Doctor recommendations differ for patients using ‘no-rub’ solutions

Contact Lenses and Eyewear

Issue: July 2008

A: Absolutely

Glenda B. Secor

Glenda B. Secor, OD, FAAO: I absolutely do. No one has ever shown that not rubbing and rinsing (passive cleaning) of contact lenses is superior to doing it. We know that lenses are always cleaner, vision is clearer, comfort is improved and ocular health is safer when lenses are digitally cleaned before disinfection.

Assuming compliance issues with rubbing and rinsing will occur, encouraging patients to do it will probably only result in them doing it occasionally – which is better than never.

Some patients have felt that the packaging of multipurpose solutions labeled “no-rub” forbade them from rubbing, and they often are relieved to know that it is all right to rub their lenses. Subjectively, they have observed the improvement in their contact lens experience with better care and are appreciative of the recommendation.

For more information:

Glenda B. Secor, OD, FAAO, is a private practitioner at 17742 Beach Blvd. #305, Huntington Beach, CA 92647; (714) 596-4488; fax: (714) 596-5522; e-mail: gbsod@aol.com.

A: Lens care more important than lenses

David I. Geffen

David I. Geffen, OD, FAAO: I have always recommended that patients rub and rinse their lenses even with the introduction of the “no rub” products. I have always believed that for proper care and long-term health and comfort, lens care is probably more important than the lenses themselves.

With the recent problems with lens care, it is apparent that our patients are not caring for their lenses properly, and it is up to us as doctors to prescribe lens care as carefully as we prescribe the lenses.

For more information:

David I. Geffen, OD, FAAO, can be reached at 8910 University Center Lane, Suite 800, San Diego, CA 92122; (858) 455-9950; e-mail: DIG2020@aol.com.

A: Young, healthy patients can just rinse

Monique Cupryn

Monique Cupryn, OD: Young, healthy patients may simply rinse their contact lenses before soaking overnight. However, patients with contact lens papillary conjunctivitis (CLPC) and those fit in silicone hydrogel materials should be advised to rub their lenses prior to overnight disinfection.

Silicone hydrogels account for more than 50% of new soft lens fits in the United States. With the improvement in corneal oxygen transmissibility can come some compromises in lens modulus and surface wettability. The dual pathogenic mechanisms of lens stiffness and propensity for lipid deposits can cause mechanical or immunological/allergic irritation of the tarsal conjunctiva, resulting in CLPC. Contact lens intolerance and patient dropout may ensue.

Ideally, a daily disposable lens should virtually eliminate most contact lens complications. For those patients wearing their lenses on a more extended basis, rubbing and rinsing, enzymatic treatment or peroxide systems provide excellent alternatives in maintaining good ocular health.

For more information:

Monique Cupryn, OD, can be reached at 210 26th Ave. North, St. Petersburg, FL 33704; (727) 550-2258; fax: (727) 826-5599; e-mail: mcupryn@tampabay.rr.com.

A: Rubbing not necessary for most frequent replacement lenses

Arthur B. Epstein

Arthur B. Epstein, OD, FAAO: Since the Bausch & Lomb and Advanced Medical Optics solution recalls, debate about the need for lens rubbing has grown heated. Typically, strong conviction and dogma usually obscure both scientific reason and common sense. Of importance to clinicians are the science and the facts.

Rubbing will decrease pathogen loads – provided it is followed by an adequate rinse step; however, the reality is that most patients will not rub regardless of what they are instructed to do. Admonishing these patients to do what they will not serves no purpose other than to disrupt the doctor-patient relationship.

Studies by Alcon Labs found little change in patient behavior pre- and post-introduction of no-rub solutions. A recent study by CIBA Vision found that even the intense media coverage of the Fusarium outbreak produced no lasting change in patient compliance. The bottom line is that only about 40% of patients rub, while two-thirds of patients rinse.

The Centers for Disease Control and Prevention investigation of the Fusarium and Acanthamoeba outbreaks and the Joslin report on the Acanthamoeba outbreak found no statistically significant association between patient compliance and infection other than a weak association with toping off. In fact, no study of contact lens wearers has ever found a statistical link between patient compliance factors and increased risk of infection.

While lens rubbing appears to yield little if any benefit in reducing the risk of microbial keratitis, digital cleaning may be beneficial for heavy depositors and patients who wear infrequent replacement lenses (especially toric lenses that tend to deposit more due to rotational stability). Rubbing may also benefit silicone hydrogel wearers with heavy lipid deposits. However, for most disposable and frequent replacement lenses, I find that modern no-rub approved solutions do an excellent job of passively cleaning lenses.

Regardless of whether I advise rub or no-rub care, I always recommend a no-rub approved solution. No-rub solutions are tested and approved to the higher “stand-alone” standard and provide both compliant and noncompliant patients a more effective safety net.

For more information:

Arthur B. Epstein, OD, FAAO, is a founding partner of North Shore Contact Lens & Vision Consultants PC, a referral-based contact lens specialty and primary eye care practice on Long Island, N.Y. Dr. Epstein can be reached at Vision Consultants, One Expressway Plaza, Suite 100, Roslyn Heights, NY 11577; (516) 299-4540; fax: (516) 288-4542; e-mail: artepstein@artepstein.com. He is a paid consultant for Alcon.

References:

Chang DC, Grant GB, O’Donnell K, et. al. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA. 2006;296(8):953-963.

Joslin CE, Tu EY, Shoff ME, et. al. The association of contact lens solution use and Acanthamoeba keratitis. Am J Ophthalmol. 2007;144(2):169-180.