WHY HYDROGEN PEROXIDE IS MY FIRST CHOICE

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H2O2 solution can help avoid noncompliance issues that lead to contact lens complications.

Abbott Medical Optics
800.347.5005 | Surgical.JNJVision.com
Oxysept Disinfecting Solution/
Neutralizer Ultracare Formula
Description: Sterile 3% hydrogen peroxide solution for lens disinfection. Oxysept Neutralizing Tablets are a delayed-release neutralizing tablet that is added at the beginning of the disinfection cycle and colors the solution pink to show that the tablet has been added. This tablet allows disinfection to occur before neutralizing the solution all in one easy step. Oxysept Cup is a specially designed lens cup that must be used with this system.

Alcon Laboratories
800.451.3937 | Alcon.com, 
ClearCareSolution.com
CLEAR CARE Cleaning & Disinfecting Solution
Description: Preservative-free sterile solution containing micro-filtered hydrogen peroxide 3%. Comes with PLATINUM DISK, which activates bubbles to clean your lenses by neutralizing the hydrogen peroxide and lens baskets to hold contact lenses in place. CASE fill line helps you use just the right amount of solution for your lenses.
CLEAR CARE Plus Cleaning and Disinfecting Solution with HydraGlyde
Description: System consists of preservative-free CLEAR CARE Plus Cleaning & Disinfecting Solution, a 3% hydrogen peroxide solution. Features HydraGlyde Moisture Matrix technology for sustained lens moisture. Also comes with CLEAR CARE* PLUS lens case consisting of a transparent cup and a connected unit of screw cap, lens holders (baskets) and the neutralizer catalyst disc.
CooperVision, Inc.
800.341.2020 | CooperVision.com
Refine One Step
Description: Preservative-free, one-step, 3% hydrogen peroxide solution. Consists of Refine One Step hydrogen peroxide solution, platinum disc neutralizer and barrel lens case.

Keeping patients in contact lenses without complication is the goal of many practices. Unfortunately, however, patients do not always adhere to our recommendations for safe wear and care.

Hydrogen peroxide (H2O2) contact lens solutions afford practitioners ease of mind when it comes to safety and offer patients visual feedback and ease-of-use benefits. The H2O2 products on the market today are as ideal as it gets and our go-to system for patients. H2O2 contact lens disinfection is now my number one choice when it comes to reusable contact lenses.

COMPLICATING FACTORS
Contact lens fitting success has historically been jeopardized by the occurrence of complications. Improper cleaning and disinfection, reuse of solutions, not replacing lens cases and contact lens over-wear have been proposed as causes of complications.

A 2011 study found that only 2% of individuals demonstrated good compliance, with only 0.4% fully compliant. The remaining 98% engaged in risky practices, including tap water exposure, sleeping in lenses not approved by overnight wear, wearing lenses beyond the manufacturer’s recommended replacement frequency, failing to wash hands, failing to replace the lens case and solution misuse.

We can address many of these issues by properly educating patients and by encouraging them to use H2O2 disinfection.

AROUND FOR LONG
H2O2 disinfection of contact lenses has been around for quite some time, and it is oftentimes what other methods are compared against. H2O2 disinfection consists of 3% peroxide per case with a neutralizing agent. Very low levels of peroxide remain after neutralization, with a goal of less than 100 parts per million to avoid ocular detection.

Modern systems include surfactants, buffering and wetting agents to increase lens wettability and lens comfort during the wearing cycle. We now have a system that is historically well known for its disinfection properties and has additives that increase wearability and comfort.

Additionally, H2O2 may simplify patients’ care regimen—a significant advantage for a patient base known to be non-compliant. (Remind patients to use the special case that comes with the solution, not to rinse contact lenses with the solutions and keep the solutions out of their eyes.)

Here are the steps required in the H2O2 care process: Wash hands, place lenses into the baskets and rinse for five seconds, and fill the case, tighten the cap and soak for at least six hours.

For comparison, here are the steps required in a common multipurpose solution: Place at least three drops on each side of the contact lens, rub the lens for 20 seconds, rinse each side of the contact lens for five seconds, and fill the case, insert the lenses and tighten the cap.

ALL-IN-ONE
Multipurpose solutions (MPS) first came to market in 1995. Patients can use these agents as an all-in-one product to clean, disinfect and store contact lenses. After 1997, MPS became the predominant disinfection method used by contact lens wearers.

CLEAR CARE PLUS combines 3% hydrogen peroxide with HydraGlyde Moisture Matrix technology for sustained moisture.

However, the convenience of requiring only one solution to perform a multitude of tasks has resulted in noncompliance with labeling instructions in more than 79% of users. MPS require rubbing and rinsing of the lenses (per the package inserts), yet as many as 75 to 77% of patients fail to do so, despite the increased risk of biofilm formation and increased bioburden of pathogens. H2O2 does not require lens rubbing, and the frequency of all contact lens-related adverse events is reduced through the usage of H2O2 disinfection.

Another challenge: One study found that 22% of subjects reported topping off MPS instead of using fresh solution. This is particularly worrisome, as this behavior was implicated as a key factor in the outbreak of contact lens-related fungal keratitis. The design of the H2O2 system counteracts this disinfection misuse. Patients get visual feedback with peroxide disinfection (the bubbles). They are discouraged from topping off H2O2 because there would be no bubbles.

CONTACT LENS WORKSHOP
The FDA sponsored a two-day Contact Lens Care Product Workshop in January 2009, several years after the outbreaks of contact lens-related fungal and Acanthamoeba keratitis. A comprehensive research plan tested contact lenses and their lens care products in experiments meant to mimic real-world challenges that face patients. The results were published in 2012.

In 2006, researchers found that biocides and MPS preservatives can be taken up into contact lenses, leaving what remained in the case questionably ineffective. Any loss of efficacy of a solution from preservative uptake, combined with MPS misuse by patients (topping off, for example), could have a marked effect of disinfection and safety.

The FDA experiments also attempted to determine preservative depletion and the resultant efficacy of the remaining preservative in solution. Because uptake into the lens is a potential problem, the subsequent release of the biocide is also problematic. The FDA found that MPS can lose its bactericidal efficacy when a contact lens is introduced and can have less microbiocidal action against common eye pathogens.

H2O2 does not have similar challenges. Peroxide can enter and exit a lens with ease and is nearly completely neutralized after the disinfection process. The bactericidal efficacy of H2O2 is consistent in the presence of contact lenses.

DEDICATED PATIENTS
Many patients today have challenges with contact lenses. These challenges can result in eventual contact lens dropouts. In one study of patients with lid papillae, my colleagues and I found H2O2 to outperform MPS in the following areas: lens cleanliness, clarity of vision, and lenses feeling clean and like new (after disinfection). The individuals also reported reduced irritation, grittiness/scratchiness, burning/stinging, itchiness, dryness and blurred vision.

Patients who use H2O2 are oftentimes very dedicated to the product. I have found that patients are well aware of the category of peroxide disinfection and the brand that they use (and they are correct!). Modern advances now afford additional benefits to this process in terms of improving lens comfort and wear. H2O2 is easy to use, and patients are less likely to misuse it. It offers visual cues to our patients. That’s why these solutions are my first-line recommendation for reusable contact lenses.

Christopher W. Lievens, OD, FAAO, is chief of staff at The Eye Center at Southern College of Optometry, where he also is a professor. He has received compensation for consulting and/or speaking for Alcon.

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