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Multipurpose contact lens solutions: suitable for all patients, all lenses?
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September 1999
With the large variety of contact lenses available today and the steady stream of new developments in this field, the notion of which contact lens solution to recommend has changed as well. Now, the wearer’s age and the lens material are not the only factors important in determining which solution will best serve a patient’s needs.
While many patients fare well with soft, daily-wear lenses that are replaced approximately once a year, these are less commonplace today than they were years ago. Lenses that are replaced on a daily, weekly, biweekly, monthly or quarterly basis offer patients superior ocular health and convenience. For this reason, multipurpose solutions have taken center stage.
Leaders of the multipurpose pack are OptiFree Express (Alcon, Ft. Worth, Texas); Complete Comfort Plus (Allergan, Irvine, Calif.); ReNu MultiPlus (Bausch & Lomb, Rochester, NY); SoloCare (CIBA Vision, Duluth, Ga.). Most recently, CIBA Vision received approval from the Food and Drug Administration to state that SoloCare effectively removes protein from both soft contact lenses and rigid gas-permeable lenses in a 10-minute period, as opposed to the 4-hour time frame of most other solutions. Already being introduced in Europe, SoloCare with the 10-minute indication is not yet available in the United States and Canada.
“I’m surprised that I’m as pleased as I am with multipurpose solutions,” said Peter Bergenske, OD, in group practice in Middleton, Wis. “A large percentage of our patients use disposable lenses, and that’s one of the reasons that we can get away with these products — the lenses are being replaced frequently. You would be inclined to doubt whether they’d work as well on conventional lenses or lenses that are replaced on less frequent intervals.”
Strong enough to stand alone?
Like Dr. Bergenske, many practitioners share the view that today’s multipurpose solutions are sufficient for daily cleaning and disinfection of frequent-replacement lenses. Just how frequently the lenses should be changed to achieve the maximum benefit from a one-bottle solution may be slightly more difficult to determine, however. “I typically recommend a multipurpose solution to anyone who replaces a lens more than once a month,” said Douglas Weberling, OD, who works in a two-person practice in Bristol, Va. “Beyond 1 month, I’m not as comfortable recommending a multipurpose solution, because I don’t have as much confidence in my patients performing the proper regimen all the time. So then, I’ll recommend something like Quick Care (CIBA Vision).”
Sue Faro, senior product manager at Alcon, said that many clinicians will recommend an adjunct cleaner such as Alcon’s SupraClens daily protein remover if the lenses will be worn more than 30 days. “Even many patients in shorter wearing schedules can feel a comfort improvement when using SupraClens,” said Ms. Faro.
When is an adjunct necessary?
While adjuncts, such as a daily cleaner or a daily or weekly protein remover, may not be necessary for lenses replaced on a frequent basis, it often depends on the individual, said Richard Weisbarth, OD, FAAO, executive director, professional services and customer satisfaction, North American Optics at CIBA.
“Because the majority of patients are replacing their lenses at 2 weeks or 1 month, those types of patients don’t have to use supplements as a general rule,” he noted. “My recommendation is not to start the patient with any supplements. However, if, at a follow-up visit, something does not seem right, you might want to add a supplement, especially something like an enzyme cleaner.”
Some patients may need an enzymatic cleaner to help the lenses last longer, said Joseph Vehige, OD, manager, lens care clinical research at Allergan. “The multipurpose products that are single-bottle have been very well-established in removing conventional soils, such as debris and lipids, for years,” he said. “The part that’s new is the protein management aspect. Some people will need to use an enzymatic cleaner if they want to get the maximum life out of their lenses. But lens-life extension is not important to many lens wearers and is generally not important to the optometrist. I think the optometrist wants the patient to discard the lens in a timely manner as opposed to making heroic efforts to keep the lens working.”
However, the practitioner does want the lens to remain comfortable and healthy to wear until it is supposed to be replaced, said Gary Orsborn, OD, MS, FAAO, director of technical marketing at Bausch & Lomb. “It is important to practitioners to recommend a product with which their patients will be satisfied — one that will provide excellent disinfection efficacy so it provides safe contact lens wear,” he said. “Also important is that the lens will remain clean through the length of wear that the practitioner has prescribed. It is important to prescribe products that provide all of these attributes.”
A benefit of multipurpose solutions, said Dr. Weberling, is the convenience that may have persuaded many former wearers to return to contact lenses and give them a second chance. “People years ago dropped out because of the many steps involved in caring for a lens, and they didn’t realize that things have changed,” he said. “They have come back because of the convenience.”
Rub and rinse
Multipurpose solutions are effective enough on their own as long as patients remember that one-bottle care does not mean one-step care, warned practitioners. Digital friction, Dr. Bergenske said, is necessary for the multipurpose solutions to sufficiently clean the lenses.
“The biggest problem with multipurpose solutions is that many people lose sight of the fact that they are multipurpose,” said Dr. Bergenske, who said he recommends a variety of products but is particularly impressed with OptiFree Express. “Patients who just put the lens in the case and store it, even if it’s a 2-week or 1-week disposable lens, often don’t get the comfort and lens life that they want. It is simply because they’re not completing all of the steps.”
Ms. Faro, also, stressed the importance of the rub-and-rinse method to keep the lens free of bacteria. “Digital cleaning plays a role in keeping the lens clean and comfortable as well as in removing microorganisms from the lens,” she said.
Chuck Aldridge, OD, FAAO, in solo practice in Burnsville, N.C., advises his patients to become aware of the time they are spending cleaning — or not cleaning — their lenses and adjust it accordingly. “Digital cleaning is still a very strong link in getting that final product of a clean lens,” advised Dr. Aldridge, whose office primarily recommends ReNu MultiPlus. “My personal feeling is that there is no replacement for digital cleaning action. I tell my patients to give it at least a 30-second digital cleaning. If they use their wristwatch or a stopwatch when cleaning, they will be amazed at how long a period of time that is.”
Patient compliance
An end to digital cleaning?WAYNE, N.J. – For the rub-and-rinse-challenged set, a new cleaning system has been designed to eliminate the need for digital cleaning. The Lens Comfort Ultrasonic Cleaning and Disinfecting System, launched in July by Lens Comfort Inc., is a miniaturized ultrasound system designed to clean, disinfect and remove protein with just the push of a button. “It replaces the patient as the key ingredient in getting clean lenses,” said Bob Gilbert, marketing consultant for Lens Comfort. “Right now, the only tools ODs and MDs have to deal with the symptoms of allergies are varying lens materials and pharmaceuticals, and this system provides them with an additional tool that really gets to the nub of the matter — the necessity of clean lenses for allergy sufferers.” The lenses are placed into a basket, submerged in about 11 mL of Lens Comfort multipurpose solution and capped. The ultrasound device is activated by pushing a button, and tiny microscopic bubbles are released and implode against the lens, emulsifying oils and proteinaceous matter. The ultrasound also damages bacterial cell walls, said Mr. Gilbert. The cleaning process is completed in 15 minutes and disinfection is achieved after 4 hours in the multipurpose solution, he said. “You have a one-two punch here: you’re getting disinfection by both mechanical abrasion and injury to cells, and then you have a disinfectant that effectively kills them off.” The kit, which comes with a 12-oz. bottle of solution and wall transformer, is being marketed exclusively through optometrists and ophthalmologists, as well as opticians in states where they may dispense contact lenses, Mr. Gilbert said. The product may also be ordered online at www.lenscomfort.com.
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While convenience is a big reason many contact lens wearers choose a multipurpose solution, Dr. Weisbarth agreed that patients might not understand or may simply ignore the proper procedure for using it. “Compliance is a mixed bag,” he said. “There is the misperception that multipurpose means you don’t have to clean, rinse and disinfect. I don’t think compliance is a big plus with the multipurpose solutions and, therefore, I wouldn’t say that’s a reason why practitioners would prescribe them over something else. The main reason is the ease of use.”
Another problem with compliance with multipurpose solutions is frequently switching brands, which can result in an adverse reaction, said Dr. Weberling. “Many patients feel that all of them are the same,” he said. “People will switch to the brand that is cheapest, or if a certain product isn’t carried in a store, they will buy something else. I find that we have some different hypersensitivity reactions to off-brand solutions.”
Dr. Weberling suggested advising patients to call the office if they cannot find the product that was originally prescribed for them to help prevent a reaction. “Hopefully, the doctor has taken into account what he or she thinks that person needs or what solution is recommended for what lenses he or she has,” he said. “Many solutions are recommended for all lenses; some are only approved for certain lenses. That would be my big concern.”
Care for young lens wearers
While compliance varies from person to person, Dr. Bergenske stressed that a high-risk group in terms of compliance is juvenile contact lens wearers. “If we prescribe a disposable lens that is going to be replaced every week or two, we almost always use a multipurpose solution,” he said. “The exception, sometimes, is with kids. If kids are fitted with even a disposable lens, we’d still be inclined to recommend something such as Pure Eyes (CIBA Vision) just because I’m not as inclined to trust that they’re going to follow proper procedures. I think that product is the most likely to give you adequate disinfection regardless of what you do.”
He said the same theory can be applied to adult wearers. “If they will simply put the lenses in something like Pure Eyes and never do the other steps, we still know that we’re getting a pretty good job of disinfecting the lens, regardless of whether it’s clean or not,” he said. “There’s some evidence that just the oxidation that occurs with peroxide does actually clean the lens somewhat even if you don’t digitally clean it.”
Younger lens wearers also benefit from wearing a frequently replaced disposable lens, recommended Dr. Weberling. “With the younger set, I go with a 2-week replacement,” he said. “So even if they don’t comply with the digital part of it, at least every 2 weeks they’re getting a fresh lens. I like to give the younger patients that or a daily lens where I don’t have to worry about what they’re doing.”
The “drop-in” method
Often, then, practitioners find themselves in a dilemma: prescribe a peroxide system for patients who may find the multistep process too lengthy or tedious, or recommend a multipurpose solution and risk encountering problems with compliance. If the industry follows the patient’s lead and develops a solution that will clean and disinfect with no digital cleaning necessary, the patient as well as the optometrist would benefit, said Dr. Weisbarth.
“I think that every manufacturer is looking for products that are even easier to use, which could mean no-rub, no-rinse products that would increase compliance,” he said. “Ultimately, the industry needs a solution that’s patient-proof, where the patient can just do anything and, regardless of what they do, it would be the right thing. We wouldn’t have the issues with patient compliance, and we wouldn’t have the issues with patient misunderstandings.”
While it is on the horizon, Dr. Weisbarth said, the industry has not yet reached that point. “I think that every manufacturer is heading in that direction, and we’re making improvements every year with each new product that comes out,” he said.
The idea is one that makes sense for the manufacturers to delve into, said Dr. Vehige, to better serve today’s contact lens wearer. “It’s a logical area for companies to explore, based on how products are being used,” he said.
The future of contact lens solutions
Dr. Orsborn said that, for Bausch & Lomb, this next step is in the development stages. “Certainly, Bausch & Lomb is evaluating a number of different types of solution products that offer new levels of convenience without any kind of compromise to the performance of the product,” he said. “We have a number of different products in the pipeline right now. Included in that could be a no-rub type of regimen or some other product that could be the ‘foolproof’ system.”
Dr. Weberling feels relatively optimistic about witnessing the development of such a product considering the strides that have already been made in optometry. “Who would have thought 10 years ago that I’d be comanaging so many laser surgeries, and whoever thought that we’d have disposable lenses and daily lenses?” he said.
For Your Information:
- Peter Bergenske, OD, is in group practice at Isthmus Eyecare. He may be reached 8313 Greenway Blvd., Middleton, WI 53562; (608) 836-0678; fax: (608) 836-0858; e-mail: pbergenske@mailbag.com. Dr. Bergenske has no direct financial interest in the products mentioned in this article. He is a paid clinical investigator for CIBA Vision and Alcon.
- Douglas Weberling, OD, is in private group practice. He may be reached at 1701 Euclid Ave., Bristol, VA 24201; (540) 466-4227; fax: (540) 466-3937. Dr. Weberling has no direct financial interest in any products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- Sue Faro is senior product manager at Alcon. She can be reached at Alcon Laboratories Inc., 6201 South Freeway, Fort Worth, TX 76134; (817) 293-0450; (800) 757-9195; fax: (817) 568-7177; e-mail: sue.faro@alconlabs.com.
- Richard Weisbarth, OD, FAAO, is the executive director, professional services and customer satisfaction, North American Optics at CIBA Vision. He may be reached at 11460 Johns Creek Parkway, Duluth, GA 30097-1556; (770) 418-3560; fax: (770) 418-3151.
- Joseph Vehige, OD, is the manager, lens care clinical research at Allergan. He may be reached at 2525 Dupont Drive, Irvine, CA 92713; (714) 246-4500; fax: (714) 246-5457.
- Gary Orsborn, OD, MS, FAAO, is director of technical marketing at Bausch & Lomb. He may be reached at One Bausch & Lomb Place, Rochester, NY 14604; (716) 338-6000; fax: (716) 338-6481.
- Chuck Aldridge, OD, FAAO, may be reached at PO Box 218, Burnsville, NC 28714; (828) 682-2104; fax: (828) 682-4217. Dr. Aldridge has no direct financial interest in the products mentioned in this article. He is a paid clinical investigator for Bausch & Lomb and CIBA Vision.