Do's and Don'ts of Contact Lens Care

Oftentimes, contact lens wearers will skimp on their lens care because some of the solutions are costly and it seems like a good way to save some hard-earned cash. This is not a good idea.

Cutting corners can result in infections or irritations, and after one or two copays to your ophthalmologist or optometrist office you will probably spend more than what you saved in a year by cutting corners, plus your discomfort and inability to wear your contact lenses while you are being treated.

The reasons you clean your contacts is to give increased lens comfort, prolong lens oxygen permeability, and to protect your eyes from infection. The reason you have to disinfect your contact lenses is - as nasty as it may sound - your eyeball and eyelids are covered in essential bacteria that are kept in check by your body’s immune system. When you remove your contact lens at night it is covered in these essential bacteria. If you don't kill them overnight this will allow the bacteria to grow unchecked and then, instead of inserting a freshly cleaned lens, you are inserting a lens covered in more bacteria than your eye is used to and you end up getting an infection.

Let’s talk about the most widely used type of solution - the multipurpose solution. While this is often the most incorrectly used solution, multipurpose solutions are a very safe and effective disinfection method when used properly.

Many multipurpose solutions advertise themselves as “No Rub.” Just put it in the case and you are done. This is OK to do, but a quick rub with the no-rub solution in the palm of your hand and the opposite hand’s middle or ring finger provide and even better cleaning option. Just the slight roughness of your fingerprint adds a light scrubbing effect that helps improve the removal of surface debris, protein and mucous better than just letting the lens soak overnight. This rubbing of the lens is especially important for women to remove any cosmetics that are rarely removed by just soaking alone. This few seconds of extra cleaning will make your lenses stay more comfortable longer during their wearing cycle, and help to keep the pores of the lenses open, allowing more oxygen to contact your cornea to keep them healthier for your eyes.

Many name brands and store/warehouse brands of multipurpose solutions exist. All are FDA approved to do the same thing: clean/disinfect/rinse/store your contact lenses. You can't really mess them up unless you try. Remove the lenses, lightly rub them with the multipurpose solution, place your lens into a CLEAN and DRY lens case, and cover the lens with solution to disinfect it. Then let it sit for the amount of hours recommended by the manufacturer, generally between 4 to 8 hours, or overnight. Remove the lenses in the morning, rinse with the same multipurpose solution and rinse the lens case out and leave it open to air dry in an area away from your sink and toilet to prevent airborne contaminants from getting into your case as it dries.

The biggest misuse of the multipurpose solution is not changing your case’s solution nightly and just adding more solution to the case each night. We call this “topping off the case.” This is NOT safe because it will lose disinfection power since the old/used solution was busy killing the bacteria and organisms from the night before. Just adding a little fresh solution will eventually allow for the bacteria to take over and you may be adding more bacteria into your eyes than if you never disinfected the lenses to begin with.

Multipurpose solution companies oftentimes will give you a new case when you buy bigger bottles of solution. This is meant for you to START with the NEW CASE with the NEW BOTTLE of solution. Not to stash the case away and have a drawer full of new cases. There are fungi and other organisms that have been demonstrated to grow from very old lens cases so USE the new case and don't keep it for when you break the old one.

There are many different multipurpose solutions on the market. They aren't cheap and it is tempting to purchase “what is on sale” to save a few dollars. If it does the same thing as the expensive one, then why bother spending the extra? But remember, your contacts are like little sponges that soak up your lens solution. The lens companies don't care if brand A’s solution is compatible with brand B’s or C’s. So over time you can develop a sensitivity to one particular brand of solution, or mixing solutions with the same lens can cause a chemical reaction that occurs because the solutions are not compatible. If you are using the same brand regularly and start having issues your doctor may recommend a solution change to another company that you haven't tried and this may potentially solve your problem. But if you have used several different ones in a few weeks prior to your visit it makes it much harder to determine the cause of your irritation.

The generic/store brands are fine products but a grocery store or discount chain doesn’t have a factory that makes their solution for them; they purchase it from a larger supplier. These third-party suppliers can alter their recipe for their multipurpose lens solution and you as the consumer never know. You could just start finding your contacts are not as comfortable as they used to be and it is actually the unknown generic solution change that is bothering you. Brand name companies like Bausch and Lomb, AMO, and Alcon will rarely make product changes without making consumers aware that they've reformulated the product so if something changes with the reformulated product you have a better chance of knowing it than with a generic solution manufacturer.

Finally, there is a product called saline solution. Saline is extremely inexpensive, generally half to a third the price of multipurpose solutions. This is a product made by many different companies and was the first lens solution ever used. Saline solution was initially used in a heat disinfection system where the lenses were boiled nightly. The boiling of the lens provided the disinfection, not the saline solution. The solution was to just to prevent the lens from drying out while you cooked it. You should NEVER use saline solution as a replacement for multipurpose solution. Saline solution is NOT a disinfectant for your lenses. It doesn’t contain an agent that will prevent bacteria and organisms from growing in the case overnight and potentially can set you up for infections. However, it’s totally acceptable if you want to rinse your lenses in the morning with saline prior to inserting them after they were disinfected with your multipurpose.

Oftentimes, a practitioner will recommend a certain type of solution to help with things like dryness, environmental allergy-sensitive patients, or patients who are allergic to multipurpose solutions. I always recommend to check with your practitioner before making any changes to your lens care solution or lens care routine. The best advice for saving money on your preferred solution is buy extra when it is on sale, buy in bulk, and buy what is most comfortable in a multipurpose solution for you. Then stick with it and use it correctly for many years of happy lens wear.

More middle-aged and older adults are wearing soft contacts than ever.

And one of the biggest reasons they decrease or stop wearing contacts is the difficulty they face reading with their contacts after presbyopia begins to set in around the early 40’s.

Presbyopia is the diminished ability of the natural lens in our eyes to focus up close on near objects. It begins with the occasional medicine bottle being a struggle to read to eventually even having a meal is blurred. As I am going through this problem myself, it is very frustrating to stare at something up close and have it be blurry regardless of what I do.

So there are three basic choices a contact lens wearer can do to aid their reading while still wearing contact lenses.

Reading Glasses

Initially, the use of an over-the-counter reader or prescription reading glass for occasional use works well for people in the early stages of presbyopia. They are worn over distance contact lenses so there is little adjustment and vision is clear near and far. However, they need to be with you, not left in the car or at work, and oftentimes people end up just wearing readers all day since it is just that much clearer.

Monovision

This fitting technique can be used with any type of contact lens. The brand of lenses you are currently wearing can often be used to fit you with monovision. Your dominant eye is determined. Then the non-dominant eye prescription is adjusted to compensate to make it a reading contact lens. So once fitted you have one eye for distance and the other for reading. Yes, it sounds really crazy, but it actually works quite well. Your brain initially has to adjust to using each eye individually to obtain the sharpest vision, but once this is achieved, year-to-year adjustments can be made to the reading eye to allow comfortable distance and reading vision for many years.

Monovision fits are not always successful. Some people just cannot adjust to it regardless of motivation or desire. It seems to work best when someone has had some difficulty with reading and they are noticing more and more that they need their readers. At that point, they can appreciate the ability to read and their brain seems to adapt more readily. When I wear my contacts this is the option I have used for myself.

Multifocal Contacts

Another option is multifocal contact lenses. Most every major manufacturer of soft contact lenses has some type of disposable multifocal lens available. They do not work like multifocal glasses. They use a technique called simultaneous viewing where you are actually looking through all the powers at once.

To visualize this, imagine a vinyl record with the label in the center and the various tracks extending outward. Most of the lenses are made with the strongest reading power located in the center where the label would be, then each ring further out gradually becomes weaker until you reach your full distance power. So essentially you are looking “around” the reading part for distance then through the center for reading. It works, sort of.

Multifocal lenses work better on younger patients, say 40-50 years old, for help with reading. There is no adaptation period to these lenses like monovision. What you see is what you get. But if you have any significant amount of astigmatism or if you wear a toric contact that corrects for astigmatism, multifocal lenses are not for you. And because the reading is central in the lens, if you make it too strong for reading then you blur the distance vision too much, so oftentimes a multifocal lens wearer after age 50 faces a dilemma to either wear reading glasses to boost their reading needs or change to monovision.

Conclusion

In conclusion, while none of the options are perfect they all may present some level of relief in your quest to continue to wear contacts into middle age, retirement and beyond. But some options may better serve you at a certain point in your life or career than others. So while you happily wore contacts from your teens into your 40’s, just because you’re another year older is no reason to give them up. Talk to your ophthalmologist or optometrist to see what choices are best for you.

Article contributed by Eugene Schoener O.D.

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