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Contact Lens Care

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					Contact Lens Care

         Liezel Fourie
          B.Optom (RAU)
  Professional Services Manager




               -0-
                           Contents



1. The purpose of contact lens care……………………………………………………...1

2. Micro-organisms…………………………………………………………………………1

3. Lens Deposits……………………………………………………………………………1

4. The effect of deposits on contact lenses……………………………………………...2

5. Lens care products………………………………………………………………………4

6. Preservatives…………………………………………………………………………….4

7. The steps of lens care…………………………………………………………………..5

8. Types of lens care products……………………………………………………………6

9. Daily cleaners……………………………………………………………………………6

10. Rinsing solution (saline)………………………………………………………………..7

11. Disinfecting solutions…………………………………………………………………...7

12. Chemical disinfectants………………………………………………………………….8

13. Hydrogen peroxide………………………………………………………………………9

14. Wetting agents & lens lubricants……………………………………………………..12

15. Protein tablets (enzymatic cleaners)…………………………………………………13

16. Care of the lens case………………………………………………………………….14

17. Lens care for occasional wearers…………………………………………………….14

18. Patient compliance…………………………………………………………………….16

19. Soft contact lens instructions…………………………………………………………17

20. Contact lens do’s and don’ts………………………………………………………….26

21. Cosmetic tips…………………………………………………………………………...27

22. References……………………………………………………………………………...28




                              -0-
The Purpose Of Contact Lens Care

Contact lenses need to be cleaned and disinfected every time they are removed

from the eyes. This is very important to maintain good eye health. Lenses that are

not cleaned properly can cause serious complications.


Micro-organisms

Micro-organisms include bacteria, fungi and viruses (among others). These micro-

organisms can invade the cornea to cause eye infections and even corneal ulcers.

Symptoms and severity vary, depending on the micro-organism involved. Some

infections can even lead to a permanent loss of vision.


Contact lens wearers are especially at risk of microbial invasion, because micro-

organisms can easily be absorbed into the contact lens material. It is therefore

crucial that contact lenses are cleaned and disinfected on a regular basis. If a

contact lens wearer develops an eye infection, lens wear should be stopped

immediately until the infection clears up. The longer he wears the lenses, the worse

the infection will get and the more severe the consequences might be! A contact lens

wearer should always have a recent pair of spectacles as a back-up.


Lens Deposits

A person’s tears contain proteins, lipids (fats), calcium, mucus and other debris.

These substances can bind to the surface of a contact lens. In addition to the

deposits found in the tear film, external substances like cosmetics may also collect

on a contact lens. Deposits need to be removed with contact lens cleaning solutions

(lens care products). If not, it will build up on the surface of the contact lens, and over

time cause a reduction in vision and comfort. Symptoms include red, itchy,

irritated eyes.
                                           -1-
Protein deposits can lead to a condition called GPC, which is a reaction towards the

protein on a contact lens. Symptoms include little bumps forming underneath the

upper eyelids, discomfort and a discharge. Because GPC is usually caused by lens

deposits, an intensive cleaning regime might get rid of the problem. Changing a

patient onto daily disposable lenses is the best solution. Because the lenses are

replaced with a fresh pair everyday, there is no build-up of deposits.


Environmental substances which can trigger allergies in allergy sufferers (like

pollen), can also build up on contact lenses, aggravating the condition over time.

Again, daily replacement contact lenses are the best solution for these patients.


Though most deposits can be removed from contact lenses by making use of the

various lens care products available, some deposits, like calcium, can’t be removed.

Once a contact lens has calcium build-up on the surface, it needs to be replaced.

Cleaning contact lenses regularly and thoroughly are therefore extremely important

to keep lenses clean and free from deposits, and to make sure they last as long as

they’re supposed to. Because conventional lenses are supposed to last up to a year,

a more rigorous cleaning regime is needed to prevent the build-up of deposits.


Some patients are more prone to deposits than others, and might need a more

intensive cleaning regime. Even when wearing disposable lenses.


The Effect of Deposits on Contact Lenses

Contact lens deposits can cause changes in the lens fit, the amount of oxygen

passing through the lens as well as the quality of the lens surface and edge.

Deposits cause the lens to fit tighter. When a lens is too tight on the eye, this




                                         -2-
interferes with the tears’ ability to flush dirt and debris from underneath the lens,

creating the ideal breeding medium for harmful micro-organisms.


Deposits also interfere with the ability of a contact lens to absorb water. Symptoms

include burning, itchy, scratchy eyes, as well as a reduction in vision. Because

hydrogel lenses transport oxygen through the water in the lens material, less water

means less oxygen passing through the lens to the eye. This can lead to red,

uncomfortable eyes. Patients will often decrease their wearing time due to

discomfort, and some might even stop wearing contact lenses all together.




                                  New contact lens


                                  Deposit build-up


                                   Lens fits tighter
                         Interferes with normal tear function


                 Formation of medium for harmful micro-organisms


                       Less water gets absorbed by the lens
                            Less oxygen passes through


                       Red, dry, burning, itchy, scratchy eyes
                                 Decrease in vision


                              Decreased wearing time


                             Drop out of contact lenses




                                         -3-
Lens care products


Lens care products are products designed for the cleaning, rinsing, disinfection,

storage and lubrication of contact lenses.


Why can’t water be used for contact lenses?

Tap water contains chlorine, minerals and metal particles, which can be harmful to

both the eye and the contact lens. Water also contains micro-organisms which can

cause serious eye infections.


Preservatives

Most lens care products contain preservatives. Contact lens solutions are sterile until

first opened. Once opened, it is the preservative’s function to prevent the growth of

micro-organisms that enter the container during use. It is important to note that

preservatives can only prevent microbial growth under normal circumstances, for a

certain period of time. Always follow the storage instructions of the supplier. If the

bottle of solution is left open after use, the preservative might not be able to cope

with the amount of micro-organisms entering the container, increasing the risk of eye

infections. This is also why lens care products need to be discarded 3 months after

opening, regardless of the expiry date. If a contact lens patient doesn’t use his

solution very often, e.g. an occasional wearer or an extended wear patient, always

give him the smallest size of solution available.


Some patients can be sensitive to the preservatives used in lens care products.

Sometimes it helps switching them to a different solution with a different

preservative, or rinsing the lenses with unpreserved saline before insertion. The best

solution for these patients is to change them to a preservative-free system.

                                          -4-
The Steps of Lens Care:


   Cleaning

‘Washing’ and rubbing of the lens to loosen and remove micro-organisms, deposits

and debris such as make-up from the surface of the lens. Lenses should be cleaned

straight after removal from the eye. A daily cleaner or an All-in-One (multi-purpose)

solution can be used for this purpose.


   Rinsing

After cleaning, the contact lens needs to be rinsed to remove any deposits and

debris that have been loosened through the rubbing process. Any traces of daily

cleaner should be rinsed off thoroughly to prevent it from irritating the eyes. Lenses

can also be rinsed before insertion into the eyes. Saline or an All-in-One solution can

be used.


   Disinfection

This is the most important step. A disinfecting solution is used to kill potentially

harmful micro-organisms.


   Protein Removal

Patients wearing conventional lenses, or disposable lens wearers who are prone to

deposits, are advised to use a special enzyme tablet from time to time, to remove the

protein from the lens. Soft lens wearers should use these tablets once a week, and

hard lens wearers once a month, or as recommended by the optometrist.




                                         -5-
   Re-wetting

A lens lubricant (lubricating eye drop) can be used if needed to alleviate dryness and

to render the lenses more comfortable. Hard lenses may require wetting before

insertion to improve wettability (to make sure the lens is covered with a layer of

tears).


Types Of Lens Care Products


   Daily Cleaners

A daily cleaner is a ‘liquid soap’ specially formulated for the

cleaning of contact lenses. The daily cleaner helps to loosen

deposits and debris from the surface of the lens. Some daily

cleaners contains small beads that exfoliates the lens. The daily

cleaner Miraflow®, contains alcohol, which removes oily deposits

from the lens surface. The alcohol also kills micro-organisms, eliminating the need

for a preservative, and making disinfection more effective. Miraflow can also prevent

the build-up of calcium deposits on the lens. As we said earlier, once a lens has got

calcium deposits, it has to be replaced.


Cleaning is the first step after the lenses are removed from the eyes. Usually a few

drops of daily cleaner is dropped onto the surface of the lens. The lens is then

rubbed gently to loosen dirt. Any daily cleaner need to be rinsed off very thoroughly,

as it can react with certain types of contact lens disinfectants or cause irritation when

the lenses are inserted back into the eyes.


These days daily cleaners are mainly prescribed for use with conventional lenses. It

is a very important cleaning step to make sure conventional lenses last


                                           -6-
as long as it’s supposed to. However, patients who are prone to deposits can benefit

from the use of a daily cleaner with their disposable lenses. These patients often

complain that their lenses are less comfortable and their vision less clear towards the

end of the month.


   Rinsing Solution (Saline)

Saline is a combination of water and salts (similar to tears). Saline is used for rinsing

the lenses to remove daily cleaner and debris from the surface of the lenses. Saline

can also be used to rinse lenses before inserting them into the eyes. Generally

patients using All-in-One solutions don’t need saline for rinsing,

but if someone is sensitive to the preservative in their All-in-One

solution, they can use a preservative-free saline, like SoftWear®

saline to rinse their lenses prior to insertion. It is important to

remember that saline doesn’t kill micro-organisms and should

never be used on it’s own. Always use a contact lens

disinfectant as well.

                                              Figure 2: A Preservative-free Saline Solution

   Disinfecting Solutions

Contact lens disinfectants can be divided into 2 types: Chemical disinfectants and

peroxide systems.


   Chemical Disinfectants

   Chemical disinfectants make use of it’s preservative to kill micro-organisms. A

   higher concentration of preservatives is needed to disinfect lenses than to

   prevent microbial growth in the container. Chemical disinfectants are also

   referred to as All-in-One solutions, or multi-purpose solutions, as it


                                          -7-
   can be used for cleaning, rinsing and disinfection. Some, like SOLO-care™ and

   ACTI-clean, also remove protein. Chemical systems are simple and convenient to

   use. The disadvantage if chemical disinfectants is that certain patients can be

   sensitive to the preservatives used. These patients will experience irritation upon

   insertion of the lenses. Some patients might be sensitive to one chemical

   disinfectant, but not to the next. That is why it is advisable for patients to stick to

   the disinfectant that works for them, and not to chop and change. As mentioned

   earlier patients who are sensitive to the preservative, can rinse their lenses with

   unpreserved saline prior to insertion. The best option for these patients is to

   change over to an unpreserved, peroxide system.


   After the cleaning (rubbing) and rinsing process, lenses need to soak in the

   chemical disinfectant for the required period of time (which differs from product to

   product). It is very important that the patient always use fresh solution, and never

   re-use solution. When solution is reused, the preservative might not be capable

   of killing micro-organisms anymore, increasing the risk of eye infections.




Figure 3: Examples of chemical disinfectants


                                           -8-
   Hydrogen Peroxide

   Hydrogen peroxide is a very effective, preservative-free disinfectant, proven to be

   effective against a wider range of micro-organisms than chemical

   disinfectants. Hydrogen peroxide needs to be neutralised before the lenses can

   be inserted into the eyes. During the neutralisation process, hydrogen peroxide is

   broken down to water and oxygen. Hydrogen peroxide systems usually also

   contain salts, which then turn the water into a gentle saline solution that will not

   irritate the eyes. Some peroxide systems make use of tablets to neutralise the

   hydrogen peroxide, while another, AOSEPT® make use of a platinum coated disc

   in the bottom of the contact lens container to break down the peroxide.


   If unneutralised hydrogen peroxide comes into contact with the eye, it can cause

   intense burning, redness, tearing and light sensitivity. To avoid this the

   manufacturer’s directions should always be followed carefully. If a customer buys

   a hydrogen peroxide system from you, it is always a good thing to make sure

   they’ve used it before, and know how to use it. Should unneutralised peroxide get

   into a patient’s eye, the eye should be rinsed thoroughly with tap water.




Figure 4: The AOSEPT® system             Figure 5: the AOSEPT cup
                                         with the platinum disc neutraliser

                                         -9-
Advantages of Hydrogen Peroxide disinfection:

   Chemical disinfectants have large molecules which do not penetrate into the

   pores of a contact lens. Hydrogen peroxide molecules are small enough to

   penetrate.

   Hydrogen peroxide also provides a surface-cleaning action which helps to

   remove deposits and debris from the surface of the lens, even without

   rubbing. This is also why there is usually a slower build-up of deposits on

   lenses cleaned with peroxide systems than those cleaned with chemical

   systems.

   If used correctly, once neutralised, the peroxide is broken down to a saline

   solution which is very gentle on the eyes, as it doesn’t contain any

   preservatives which can cause irritation.

   Some hydrogen peroxide systems, like AOSEPT®, can be used with both hard

   and soft contact lenses.


Disadvantage of hydrogen peroxide:

   Can burn eyes if not properly neutralised.


Precautions:

To prevent hydrogen peroxide from burning the eyes, the following precautions

should be taken:

   Never allow unneutralised hydrogen peroxide to come into direct contact with

   the eyes.

   If lenses need to be rinsed, e.g. to remove a spec of dirt, use saline to rinse

   the lens. (Always recommend to your hydrogen peroxide patients to keep

   some saline on hand).



                                     - 10 -
Always use the lens case supplied with the system. This is especially

important when using AOSEPT®, as it contains the platinum disc necessary

for neutralising the AOSEPT solution.

With AOSEPT a new contact lens cup is supplied with each bottle of solution.

The new cup contains a new platinum disc. Always use the new cup with the

new bottle of solution, and don’t re-use the old cup. With time the ability of the

platinum disc to neutralise the peroxide will decrease. As a safety precaution

the disc is designed to be effective for at least 3 bottles of AOSEPT solution,

but it should never be used for more than one!

If a daily cleaner is used in combination with the hydrogen peroxide system, it

should be rinsed very thoroughly off the surface of the lens before placing it

into the hydrogen peroxide. Daily cleaner that is not rinsed off properly can

cause foaming and overflowing of the hydrogen peroxide in the lens cup.

Fill the cup up to the fill line. Overfilling can cause hydrogen peroxide to

overflow.

Do not shake the cup! Shaking can cause a small amount of solution to stick

to the lid and not be neutralised. When the cup is opened in the morning, this

solution might drop onto the lens, and cause stinging upon insertion into the

eye.

Do not cover the air hole. When the peroxide is neutralised, it is broken down

to water and oxygen. This oxygen need to be able to escape. If the air hole is

blocked, pressure will build up in the contact lens cup, which can cause it to

explode!

Once hydrogen peroxide has been broken down to saline, it contains no

preservatives to prevent microbial growth. If the lenses are not worn



                                  - 11 -
              o for more than 24 hours, the whole disinfecting process should be

                  repeated before lenses are worn.


   Wetting Agents & Lens Lubricants

Hard lenses may require a wetting agent to enable the tear layer to spread evenly

over the surface of the lens (to prevent dry spots). The wetting solution is rubbed

on the lens before the lens is inserted into the eye.


Soft contact lenses do not require wetting solutions before insertion. However, lens

lubricants (lubricating eye drops) can be used to re-wet the lens during wear to

improve comfort. Lenses may dry out due to wind, heat, air conditioners, certain

medications (like sinus medication and oral contraceptives), lack of tears and

infrequent or improper blinking. Lenses that dried out on the eyes can even affect the

vision.


Lens lubricants are also helpful to re-wet lenses after waking up with extended wear

lenses. During sleep tear production decreases which can cause the lenses to feel

dry and uncomfortable in the morning.


Patients who have trouble removing their lenses, or often tear their lenses upon

removal from their eyes, might benefit from using lubricating drops a few minutes

before lens removal.


It is important that patients only use drops designed for use with contact lenses, or

preservative-free eye drops, together with their soft contact lenses. The amount of

preservative in other eye drops might be too high. Because the drops are absorbed

into the lens material, it can cause stinging and irritation.



                                           - 12 -
In order to prevent contamination of the eye drops, which can lead to eye infections,

the patient should not touch the dropper tip to the eye or any surface during

instillation. Bottles should be kept tightly closed, and discarded 30 days after opening

(regardless of the expiry date).


Preservative-free lubricants in single-dose units are a very good choice. It can be

used with or without contact lenses. Because it doesn’t contain a preservative, it

won’t sting or irritate the eyes upon insertion and it can be used as often as needed,

without causing damage in the long term. Because there are no preservative to

prevent microbial growth after opening, the vial should be discarded directly after

use.


   Protein Tablets (Enzymatic Cleaners)

Enzymes break down proteins, removing them from the surface of the lens. These

days, with disposable lenses, most people don’t need to use protein tablets

anymore. The reason for this is that their lenses are discarded before protein

becomes a problem. Some patients do however have more protein deposits. They

might complain that their monthly lenses become blurry and uncomfortable towards

the end of the month. These people can benefit from using a protein tablet in the

middle of the month to get rid of those protein deposits. The best solution for them,

however, would be to switch to a daily disposable contact lens.


It is advisable for people wearing conventional contact lenses to use a protein tablet

on a regular basis. This would prevent complications like GPC which can be caused

by a protein build-up on the lens. It will also extend the lifespan of the lenses. Soft

lens wearers need to do protein removal once a week. Because hard



                                         - 13 -
lenses don’t absorb deposits into the material like soft lenses, monthly protein

removal is sufficient.


Please note: Peroxide systems are very strong, and will destroy the working of most

protein tablets which are designed to be use with chemical disinfectants. A patient

using a peroxide disinfectant, should use Ultrazyme protein tablets, which are

developed especially for use with peroxide systems.


The cleaning process involves soaking the lens in the enzyme solution. Instructions

differ from product to product. Always follow the manufacturers instructions.


Care of the Lens Case

Old, dirty lens cases are a leading cause of eye infections among contact lens

wearers. After lenses have been inserted into the eyes, the lens case should be

rinsed with sterile saline or a chemical disinfecting solution, and be left open to air

dry. Do not use tap water, which can contain harmful micro-organisms. Lens cases

should be replaced at regular intervals (at least once every six months). For this

reason, contact lens cleaning systems which include a new lens case with each

bottle, like ACTI-Clean, SOLO-care™ or AOSEPT®, are highly recommended.


Lens Care for Occasional Wearers

If lenses are stored in solution for a long period of time, the preservative may loose

it’s efficiency to prevent microbial growth, and contamination might occur. Some

systems do not have long term storage capabilities and others do. Always refer to

the manufacturers instructions. As safety precaution, lenses should always be

cleaned and disinfected 24 hours before use.




                                        - 14 -
                                      Lens
                                     Removal



                                      Cleaning       Daily Cleaner or
                                     (Rubbing)      All-in-One solution




                                      Rinsing             Saline or
                                                    All-in-One solution

  Enzyme            Protein
  Tablets          Removal

                                    Disinfection    Peroxide system or
                                     & Storage      All-in-One solution

  Saline or
  All-in-One        Rinsing
   Solution
                                   Insertion into
                                      the Eye

    Lens            Re-wetting
  Lubricant        (Lubrication

                                      Lens
                                     Removal




      Lens Care                    Optional           Lens Care
      Procedure                   Procedure            Product




Figure 6: Contact Lens Care




                                    - 15 -
Patient Compliance

Proper lens care and wearing procedures are essential for the safe and effective use

of contact lenses. Make sure the patient has clear instructions on:

   Lens care procedures (how to clean and care for his lenses)

   Lens wearing schedules (how to build-up lens wear in the beginning, how many

   hours his lenses can be worn per day; daily wear, extended wear or flexi-wear)

   Lens replacement schedules (when should lenses be replaced)

   Follow-up visits (when should he return for his next follow-up)

If a patient doesn’t follow these instructions properly (is not compliant), it increases

his risk of developing contact lens related complications and infections.


Reasons for non-compliance include:

   Patient didn’t receive proper instructions from his eye care practitioner

   Patient doesn’t understand, or can’t remember the instructions

   Patient find the procedures time consuming and inconvenient

   Patient tries to save money

   Patient follows the advise from others (friends or family members)


Common mistakes patients make include

   Not washing their hands before handling their lenses

   Leaving out steps from their lens care regime

   Not rinsing the lenses properly after using a daily cleaner or protein tablets

   Hydrogen peroxide that hasn’t been neutralised before inserting lenses

   Using the wrong type of solution for the procedure (e.g. using saline as a

   disinfectant)

   Re-using the old solution in the lens case and not using fresh solution

   every day
                                         - 16 -
   Using old, dirty lens cases

   Not closing the bottle of solution after use

   Using expired solutions

   Changing lens care systems without consulting their optometrist first


Non-compliance can lead to problems ranging from minor irritation to vision-

threatening conditions like corneal ulcers. It is important that the patient understand

the need for proper lens care and that he has clear understanding of the necessary

procedures. In addition to teaching patients how to care for their lenses, also explain

to them why it is so important. It is always helpful to give them a written form with the

recommended lens care products and regimen for future reference.



Soft Contact Lens Instructions

During Contact Lens Instruction, the patient is shown the proper way to insert and

remove his contact lenses, which he needs to practice under supervision until he

mastered it. The patient then needs to be shown how to clean and care for the

lenses. The recommended lens wearing schedule, replacement schedule and follow-

up visit schedule should then be explained to him. Often the optometrist will leave

this responsibility in your hands.


Preparation

To help the patient relax, contact lens instructions should be done in a private area,

away from the eyes of other patients or staff members. Instruction should take place

at a clean table with a comfortable chair and good lighting. On the table there should

be a loose standing mirror with a comfortable height, a box of tissues, an empty lens

case, a bottle of rinsing solution and a starter kit of the lens care

system the optometrist recommended.

                                           - 17 -
Please note: Directions for usage may differ from product to product. Make sure that

you’re familiar with the directions of that specific lens care system, and that you’ll be

able to explain to the patient how to use it.


N.B. Before you start, both you and the patient should wash your hands and dry it

with a clean, dry, lint-free towel (without loose fibers which might stick to the surface

of the contact lens). Hands should always be washed thoroughly before handling

contact lenses. This will prevent dirt from sticking to the surface of the lenses, and

more importantly, prevent the transfer of harmful micro-organisms from your hands

to the surface of the lens. Always explain this to the patient.


It is advisable to take a seat at the side of the table, next to the patient, so you can

have a clear view of what he is doing. Try your best to make the patient feel

comfortable and relaxed. Be patient! Remember, the more relaxed the patient is, the

quicker he’ll succeed!


Tip: Long fingernails can make lens handling very difficult for a new, inexperienced

wearer. A pair of nail clippers can come in very handy, and should always be kept

around.


Instructions To The Patient:


   Contact lens insertion

1. Take the lens out of the storage solution and make sure it is not damaged.

   Tip: Always insert or remove the right lens first, then the left. Most people’s eyes

   differ. By always handling the same lens first, you reduce the chance of swopping

   your lenses around.



                                          - 18 -
2. Place the lens in the palm of your hand, and rinse with a bit of rinsing solution to

   make sure there are no foreign particles on the lens. Place the lens on the tip of

   you index finger and make sure that it’s clean and undamaged.

3. Make sure the lens is not turned inside-out. There are 2 methods to determine if

   the lenses are the right way around:

   Method 1:

   Place the lens between your thumb and index finger. Gently squeeze the edges

   together.

      If the edges come turn towards each other, the lens is the right way around

      If the edges turn outward, the lens is inside-out.




   Method 2

   Place the lens on the tip of your index finger and look at it’s shape.

      If the lens is shaped round, like a bowl, it is the right way around.

      If the edge has a lip that turns outward, the lens is inside out.




                                          - 19 -
   If the lens is turned inside-out, use your fingers to gently turn it the right way. DO

   NOT USE YOUR FINGERNAILS!

4. Place the lens on the tip of your right index finger (left, if you are left-handed).

   Tip: Make sure your finger is dry to prevent the lens from sticking to your finger in

   stead of the eye.

5. Use the middle finger of the same hand to pull down your bottom eyelid.

6. With the fingers of your other hand, pull the top eyelid open.

   Tip: The fingers holding the top eyelid should be placed as close as possible to

   the eye lashes to make sure that the eyelid can’t close. It is a normal reflex for

   the eye to close when something comes near. The secret when inserting a

   contact lens is to hold the eyelids open as wide as possible, and as tight as

   possible to prevent it from closing.




Figure 7: Wrong way - The finger holding the top lid      Figure 8: Correct way – lid held
is placed too high above the eyelid. The lid can still    tightly, close to the lashes, to
close.                                                    prevent it from closing.



7. Place the lens directly onto the eye and gently roll it of the index finger.

   Tip: Always keep both eyes open so you can see what you’re doing. Concentrate

   on the image in the mirror, not on your finger coming closer, as this will reinforce

   the reflex to close your eye.

8. Once the lens is in your eye, while still holding the top lid firmly, leave



                                              - 20 -
   the bottom lid and look down slowly. This will get rid of any air bubbles trapped

   underneath the lens. If you don’t look down first, chances are good of the lens

   popping out again when you blink.

9. You can now release the upper lid.

10. Repeat for left eye, still using the right hand to insert the lens and the left hand to

   hold the eyelid (if you’re right handed).


Carefully watch the patient as he’s practicing to see if he’s doing anything wrong.

Give him guidance and talk him through the process.


Directly after insertion the lens might feel slightly uncomfortable, and vision might be

blurry. This should disappear after a few seconds, once the lens has settled. If not,

check for the following:

   The lens might not be centered on the eye (see next section: Centering the lens)


If the lens is centered, remove it (see section on lens removal) and check for the

following:

   Dirt or particles on the surface of the lens. If this is the case, clean and rinse the

   lens and put back into the eye.

   The lens is on the wrong eye (might cause vision to be blurry)

   The lens is inside-out

   The lens may be damaged. If this is the case, do not put the lens back into the

   eye. Discard it and replace with a new one.


   Centering the lens

Sometimes the lens may be displaced onto the white of the eye during insertion or

wear. There are three methods to center a lens:


                                          - 21 -
Method 1: Look in the direction of the displaced lens. Blink gently. The lens should

automatically move into position at the center of the eye.

Method 2: Close your eyes and gently massage the lens into place through the close

eyelid.




Method 3: Gently push the lens back into position with the eye open, using finger

pressure on the edge of the upper or lower eyelid.


   Lens removal

1. Use the middle finger of your right hand to pull down the lower eyelid (use the left

   hand if you’re left-handed).

2. Use the other hand to pull up the top eyelid, holding it close to the eye lashes.

3. Look upward while keeping your head straight

4. Slide the lens down onto the lower white part of your eye, by placing your index

   finger on bottom edge of the lens.

5. While still looking up, pinch the lens gently between your thumb and index finger,

   removing it from the eye. (DO NOT USE YOUR FINGER NAILS!)




                                         - 22 -
Tip: It may be easier to remove your contact lenses if you use rewetting drops 10 to

15 minutes before removal.


   Cleaning and disinfection

Once you’re confident that the patient mastered the insertion and removal

techniques, demonstrate the cleaning and disinfection procedures to him. It is

advisable to ask the patient to repeat the procedure in front of you, to make sure he

fully understands. Also explain to the patient why good lens hygiene is so important.


   Cleaning

      Wash, rinse and dry your hands

      Remove the right lens from your eye

      Place the lens in the palm of your hand, add a few drops of daily cleaner or

      disinfecting solution (whichever the optometrist prescribed) onto the lens*

      Rub the lens gently in a back and forth motion. Rubbing a lens in a circular

      motion may cause it to split or tear*

   * Follow the manufacturer’s instructions for use


   Rinsing

      Rinse the lens thoroughly, using saline or All-in-One solution (whichever the

      optometrist prescribed)

      Any traces of daily cleaner should be rinsed off (if used in the cleaning

      process). Remaining daily cleaner may irritate the eye, and even interfere with

      the disinfection process.


   Protein removal (enzymatic cleaning)

      Only if prescribed by optometrist


                                          - 23 -
      Follow the manufacturers instructions

      Protein removal should be done once weekly for soft contact lenses (unless

      differently indicated by the optometrist)


   Disinfection

      Disinfect the lenses, following the manufacturers instructions.

      Always use fresh disinfecting solution. Re-using solution may lead to eye

      infections.

      Lenses must be fully covered by the disinfecting solution. This is to ensure

      proper disinfection and to prevent them from drying out.

      If a flat lens case is used, always put the lens into the case first, before filling it

      with disinfecting solution. If it’s done the other way around, the lens may end

      up floating on top of the solution, and get caught in the lid when closed.


NB. Directions for use differ from product to product. Always follow the

manufacturers instructions


   Care of the lens case

      Always empty the lens case after inserting the lenses into your eyes.

      Rinse the lens case with sterile saline or chemical disinfecting solution

      Leave open to air dry

      Replace the lens case at least every six months

      If you use a lens care system where a new lens case is supplied with each

      bottle of disinfecting solution, always use the new lens case when opening the

      new bottle, and discard the old case.




                                          - 24 -
   Lens wearing schedule

It is advisable that patients who have never worn contact lenses before, should

gradually build up their wearing time over a period of days to allow their eyes to

adapt to the lenses. An example is where the patient starts by wearing the lenses for

3 hours on the first day, and then add an extra hour everyday until he wears the

lenses for a full day. Wearing schedules vary, according to fitter preference. Ask the

optometrist how he would like your contact lens patients to build up their wearing

times.


   Lens Replacement Schedule

Don’t forget to tell the patient how often he should discard and replace his lenses.

Explain to him that old lenses may be harmful to the health of his eyes. It is

advisable that the patient order his next supply of contact lenses well in advance, to

allow for delays in delivery.


   Follow-up Visit Schedule

Inform the patient when he is due for his next follow-up visit(s) (based on the

optometrist’s preference). Most optometrists like to see a new contact lens patient a

week after his contact lens instruction, to make sure everything is fine. If all is well,

the patient’s next supply of lenses can be ordered. Routine follow-up visits are very

important because it helps to prevent problems. Signs of a problem can be detected

early, and treated before the patient even becomes aware of it. Contact lens patients

should have their eyes examined at least once a year, or even more regularly if

required by the optometrist.




                                         - 25 -
   Contact lens do’s and don’ts

Some general rules and suggestions that the patient needs to be made aware of:

   Always wash your hands before handling your lenses. A soap which doesn’t

   contains oils, lotions or perfumes is recommended. Rinse your hands thoroughly

   and dry with a clean, lint-free towel.

   Handle your lenses over a smooth, clean area, like a table. If it is a basin or a

   sink, make sure the plug is in!

   Use your finger tips to handle your lenses. Avoid using your finger nails or sharp

   objects like tweezers.

   Clean and disinfect your lenses each time you remove them from your eyes

   Always carry a spare pair of lenses with you for emergencies

   Follow the complete lens care regimen, exactly as directed, without leaving out

   any steps

   Do not change to a different lens care system without consulting your optometrist

   Components of different lens care systems should not be mixed, unless under

   the direction of the optometrist

   Saline solution are used to rinse lenses. Saline will not kill germs and should

   always be used in combination with a contact lens disinfectant.

   To prevent contamination, always keep lens care products tightly closed

   Do not touch the dropper tip of the solution to any surface, including the lens and

   the eye

   Discard any remaining solution 3 months after opening

   Never use expired solution

   If you haven’t worn your lenses for a while, repeat the cleaning and disinfecting

   processes before wearing them again

   Do not wear a damaged lens.

                                            - 26 -
Only use wetting drops, especially formulated for use with soft contact lenses, or

preservative free, lubricants in single dose units. Don’t use any other eye drops

with your contact lenses.

If you ever find your eyes to be sore or red or there’s a discharge, remove your

lenses immediately and contact your optometrist

Always have a pair of spectacles as a back-up. Should you develop an eye

infection, you’ll have to stop wearing your contact lenses completely until it

cleared up (which can sometimes take weeks). By wearing your contact lenses

you don’t give the eye a chance to heal, making matters worse. You can even

end up with a corneal ulcer!


Cosmetic tips

Apply your make-up after inserting your lenses into your eyes.

Remove your lenses before removing your make-up.

Use a fast drying, fibre free mascara.

Be careful when applying facial powder, or powder eye shadows. Small particles

can get into the eye and get trapped beneath the lens. If it becomes a problem,

switch to cream formats.

Apply eyeliner on the edge of the lower eyelashes, rather than inside the eyelid.

Liquid eyeliner can permanently stain your lenses!

Cosmetic products like hand creams, sunscreens, nail polish, etc. should never

be allowed to come into direct contact with your lenses, as it can penetrate the

lens material.

Take care when using aerosols like deodorant, hair spray or perfume. Never use

these products near an open lens case or open lens care bottles. Close your

eyes when spraying!


                                     - 27 -
References


1. The CIBA Vision® Learning Program, CIBA Vision 1991

2. Soft Contact Lens Care, Anne Austin Thompson, O.D. CIBA Vision 1993

3. Design and Fitting of Soft Contact lenses, Anne Austin Thompson, OD. CIBA

   Vision 1995

4. Guide to Lens Care, CIBA Vision




                                     - 28 -

				
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