New multipurpose solutions aim to make contact lens care more comfortable without sacrificing lens hygiene.
In the early 2000s, you may remember, a sudden flurry and panic surrounded the contact lens solution industry. Sight-threatening microbial infections were occurring in relation to specific soft contact lens solutions, particular lenses and the manner in which patients were using (or not using) the solutions as directed.
This was a huge moment for many in the profession. We expect the solutions we recommend to deliver effective cleaning, disinfection and overall safety for our patients—no matter how they use that solution. But, when the effectiveness of those solutions and lens compatibility came into question, we realized that we needed to examine those expectations more closely. Proper education of patients, pairing specific contact lenses with cleaning/disinfection systems, and ensuring that the solutions we were prescribing met the standards we desired became even more important.
Thankfully, the solution industry responded, leaving those fears of microbial keratitis in the past. Even though my practice primarily dispenses daily disposable contact lenses, I still study the technology available to our patients as far as contact lens solutions.
Every multipurpose solution must pass rigorous standards of disinfection to receive approval from the U.S. Food and Drug Administration. The days of “no rub” solutions are long past. Indeed, if you look at contact lens solutions (under “Medical Devices”) on the FDA’s website, the instructions, in bold, tell patients to “rub and rinse” contact lenses, to not top off solutions in the case and to be sure to replace the lens case at least every three months.
Here are some of the solutions available today and how they work.
Biotrue Multipurpose Solution from Bausch + Lomb is “formulated to work like the eyes,” according to the company. The solution contains hyaluronan, a lubricant found naturally in the body and in the eye to help lenses stay moist and comfortable throughout the day. Bausch + Lomb formulated this solution to match the pH of healthy tears to enhance the performance of the dual disinfectants. Biotrue is designed to keep tear proteins, which have natural antimicrobial actions, active while breaking up denatured proteins that build deposits on lenses. Also, Biotrue only requires a four-hour soak in the lens case to deliver the FDA-required disinfection standards.
Bausch + Lomb also recently launched renu Advanced Formula multi-purpose solution for soft contact lenses, including silicone hydrogel lenses. This new formula, which contains three disinfectants and two surfactants replaces the company’s renu sensitive and renu fresh solutions.
Alcon Laboratories, a division of Novartis, has several multipurpose solution options on the market under its Opti-Free brand. Its newest formulation, Opti-Free Puremoist Contact Lens Solution, contains a HydraGlide Moisture Matrix. This wetting agent embeds itself on the surface of and within the lenses to create a lubricating “cushion” of moisturre around the lens to reduce lipid deposition and provide lasting lens surface moisture. The solution is preserved with Polyquad and Aldox to disinfect soft lenses following the rub and rinse instructions and six-hour soak.
Clear Care Cleaning and Disinfecting Solution, also from Alcon, is a 3% hydrogen peroxide, preservative-free, based cleaning and disinfecting solution that is indicated for use with soft and gas permeable contact lenses.
The hydrogen peroxide cleans and disinfects lenses with a special case that contains a platinum disk to activate cleaning bubbles and neutralize the peroxide to a gentle saline after six hours of soaking. For sensitive patients, this preservative-free neutralized solution is gentler to the eye creating an overall improved lens-wearing experience. Instruct patients to be careful not to use the solution improperly as 3% hydrogen peroxide solution directly from the bottle or that hasn’t yet been fully neutralized/converted into a gentle saline can irritate the ocular surface and cause temporary but severe burning and stinging.
More recently, Alcon introduced CLEAR CARE PLUS, with HydraGlyde Moisture Matrix technology added to the formulation. As mentioned above, this wetting agent surrounds soft lenses in long lasting moisture for extra hydration.
Blink Revitalens Multi-Purpose Disinfecting Solution from Johnson & Johnson Vision is intended for soft contact lenses, including silicone hydrogel lenses. This solution uses Alexidine and Polyquad as its preservatives/disinfectants. There is no noted wetting agent, however, it conditions and removes proteins, providing more than 16 hours of comfortable wear. In studies, it demonstrated broad-spectrum disinfecting similar to hydrogen peroxide systems and a 100% kill rate of Acanthamoeba.
Generic multipurpose solutions are available, but studies have shown that these “store brand” solutions are not equivalent to, or as effective as, branded solution systems. This can be confusing to our patients, especially since the same manufacturers of branded solutions are the ones who supply generic brands. However, generic brands are often older formulations with key differences in preservatives—which, if anything, are what our patients are most likely to be sensitive to.
Also, store brands may keep the same name and packaging, but they may also change producers, affecting the chemistry of the solution itself. To remain protected and consistent, prescribing a branded solution is the safest for our patients.
Fortunately for us and for our patients, there exist many options for contact lens care in regards to solutions, several of which have been highlighted here. It’s important that we keep ourselves and our patients informed about the what, how and why of the solutions we provide to preserve patient safety. OO
Gina M. Wesley OD, MS, FAAO, is in private practice in Medina, MN.