soft contact lens solutions lecture 2017 · 2017. 2. 2. ·...
TRANSCRIPT
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So( Contact Lens Solu3ons &
Pa3ent Instruc3on
Maria K. Walker, OD, MS, FAAO February 2, 2017
Terminology
• CL: Contact lenses • SCL: So( Contact Lenses • HEMA: Hydrogel (Contact Lenses) • SiHy: Silicone Hydrogel (Contact Lenses) • MPS: Mul3-‐purpose solu3on
2016 Distribu3on of CL FiSng
JJ Nichols. Contact Lens Spectrum.Jan 2017.
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2016 Distribu3on of CL FiSng
JJ Nichols. Contact Lens Spectrum.Jan 2017.
Pa3ent Educa3on • Very important to the success of CL wear • Noncompliance and lack of knowledge are primary causes of
SCL adverse events
• Four (prac33oner) factors contribute to pa3ent noncompliance
1. Poor instruc3on 2. No instruc3on 3. Poor example 4. Overloading pa3ent with informa3on at dispense
Pa3ent Educa3on
• Applica3on of lenses: • Washing and drying hands • Opening blister pack • Determining lens inversion
(taco test) • Actually apply lenses (several
acceptable methods) – Can demonstrate if a CL wearer – Can have staff do this, but be sure
they are well trained – Adequate ligh3ng and mirrors
Set up a good example in your office!
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Taco Test
Pa3ent Educa3on
• Removal of lenses: • Hand washing! • “Floa3ng” lenses prior to removal if 3ght
Youtube, www.aocle.org
Pa3ent Educa3on
• Lens Cleaning: Most important educa5onal step!
• Pa3ents will be most compliant if their cleaning system is simple and innexpensive
• Rub and rinse analogy • Proper management of CL cases
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Pa3ent Educa3on
• Increasing wear 3me gradually for adapta3on • NO Tap water…never EVER EVER with so( lenses! • Avoid swimming and showering • Not as much of concern with daily disposable
• Generally daily and monthly are easier for pa3ents to remember proper replacement • 1st and 15th replacement for bi-‐weekly
Lens Deposits
Mucin balls
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Pa3ent Educa3on • ALWAYS give new CL wearers wrihen instruc3on
Cosme3cs & Contact Lenses
• Makeup • Suntan lo3ons • A(er-‐shave lo3on • Shampoo • Oils / creams • Acne medica3ons • Accutane
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History of SCL Care Solu3ons
• 1971: First Hydrogel Solu3ons • Mid 1980s – MPS evolved • Introduc3on of polyaminopropyl biguanide and
polyquaternium-‐1 (preserva3ves)
• August 15, 2010: FDA guidance recommends manufacturers remove “no-‐rub” from bohles.
• Heat – uncommon now • Original chemical disinfectants
SCL Solu3on Components
• Disinfectants • Preserva3ves (Chela3ng agents) • Surfactants • Lubrica3ng agents • WeSng Agents • (minor components): Tonicity, pH/buffers, stabilizers
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Preserva5ve Toxicity
Preserva5ve Toxicity
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Preserva3ve Toxicity • 2002 study on corneal staining in hydrogel lens wearers
• 500 full 3me wearers, 20 clinical sites • Any staining present in at least one eye: 55.7% • Moderate/severe staining: 8% • No correla3on to care system
Steps of SCL Disinfec3on • Physical (rubbing, rinsing) vs. Chemical (soak 3me) • Chemical: – Myristamidopropyl dimethylamine (Aldox)
• An3-‐fungal and an3-‐amoebic ac3vity – Polyquaternium-‐1 (Polyquad)
• Also binds cell membrane components…bad? – Polyhexamethylene biguanide (Dymed, TrisChem)
• Binds (-‐)phospholipids in cell membranes. (problem?) – Hydrogen peroxide (3% = 30,000ppm)
• Very toxic at 3% • Neutralized to <100ppm
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H2O2 solu5ons
• Commonly used when pa5ents have preserva5ve sensi5vity
• Kills bacteria and fungi • 3% used (30,000ppm) • Pla5num catalyst or catalase neutralizer – Leaves the lenses in a non-‐preserved solu5on aMer neutraliza5on
Advanced Cleaning Systems
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