CLSA Eye Witness Spring 2011 - (Page 22)

FEATURE ARTICLE it to dry, it has been shown to be more beneficial to rinse the case with solution and then let it air dry. Unfortunately, these basics of contact lens hygiene are frequently overlooked by the patient. Every contact lens professional has seen patients who remove or insert their contacts without washing their hands or the contact lens case that is so filthy that words cannot begin to describe it. Finding the Solution Contact lens solutions are confusing. Take a trip down any contact lens solution aisle and the array of products and disinfection types can leave anyone in a state of uncertainty. Even though the patients are told which solutions are the best for them and their contact lenses, many patients forget which solution they use. Then, when inundated with all the choices, many patients choose either the wrong product type or the cheapest option. Both of which can cause problems with the contact lens treatment course determined by the contact lens fitter. It is not uncommon for patients to purchase products that are detrimental to the integrity of the contacts. Typical examples are saline solutions instead of cleaner, improper disinfection types and oil containing rewetting drops. Even when the proper products are purchased, improper use can be an issue. n Topping off—The reusing of solution creates an ineffective disinfection process. It is similar to reusing bathwater every day to get clean. n Not maintaining a sterile bottle tip—Some patients will touch the tip of the bottle to the contact lens itself, the surface of the contact lens case, or insert the tip into the solution already present in the lens case. n Not following the manufacturer’s instructions— Although cleaning and disinfection solutions may have a variation in the way in which they are used, they typically follow the same pattern 1. Remove lens from eye and place in palm of hand, rubbing the lens with a few drops of solution. This is true even of “no-rub” products. 2. Rinse lens with a steady stream of solution for the manufacturer’s recommended amount of time. This helps remove debris from the contact. 3. Place lens in a clean, dry case and fill with fresh solution. 4. Rinse lens again before placing in eye. Some individuals also use tap water to store and/or clean their contact lenses instead of using manufacturer formulated solutions. This is probably the biggest no-no of all. Luckily this is not as prevalent as it once was a couple of decades ago, when it was common to put salt tablets into tap water to create homemade saline. 22 w w w. c l s a . i n f o | Losing Track of Time “I thought I was supposed to wear them a month.” “I didn’t realize I had them in three weeks.” “I forgot.” “I wear them until they are uncomfortable, then I take them out.” All contact lens fitters have heard the reasons why patients wear contacts longer than they are supposed to. However, the confusion is understandable. We have disposables which are thrown away after two weeks or less, frequent replacements which are replaced monthly or quarterly, and traditional replacement schedules which are 6 months or longer. On top of that, the patient has to be aware of wearing schedules. Are these daily wear contacts that are taken out every night, or are these extended wear lenses that can be slept in? It is easy to see why the patient can over wear his or her contact lenses even with the best of intentions. Paying the Price Patients who do not exhibit proper adherence to contact lens care can develop serious infections that may create a need for corneal transplants or lead to blindness if not treated early. The three major and severe forms of infections are bacterial keratitis, fungal keratitis and Acanthamoeba. Bacterial keratitis is the most common of these infections and often occurs after the cornea is damaged from contact with a foreign body. The foreign body can be the contact itself or tiny dirt particles trapped under the contact lens. Then bacteria, especially from an improperly cleaned lens, enter the broken surfaces of the cornea resulting in infection. Antibiotic treatment can eliminate the infection but if not treated early enough severe infections can result in the need for a corneal transplant. Fungal keratitis is the rarest form of keratitis in the United States. The Fusarium form of keratitis is more common in the warmer more tropical areas of the U.S., such as Florida, than in colder, drier climates. In those areas of the U.S., the Aspergillus and Candida forms are the most common. Fusarium is the most recognizable of the fungal infections because of the outbreak in 2006 in individuals who used some Baush and Lomb solutions which have since been pulled off the market. Although fungus can enter the cornea through the same process as bacterial keratitis, and is therefore a risk factor for contact lens wearers, the risk is minimal compared to the incidences of the other two infections types. Laboratory testing is necessary to determine what type of fungal infection; howeve,r clinical features that are specific to fungal keratitis include an infiltrate with feathery margins, elevated edges, rough texture, a gray-brown pigmentation, satellite lesions, and endothelial plaque. If treated early, fungal keratitis is treated with antifungal drops. Acanthamoeba keratitis (AK) is a condition that is almost exclusive to contact lens wearers when contracted within | EyEWitnEss spring 2011 c o n ta c t l e n s s o c i e t y o f a m e r i c a http://www.clsa.info http://WWW.CLSA.INFO

Table of Contents for the Digital Edition of CLSA Eye Witness Spring 2011

CLSA Eye Witness Spring 2011

CLSA Eye Witness Spring 2011 - (Page Cover1)
CLSA Eye Witness Spring 2011 - (Page Cover2)
CLSA Eye Witness Spring 2011 - (Page 1)
CLSA Eye Witness Spring 2011 - (Page 2)
CLSA Eye Witness Spring 2011 - (Page 3)
CLSA Eye Witness Spring 2011 - (Page 4)
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CLSA Eye Witness Spring 2011 - (Page Cover3)
CLSA Eye Witness Spring 2011 - (Page Cover4)
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