contact lens solutions

Surprising “Facts” Your Patients Learn on the Internet

These O.D.s searched the web to report the most common lens care myths.

ERNIE BOWLING, O.D., M.S., F.A.A.O. (DIPL.), Gadsden, Ala.
GREGG E. RUSSELL, O.D., F.A.A.O. (DIPL), Marietta, Ga.

The Internet is a wonderful thing, that is, until your patients use it to search for advice about their vision instead of asking you. It has the advantage of being “open” 24 hours a day, and in fact, it does contain a wealth of information, although not necessarily accurate, up-to-date information. The problem is that it's sometimes difficult for patients to differentiate what's true and what's not. Even patients themselves can post blogs or write responses to others' questions and become “experts,” and if someone is searching the Internet to find answers that support his own theory, even if that theory is incorrect, he's bound to find someone somewhere who will agree with him.

A Google search for “contact lens solutions” yields 3.5 million results!¹ As your patients flock to these websites, trolling for information, they will likely encounter a lot of myths, half-truths and misinformation. Although it's impossible to review every website that discusses contact lens solutions, we have reviewed some of the worst and some of the best, so we can better educate our patients.

Recipes for disaster

In a free and democratic society, individuals can speak their minds and offer opinions without fear of recrimination. Only by verifying credentials, certifications and education do we know if someone is truly an expert on a particular topic. What surprised us most in our online research was the lack of credentials for most Internet authors. On LinkedIn, for example, someone asked a series of questions on topics ranging from lens care distribution channels to solution recalls.² Among the responses were opinions about product efficacy, the dangers of parasites such as lice, and how “surgical synthetic lens replacement” is making great strides. None of the respondents identified themselves as eyecare professionals.

We need to be sure our patients understand that postings such as these often are not regulated or reviewed by medical professionals, and they may recommend questionable or even harmful practices. For example, we know saline does not disinfect contact lenses, and Acanthamoeba infection is a real and present danger when lenses are not disinfected properly. Yet, an anonymous contributor to the eHow website has posted a recipe for homemade saline, using distilled water and table salt.³ This article includes a warning about the dangers of “improper use of homemade saline,” which we assume is eHow's disclaimer. Other sites, such as a “green living” bulletin board, offer similar recipes for saline to use for overnight storage with no disclaimers whatsoever.⁴ There are even recipes for making your own hydrogen peroxide solutions.⁵ At the bottom of one of these articles is a note that a platinum disk is to be used for the solution, but no mention of how long to store it or the concentration of peroxide to be used in the solution.

In fairness, one has to dig fairly deeply to find lay sites promoting their own information. The disturbing point for us was the lack of disclaimers and the ease with which information is imparted. Anyone can post anything on any subject on the World Wide Web. The Web makes no judgment about the quality of content.

Many of these articles are likely written by professional copywriters who lack eyecare experience. One especially prolific writer is a certified nursing assistant, who “will show you how to decide which [contact lens solution] works best for you.”⁶ This author's criteria for what works best is simply, “how long you will be able to soak your lenses each night.” He goes on to advise, “If you are unsure of the amount of time that you will soak, the best bet is to use [a multipurpose solution]. If you can let your lenses soak for at least 6 hours straight, then [a peroxide system] can be just the right solution for you.”

At the other end of the spectrum are websites that offer precautions that may go too far. For example, patients need to be careful with solution and cleaner compatibility, but one site stated solution incompatibility “in extreme cases can lead to blindness.”⁷

Trusted sites

Many people still believe the media — print, electronic, television, radio — are held to such standards that they can only report the truth. Anyone who has stood in a supermarket checkout line and scanned the tabloids knows that is a delusion. It is our job not only to thoroughly instruct patients on lens care when we dispense their contact lenses, but also to reinforce that information at each visit. It's also beneficial to know what our patients could be reading online so we can advise them accordingly.

Where should you send your patients for accurate lens care information on the Web? In general, solution manufacturers' websites provide pertinent, reference-based information on their products. We have to admit we are partial to manufacturers whose websites state, “Always use the contact lens solution prescribed by your doctor.” Some manufacturer's sites offer helpful lens care tips for eye health. Other good websites for your patients to visit include:

► Allaboutvision: www.allaboutvision.com
► British Contact Lens Association: www.bcla.org.uk/clinfo.asp
► Contact Lens Section of the American Optometric Association: www.aoa.org/contactlenses.xml
► U.S. Food and Drug Administration: www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/ContactLenses/default.htm

These sites are patient-centric and provide useful, clinically relevant information for doctors and consumers.

Ultimate trusted source

The best source of information about contact lens solutions is you, the patient's eye doctor. Studies have shown that 75% of patients comply with their eye doctor's recommendation for contact lens solutions and wearing schedules.⁸

Patients listen to their doctors and take their advice to heart. They are looking to you for accurate, unbiased information. It is important to prescribe the solution you feel is best for them, and to explain why. Using your knowledge as a filter to the abundant and often misleading and dangerous information available on the Internet, you can direct patients to the sites they need to see to educate them further. That education, like all patient education, begins with the doctor. OM

1. Google Web Search, “contact lens solutions.” Accessed 3/9/10.
2. www.linkedin.com/answers/health/health-care/HTH_CAR/627070-16007104. Accessed 3/9/10.
3. www.ehow.com/way_5635271_homemade-contact-lens-cleaner.html. Accessed 3/9/10.
4. www.dld123.com/q&a/index.php? cid=3710. Accessed 3/9/10.
5. www.ehow.com/how_5136913_make-own-contact-lens-solution.html. Accessed 3/9/10.
6. http://ehow.com/how_5614052_choose-contact-lens-solution.html. Accessed 3/9/10.
7. http://www.wholesale contactlists.com/contactlenscleaningsolution.html. Accessed 3/9/10.
8. Corbin G, Bennett L, Espejo L, et al. Comfort associated with a marketed contact lens care solution. Poster presented at: The 112th Annual AOA Congress; June 24-28, 2009; Washington DC.

	Dr. Bowling is center director at VisionAmerica, a surgical comanagement center in Gadsden, Ala. Contact him at drbowling@windstream.net.
	Dr. Russell practices at the Marietta Eye Clinic. He specializes in contact lens fittings for patients who have keratoconus, corneal scars and refractive surgery complications. Contact him at drgreg-grussell@att.blackberry.net.