’
5L1-117
CONTACT LENS CARE
A BRIEF HISTORY 1
• Thermal disinfection used on the first HEMA SCLs (1950s):
– lens case immersed in boiling water
– denaturation of tear protein induced adverse reactions/hypersensitivity
– lens deposits comfort & lens life
– eventually, enzymatic protein removal treatments addressed these issues
partially
– still the cheapest & most effective antimicrobial treatment but prions
remain effective
– later, automatic electric wet, and later still, electric dry heat units were
developed deploying lower temperatures (70-85°C) to reduce
denaturation
– still applicable to HEMA trial (diagnostic) lenses
5L1-118
CONTACT LENS CARE
A BRIEF HISTORY 2
5L1-119
CONTACT LENS CARE
A BRIEF HISTORY 3
• Next were the so-called cold chemical systems in which CLs (rigid & soft) were
immersed after cleaning & rinsing:
– disinfectants used included: mercurials (e.g. thimerosal), chlorhexidine (a
biguanide, e.g. chlorhexidine gluconate), quaternary ammonium compounds or
QACs (e.g. ATAC or ATEAC)
– a common excipient then & now was EDTA. Later, benzalkonium chloride (BAK –
rigid lens only), sorbic acid, chlorbutanol (an alcohol), benzyl, ethyl, & isopropyl
alcohols were also used
initially, EDTA included as a disinfectant/preservative enhancer, later its
calcium-chelating properties were also harnessed
– adverse reaction rates to individual ingredients or combinations of ingredients
were significant especially in hydrogel wearers. Research resulted in the evolution
of the modern polymeric biguanides & QACs that now underpin the majority of
non-peroxide LCPs
5L1-120
CONTACT LENS CARE
A BRIEF HISTORY 4
• Chlorine–based systems have appeared & disappeared
– usually in tablet form, these products proved to be less efficacious
than desired, e.g. they were less effective against fungi &
Acanthamoeba spp. [especially encysted])
– efficacy was by chlorine’s predilection for binding to biological soil,
hence removing it from solution
– they were simple & economic
• A chlorhexidine-based tablet system was introduced but the ocular
reaction rate to the product limited its marketability
• UV-generating (usually UV-C), ozone generating, & microwave oven-
based disinfection systems have also appeared. Few remain
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• Chemically, peroxide systems have changed little over time
– most are now 1-step (tablet or disc)
• A sodium chlorite-hydrogen peroxide disinfectant & a sodium chlorite
preserved (a so-called ‘disappearing preservative’) series of in-eye
products round out the current LCP market
• Other additions include anti-acanthamoebal compounds (e.g. MAPD).
Such inclusions can be expected to become more common in future
LCPs
• EDTA is still a common inclusion in LCPs
• Many solutions, especially cleaners, still include viscosity-increasing
agents
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Why have some products survived? Possibilities include:
• Success at balancing efficacy & toxicity, i.e. product is effective against micro-
organisms & relatively ineffective against the anterior eye
• Strong marketing of an acceptable product
• Availability of starter kits at little or no cost. However, unpublished studies have
shown that even free kits do not necessarily ensure market penetration/success
• Competitive pricing of an acceptable product
– intuitively, nothing will save an unacceptable product. Sometimes however,
‘failure’ takes time
• Addressing a niche market that is unattractive to competitors (often due to small
size or highly specialized nature)
• Adequate & relevant market research used to steer product development
• Luck – having the right (appropriate) product at the right time
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Why have some products failed? Possibilities include:
• Failure to balance efficacy & toxicity
• Poor marketing of an acceptable product
• Uncompetitive pricing of an acceptable product
• Addressing a niche market that is too small to be sustained
• Inadequate and/or poorly targeted market research used to steer product
development
• Failure to ‘move with the times’ – product(s) perceived as ‘old’
• Inadequately researched product
• Failure to take ‘worst case scenarios’ into account, e.g. user non-compliance
• Unforeseen changes in external factors, e.g. reticulated mains water disinfection
levels, that alter the anticipated user environment
• Bad luck
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