care and maintenance of RGP lens

RAJU KAITIConsultant OptometristDhulikhel Hospital, KUH

Introduction

• Care and maintenance is one of the most crucial aspects of contact lens wear.

• It can influence the success of contact lens wear and patients’ satisfaction with their lenses.

• Aftercare visits greatly depend upon how one care and maintains his contact lens.

CHARACTERISTICS OF RGP LENS MATERIALS

• Small matrix pores

• Deposits remain on lens surface

• Complex surface chemistry

• Silicone component decreases wettability

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Purpose of care & maintenance

• Clean lens• Good vision• Good comfort• Safe lens wear BY

– Minimizing deposit accumulation– Decreasing microbial

contaminants– Increasing lens wettability

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Why clean CL?• Pt comfort • Optimize lens performance dirty lens don’t feel good & can affect vision

• CL wear increases the risk of microbial infection

• CL prevents clearance of debris & microbes, & allows for bacterial adhesion ,disrupts normal tear flow ,weakens epithelial adhesions

• Microbes introduced to ocular surface with lens insertion

It includes….

Appropriate use & handling (pt education on lens care is important)

Hygiene

Additional instructions

Solution use

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Lens handling technique

• Insertion & removal

• Accidental lens ejection & displacement

• Emergency lens removal

• Storage & removal from the case

• Rub & rinse process

Proper Lens Care

Personal Hygiene

Before handling contact lenses, wash your hands with soap and water, then rinse and dry them with a lint-free towel.

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General measures• Good hygiene wash hands mild soap & warm water hands free of debris ,lotions & rough surfaces

• Never soak/rinse lenses in water

• Use only approved solutions (don’t use home-made solutions)

• Don't swim with lenses on

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General measures

• Prescribe wearing schedules - important that patient adheres to clinician

prescribed use & wearing schedules

• Need to continue to monitor patient for signs of complications & intervene as appropriate

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Care & maintenance components

• Cleaning solution• Rinsing solution • Disinfecting solution• Protein removers

(weekly)• Rewetting/lubricating

solution• Lens storage case

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RGP lens care products• Wetting solutions

• Cleaner

• Disinfecting /soaking agents

• Lubricant /rewetting solution

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RGP lens cleaning

• Daily surfactants

• Enzyme cleaner

• Polish (as necessary)

• Cleaning pad ?

Daily cleaner function

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• To remove loosely bound foreign matter cell debris, mucus, lipid,

protein, cosmetic or other surface contaminants

• Majority of microorganisms

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Recommended technique• Wash hands and Place lens in

palm of hand (2-3 drops of cleaner on each lens surface )

• Rub with forefinger (15/side) ‘To’ & ‘fro’ action or L-R action

• Roll forefinger in both directions to clean lens periphery

• Rinse well

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RGP lens cleaning technique……

• Avoid vigorous rubbing excessive pressure on lens prolonged cleaning with mildly abrasive cleaner

Formation of ring deposit

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Protein removers• Aids in removing /loosening

tightly bound protein deposits

• Enzymes-papain,subtilisin,pronase & pancreatin

• Weekly done

• Lenses should be cleaned & rinsed after enzymatic treatment

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Rinsing function

• To remove Daily cleaner Loosened deposits Micro-organisms

Rehydrate lens Dissolve enzyme tabs

RINSING SOLUTION TYPES

• Saline– preserved– unpreserved

• Multi-purpose solution

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Disinfecting function• Physical or chemical process producing destruction

of pathogenic micro-organisms (USA FDA,1973)• Not imply for spores • Kills or deactivate microbes left on the lens• Include –bacteria -viruses -fungi -amoeba• Restores & maintains lens hydration (more with

SCL),though low level of hydration required with RGP

DISINFECTION

• Micro-organism can attach to deposits

• Use chemical disinfection systems

• Soaking time 4 hours to overnight or as recommended

• Preservatives incorporated

PURPOSE OF DISINFECTION

Contact lenses may compromisethe eye’s natural defense by:

• Inhibiting tear film washing action

• Introducing more micro-organisms

• Compromising epithelial barrierfunction

DISSINFECTING SOLUTION

•FUCTIONS

• Kill or deactivate potentially pathogenic organisms including:

– bacteria– fungi– viruses– amoebas

• Maintain lens hydration

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Disinfection

• Mode of action cell membrane disruption enzyme inhibition

protein coagulation/complex formation

• More common disinfectants: benzylkoniumchloride,chlorhexidine,thimerosal,dymed,polyquad

DISINFECTION SYSTEM• TYPES• Heat (thermal unit, microwave)• Chemical• oxidative

- hydrogen peroxide very effective provide least amount of irritation to allergic pt

- chlorine• cold chemicals

-various disinfectants

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H2O2 based disinfection

• One-step(AO Sept) catalytic disc (Pt) delayed –release neutralizing

tablet

• Two-step dilution catalytic disc neutralizing agents catalase

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H2O2 based disinfection• Minim 3 hrs in 3% H2O2 recommended - bacteria 10-15 mins - fungi 1 hr - acanthamoeba 3-6 hrs

• Suitable for all lens type

• Neutralizing agents -sodium pyruvate -sodium sulphite -sodium thiosulphate

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Wetting & soaking solutions• Also k/a conditioning soln• Function –disinfection,wetting & storage

• Composition -antimicrobial agents -wetting agents -viscosity enhancing agent -buffer sys -salts

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Rewetting dropsUsed during lens wear toFunctions• To alleviate discomfort resulting from

insufficient lubrication by tear film

• To rehydrate CL

• clean lens surface• maintain lens wettability

• To flush debris from lens & eye

• Viscosity enhancing agent like polyvinyl pyrrolidone methylcellulose

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Every time

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Prerequisites of all CL solution• Stable, sterile & transparent

• Harmless to eye if instilled undiluted

• No adverse effect on CL material

• Compatible with all other soln for same CL type

• Should be self -sterilizing

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Lens storage & cases

• CL stored in -a clean CL storage case -fresh disinfecting soln

• Care of lens cases discard used soln scrub with a toothbrush & detergent weekly rinse with hot water air dry

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RGP lens replacement• At least annually• Residual deposits can irritate lids (esp. UpperLid)• Resurface (polish) lens annually as alternative to

replacement

• At dispensing clean & soak lenses overnight verify lenses

ADDITIONAL INSTRUCTIONS

Avoid Contact with Water

• Minimize contact with water

• Remove lenses before swimming or using a hot tub.

• Contact lenses should not be rinsed with or stored in water (tap water).

• Lens cases should be rinsed with solution, not tap water

• Appropriate Solutions

• Never put your lenses in your mouth to wet them. Saliva is not a sterile solution.

• Do not use saline solution and rewetting drops to disinfect lenses. Neither is an effective or approved disinfectant.

• To clean rgp contact lenses, you will usually have two or more solutions. One is a cleaner and the other a conditioner.

• The cleaner washes away buildup and debris that has been attracted to the lens during wear. And the conditioner puts a nice coating on the contact lens that protects it from getting dirty and keeps it comfortable.

ALWAYS

Wash, rinse and dry your hands thoroughly before handling your lenses. Have an up-to-date pair of spectacles for when you need to remove your lenses.

Replace the lenses at the interval specified by your practitioner.

Have regular check-ups with your practitioner as recommended.

Seek professional advice if you are having problems with your contact lenses.

• Ask yourself these three important questions each day that you wear your lenses:

Do my eyes look good?Do my eyes feel good? Do I see well? If you cannot answer ‘yes’ to all of these, or you have any other doubts concerning your contact lenses, remove your lenses immediately and seek the advice of your contact lens practitioner.

NEVER

Go to bed with a painful red eye - seek advice immediately.

Bring any contact lens in contact with tap water.

Wet your lenses with saliva.

Wear your lenses for swimming (unless you use goggles) or showering.

In the past GP lenses often were rinsed with tap water after cleaning

was the system originally approved by the FDA.

But now doctors recommend against this practice

microorganisms in tap water can cause eye infections.

Depending on the system, rinsing should be done with multi-purpose solution or sterile saline.

Rinsing your contact lenses with water can actually make them uncomfortable to wear. Tap water also contains microorganisms that cause eye infections.

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Summary• Purpose of care & maintenance • clean lens ,good vision, good comfort & safe lens wear

• Care system involves • C,R,D &weekly protein removing, rewetting soln if needed & lens

storage case

• Care system should be selected according to wearing schedule, lens material ,lens replacement schedule,

convenience & ocular sensitivity

Wash hands before insertion & removal of lens with soap without fragrance Proper care should be taken while handling lenses

THANK YOU……

CARE YOUR LENSES,LENSES WILL CARE YOUR VISION.