solutions

The Ideal Solution: It's Getting Close

Contact lens solution experts and manufacturers discuss the latest advances in this sector and your role in their success.

Corrie Pelc, CONTRIBUTING EDITOR, Sacramento, Calif.

Turn to your tablet, smart phone, or if you're a traditionalist, grab a piece of paper and a pen. Ready? Type or write your definition of the ideal contact lens solution. If you typed or wrote: “strong anti-microbial efficacy, ocular surface and lens material compatibility (which leads to patient comfort),” you're not alone.

“ … These characteristics will induce minimal physiological disruption to the ocular surface for the vast majority of contact lens wearers,” explains Percy Lazon de la Jara, B Optom., Ph.D., head of clinical research for the Clinical Research and Trials Centre at the Brien Holden Vision Institute in Sydney, Australia. Improved ocular physiology is likely to result in better long-term comfort during contact lens wear.”

David Meadows, Ph.D., head of Vision Care Development for Alcon, which produces the Opti-Free line of solutions, adds the ideal solution would help ensure that every lens is as comfortable as possible for every patient throughout the day, regardless of the contact lens make or model.

“With 15% to 20% of patients dropping out of lens wear in the first year [due to solution problems], there continues to be room for improvement,” he says.

Dave Hansen, O.D., F.A.A.O., head of Global Professional Services for Abbott Medical Optics (AMO), which produces the RevitaLens OcuTec Multipurpose Disinfecting Solution, Complete Multi-Purpose Solution Easy Rub Formula and the Oxysept UltraCare Formula Peroxide Disinfection System, says disinfection is paramount.

“What you need is the highest disinfection to kill the microbial world as we know it,” he says. “You want a clean and comfortable lens, but you must have the highest disinfection first for the emerging microbial pathogens.”

To determine just how close the ideal solution is, we interviewed contact lens specialists and manufacturers. (See “An RGP Solution,” page 36.)

Here's what they had to say.

Improved anti-microbial efficacy

A new generation of multipurpose solutions (MPS) is now available that has improved antimicrobial efficacy. Specifically, these solutions are comprised of two disinfecting agents. Manufacturers of the new generation of MPS products say these dual-action solutions enhance efficacy in eradicating microbes suspended in solution, says Dr. Lakshman Subbaraman, Ph.D., BSOptom, F.A.A.O., head of biological sciences for the Centre of Contact Lens Research, School of Optometry and Vision Science at the University of Waterloo in Ontario, Canada. “Moreover, these MPS have been shown to be effective against pathogens that are difficult to kill, such as Fungi and Acanthamoeba” — of particular interest to you, the practitioner, given the Fusarium and Acanthamoeba keratitis cases linked with solutions roughly five years ago.

Dr. Hansen says AMO's dual disinfection science has provided microbe removal in stand-alone, “real world” conditions.

Mohinder Merchea, O.D., Ph. D., M.B.A., F.A.A.O., F.B.C.L.A., director of Medical Affairs for North American Vision Care at Bausch + Lomb, adds that the dual disinfectant MPS, Biotrue, provides peroxide level disinfection and also provides up to 20 hours of comfort, a balance which he says is critical in making wearing lenses easier on patients and in promoting better compliance to their practitioner recommendations.

“Assuring that these lens care products have the best disinfection possible while providing patients with exceptional comfort, makes patients more likely to adhere to the recommended solution and wear schedule,” he says.

Biocompatibility

Solution manufacturers are continuing to attempt to develop products that are both ocular surface and lens-material compatible, with the most recent developments associated with ocular surface compatibility.

For instance, lens care products are beginning to move away from only using traditional ingredients and instead are using ingredients found within the ocular environment to improve ocular surface compatibility, says Dr. Merchea.

“Hyaluronan (HA) [for instance], is a naturally occurring moisture-loving molecule that is found throughout the human body and acts as a binding, lubricating and protective agent. HA is found in the vitreous, lacrimal gland, cornea, conjunctiva and in tear fluid and is essential for keeping the epithelium hydrated and stabilizing pre-ocular tear film,” he explains. “Each HA molecule is able to hold up to 1,000 times its weight in water. This property is important for keeping the corneal epithelium hydrated, for stabilizing the pre-corneal tear film and helps deliver long-lasting comfort.”

Dr. Merchea adds that HA also lubricates ocular tissues to reduce friction, resulting in the tear film lubricant spreading across the eye for a smooth coating.

Dr. Hansen says AMO's OcuTec component addresses ocular surface compatibility.

“The components of the OcuTec formula were scientifically designed without including hydrogen peroxide or having the patient compliance problems associated with hydrogen peroxide, including burning of the ocular surface,” he explains. He adds that removal of the contact lens/tear film biofilm is accelerated with AMO's recommended rub and rinse cleaning regimen.

Dr. Meadows explains that Alcon has developed proprietary formulation technologies and disinfection platforms that provide high levels of antimicrobial activity while also maximizing biocompatibility.

With regard to the lens material compatibility issue, Drs. Merchea, Hansen and Meadows say their respective companies rigorously test their solutions on all available lens materials to ensure compatibility.

Your role

Although the ideal solution is close, those interviewed stress it won't make a difference in a patient's wear experience unless you, the practitioner, provide patient education on the importance of complying with your directions.

“… Regular patient education about proper personal hygiene during handling and the importance of following critical steps, such as rubbing, rinsing and disinfecting lenses daily and using fresh solution every day and regular replacement (monthly) of the contact lens case needs to be reinforced,” says Dr. Lazon de la Jara.

The staff's role [in patient education] is increasingly important, particularly for established lens wearers, as these patients have engrained habits despite most of the industry shifting to a rub and rinse recommendation for MPS, Dr. Merchea explains.

“Both the ECP and staff can improve compliance by taking a few simple steps based on the science of persuasion: Understand the patient's existing beliefs (on hand-washing for example), and use the authority of the ECP as the expert to communicate the importance of the compliance. Finally, asking the patient for a public commitment to the desired behavior will improve adherence to the recommendation.”

There are elements required for the success of contact lens wear, says Dr. Hansen. “Industry has to provide the best technology, and practitioners have to explain to patients how to use the technology and why their directions must be followed,” he explains. “One cannot succeed without the other.” OM

Corrie Pelc is a freelance-writer based in Sacramento, Calif. She has written for both consumer and trade publications and is the former communications manager for the California Optometric Association. E-mail her at corrie.pelc@gmail.com, or send comments to optometricmanagement@gmail.com.