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Optometry Blog Continuing Education and Training Contact Lens Care Solutions C9622 General Optical Council (UK) Accreditation GOC Registered Dispensing Opticians: 2 General CET Points www.cetoptics.com GOC Registered Optometrists: 2 General CET Points www.cetoptics.com GOC Registered Contact lens opticians: 2 General Contact Lens CET points www.cetoptics.com Accreditation may also be available from other organisations. Please check the Optometry Blog for detail. To receive your CET points for this article, complete the attached Multiple Choice Questions. A pass mark of 66% (8 out of 12 correct answers) must be achieved Only one attempt is permitted The deadline for responses is 30th September 2009 If you would like us to seek accreditation for your own organisation, please contact us: www.ukoptometry.co.uk www.ukoptometry.co.uk Optometry Blog Continuing Education and Training Contact Lens Care Solutions Ngaire Franklin takes a closer look at the contact lens care market, covering sensitivity, toxicity and effectively of current and past care regimens. One of the great challenges of contact lens practice is ensuring that lenses placed on the human eye will not be a source of contamination or infection or cause inflammation. The perceived simple solution to this problem is probably to use daily replacement lenses whenever possible. Factors which limit the use of daily lenses are range of prescriptions available, although manufacturers are increasing these ranges all the time so that now high prescriptions and many astigmats can benefit from this mode of wear. Cost may be a factor if the patient wishes to wear lenses every day or very frequently. Some patients who need to wear lenses for long hours or even to sleep in may need lenses with increased oxygen permeability. Until recently, daily disposable lenses have been widely available in conventional hydrogel materials. Johnson & Johnson now introduced Acuvue TruEye™, which are a silicone hydrogel daily lens (Figure 1). These lenses were released to all UK based practitioners in the autumn of 2008. Johnson & Johnson have launched these in the UK in advance of making them available to the rest of the world in part because of the very high percentage of daily wear lens wearers in Britain (approximately 30%). It will be interesting to see how soon the other companies introduce a similar product on to the market. solutions. Patients who wish to wear lenses on an irregular basis have the reassurance that if they are using daily lenses then the lens comes from an uncontaminated source provided that they have been properly educated in hand washing procedures. Daily lenses still remain a very convenient mode of wear for many people. When considering cleaning systems for contact lenses three main lens types need to be considered, rigid lenses almost exclusively now made from gas permeable materials, hydrogel materials and silicon hydrogel materials. The practitioner will want to know that any cleaning system will effectively reduce the level of contamination on a lens after wear to the point where the lens will not present any hazard to the eye when reinserted. They will also need to know that the regime will be simple enough for patients to actually bother cleaning lenses at all. The practitioner will also reasonably expect to derive some income from the sale of contact lens cleaning products. From the patients perspective the system needs to be effective, simple to use, and affordable. Research commissioned by Bausch & Lomb1 into patient’s wearing habits “demonstrate that 98 % of all contact lens wearers are not fully compliant when it comes to executing the correct care regime at insertion and removal of contact lenses”. This is despite the fact that “93 % of contact lens wearers believe that not following the recommended lens care regime does increase the risk of contracting eye infection”1 This means that from the contact lens practitioner’s point of view that there is a huge opportunity for improvement and something of a challenge too. In taking up this challenge the practitioner needs to consider what is actually achieved “by cleaning” using currently available care systems. Figure 1 1day Acuvue TruEye™. A silicone hydrogel daily disposable lens, introduced to the UK market, in autumn 2008. It is important to differentiate between sterilization, disinfection and cleaning: The only cloud on this horizon is that increasingly research is showing that the incidence of microbial keratitis (MK) seems to remain at a similar figure for all modalities of wear. Obvious sources of contamination of daily lenses would include poor hand hygiene and reuse of lenses particularly if cleaning of the lenses is not carried out between wearing them. Daily lenses would still seem to be a first choice for anyone who is sensitive to cleaning Sterilization Sterilization will eliminate all living microorganisms, including acanthamoeba cysts and bacterial spores. This is achieved during the manufacture of lenses by the application of heat in an autoclave so that temperature and pressure are elevated, typically 115-118oC for 30 www.ukoptometry.co.uk Optometry Blog Continuing Education and Training minutes (Figure 2). Lenses when they arrive from the manufacturer will be sterile. Once the packaging has been opened the lenses will not be sterile. Care regimes used by sterilization of lenses. patients will not achieve Disinfection Disinfection depending on the antimicrobial ingredients used will eliminate a range of microorganisms however bacterial spores and acanthamoeba cysts may survive. If lenses are not disinfected then microbial keratitis (MK) is more likely to occur. Brennan and Coles2 found that contact lens wearers are 60 times more likely to develop MK than are non-wearers. Current care regimes licensed for use in the United Kingdom if used correctly will disinfect lenses effectively against a specified range of organisms. Cleaning and Rinsing. When a lens is removed from the eye the most effective way of removing surface deposits and debris is to mechanically rub and then rinse the lens with an appropriate solution prior to placing the lens in disinfecting solution (Figure 3). This process contributes greatly to the elimination of microorganisms and may account for up to 99% of the disinfection process if done properly. In recent years attempts have been made to design solutions which are effective without a rub and rinse stage but increasingly both anecdotal and scientific evidence suggest that leaving out this stage is a step too far3. Practitioners and solution manufacturers are again advising patients that they should be including a rub and rinse stage during the lens cleaning procedures. Sources of Contamination Once sterile packaging has been opened contamination can reach lens surfaces and potentially the eye from, • • • • • Hands during lens insertion The atmosphere Lens care products Contact lens cases (Figure 4) The eye itself Contaminants can include, • Figure 2. Sterilisation using an autoclave. Both pressure and temperature are elevated: Lenses are heated to 115-118 0 C Figure 3: Evidence suggests that mechanical rubbing is still the most effective way of removing surface deposits. • • • • • • • • Microorganisms including bacteria, viruses, fungi, protozoans, chlamydiae, actinomycetes and prions Cellular debris Tear constituents including proteins mucous and lipids Skin lipids Debris from fingers Cosmetics Air borne contamination Care products By products produced by interactions between any of the above Figure 4: Practitioners will regularly ask to check the state of a patient’s contact lens case. Filthy cases will harbour a large variety of harmful contaminants including whether or not the case lives in the average female hand bag (supposition) www.ukoptometry.co.uk Optometry Blog Continuing Education and Training Any care regime will therefore potentially need to have the capability to remove the above kinds of contaminant or reduce them to a level that the eyes own defence systems can cope with. then additional processes such as the use of a separate surfactant cleaner and possibly additional protein removal measures will probably need to be added to the cleaning regime. Currently available soft lens care systems fall broadly into two main types: Peroxide based systems and Multipurpose “all in one” systems. The practitioner will need to decide which system is most appropriate for the lens type being used and the individual patients need. Consideration will also need to be given as to when a surfactant cleaner will be appropriate and whether a specific protein remover will be needed in addition to the normal daily care regime. There are increasingly limited rigid lens care systems available reflecting the decline in use of rigid lenses both in the UK and globally. These also fall into two main types, multipurpose or surfactant cleaner plus conditioning and soaking solution. Again the practitioner will need to give thought as to whether an additional protein remover will be needed. Some rigid lens wearers use peroxide systems that were originally produced for soft lens wearers and find peroxide an effective way to clean rigid lenses. Proprietary saline solutions are suitable for rinsing any type of contact lens. Tap water should never be used with soft lenses. Current advice to rigid lens wearers is that they should not use tap water either as acanthamoeba in particular is found in tap water especially where lime scale is a problem, which is in many parts of Britain (Figure 5). The other problem with tap water in the UK is that it is stored in tanks in the loft in many homes, this is unusual in most of Europe, and this is another factor thought to contribute to acanthamoeba infection which is relatively high in Britain. However to put this into true perspective acanthamoeba infection is still extremely rare. It is however difficult to treat especially if advanced, causes tremendous pain and is easily missed in early stages. Practitioners should always consider this an option for patients presenting with ocular pain in the absence of clinical signs of anything very much wrong with the eye. Multipurpose Systems These are also described as “all in one” solutions as one solution is used to clean as in rub clean, then soak the lenses usually overnight to complete the disinfection process (Figure 6). Various preservatives are used to disinfect lenses. These solutions when used correctly will be effective against a range of organisms and work well with lenses that are replaced regularly i.e. monthly or bimonthly. They may not be suitable for patients who are prone to solution sensitivity. If patients are using lenses for longer than 1 month, the next replacement frequencies tend to be 3 months, 6 months or annually, Figure 5 Lime scale build-up on a bathroom tap provides a favourable microenvironment for acathamoebae. Figure 6 Multipurpose solutions clean, rinse, disinfect, and store soft lenses: Examples include ReNu (Bausch & Lomb) and Complete (Advanced Medical Optics). Each promote disinfection by removing and killing a broad range of bacteria and microorganisms. The practitioner also needs to take into consideration the material used as there is evidence that certain silicon hydrogel materials when used in combination with some solutions result in corneal staining. For more Information see www.staininggrid.com and The Institute for Eye Research matrix at www.ier.org.au. The staining pattern by the time the practitioner views it is frequently described as “doughnut” staining (Figure 7 Top) having the appearance of a ring doughnut. Immediately after insertion there will probably be staining over the entire cornea, as tears start to flush solution from the lens during wear staining will start to resolve. Tissue recovery may occur initially where the lens is thinnest and a majority of lens wearers are myopic so recovery will generally occur centrally hence the “doughnut” pattern of stain. There is some debate as to whether this is harmful www.ukoptometry.co.uk Optometry Blog Continuing Education and Training or gives increased potential for infective or inflammatory events, however patients exhibiting this staining pattern often notice much improved comfort when the solution is changed (anecdotal evidence). Patients with this problem are best seen soon after lenses are inserted, usually early morning appointments, and it is essential to instil fluorescein, a Wratten filter will aid visualization (Figure 7 Bottom). This avoids wasting a lot of chair time by changing lens type unnecessarily. day allows the eye to recover fully. If reassurance is required for either patient or practitioner then the patient can be asked to return either at the end of clinic on the same day or 24 hours later for a corneal check with fluorescein. Catalysts currently used are either the enzyme catalase or platinum: • Catalase can be put into the peroxide either in tablet form as in Oxysept 1-Step (Figure 8) or as a second solution stage as utilised by Tesco’s own brand system. (It maybe that this option is currently in the process of being discontinued by Tesco). Neutralisation takes 2 hours if using the Oxysept system or 20 minutes using Tesco’s system. • Platinum is incorporated into a disc sitting in the base of the contact lens case and neutralises hydrogen peroxide over a period of 6 hours (Figure 9). Consideration needs to be given to those patients who most benefit or need to use peroxide cleaning systems. These might include patients who are sensitive to preserved solutions or who replace their lenses less frequently than monthly. Again a rub stage should be advised with either a few drops of peroxide or a separate surfactant. This decision might need to be made after aftercare has been carried out to assess the level of any lens deposition. The need for additional protein removal procedures can also be assessed. The easiest way to incorporate protein removal is to use a tablet of Subtilisin A that is dropped into the normal disinfecting solution as frequently as recommended by the practitioner e.g. weekly. Figure 7 (Top) “Doughnut” staining found in a patient who switched from a conventional hydrogel contact lens to a silicone hydrogel. Practitioners must consider whether the patient's current lens care system is compatible with the new lens material. (Bottom) The use of a Wratten filter enhances corneal staining patterns. Peroxide Systems These systems use 3% Hydrogen Peroxide as the disinfecting agent and require a catalyst to neutralise the peroxide. Hydrogen peroxide is a very effective disinfecting agent and will destroy bacteria, viruses, fungi and acanthamoeba cysts. Un-neutralised peroxide is a potential hazard and if it gets onto the eye will result in a painful experience for the patient. There will probably be some temporary epithelial disruption and red swollen conjunctiva. This normally resolves quickly particularly if the patient has the presence of mind to rinse the eye copiously. Patients will usually attend immediately, usually first thing in the morning, wanting to check that no permanent damage has been done. Normally leaving lenses out for the rest of the Figure 8 Oxysept® peroxide disinfection system (Advanced Medical Optics). The case is filled with solution. One neutralization tablet is added and the case inverted several times to ensure full neutralisation. Following a minimum of a six hour soak, the tablet will have coloured the solution pink indicating that the lenses are neutralised and are ready to wear. www.ukoptometry.co.uk Optometry Blog Continuing Education and Training imadazoline derivatives. Other cleaning agents may be used in combination with surfactants. These include, • • • isopropyl alcohol, found in MiraFlow®, (Ciba Vision) which acts as a lipid solvent and has some preservative action (Figure 10) polymeric beads that have a very mild abrasive action and chelating agents e.g. EDTA (ethylene diaminetetraacetic acid) which remove mineral ions. Figure 9: Aosept®(CIBA Vision) utilises a platinum coated disc to neutralise the hydrogen peroxide, over a minimum period of 6 hours. It is important to remember that once the peroxide has been neutralised the lenses will be sitting in saline and if there are any residual microbes in the solution then they will potentially start to multiply. Standards The current standard to which contact lens solutions are manufactured is BS EN ISO 14729:2001. This standard is identical to EN ISO 14729:2001 and ISO 14729:2001. This standard relates to Contact lens care products and covers microbiological requirements and test methods for products and regimens for the hygienic management of contact lenses. The challenge organisms used in this standard include bacteria, yeast and mould and are Stapphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Candida albicans and Fusarium solani. There is currently no requirement for contact lens solutions to be effective against acanthaeomeba. Figure 10 MiraFlow(Ciba Vision) is a preservative free, alcohol based daily contact lens cleaner. “MiraFlow loosens and removes deposits and debris to help maintain comfort and vision." Specific surfactant cleaners are particularly useful if lenses are replaced relatively infrequently i.e. less than monthly. Patients who tend to deposit lipid and other debris also benefit. These cleaners need to be thoroughly rinsed from the lens surface prior to disinfection as they will irritate the ocular surface. Disinfecting Solutions Product Types Care products can be considered by the function that they have within the care regimen. Cleaner/Surfactant Surfactants work in the same way as detergents used in washing up liquids and washing powders to clean kitchen utensils and clothes. Debris is dissolved and the surfactant forms a monolayer around lipid droplets. Recombination of lipid is prevented so fats are emulsified. Common surfactants include poloxamine and amphoteric These complete the cleaning cycle and include peroxide systems and multipurpose solutions. Multipurpose solutions may include surfactant ingredients them Disinfecting solutions designed for use with soft lenses increasingly use additional ingredients that attempt to enhance moisture retention properties of lens materials e.g. Focus Aqua, Ciba Vision and Opti-Free Replenish, Alcon. Disinfecting solutions designed for use with rigid lenses will include agents that wet and condition the lens surface. www.ukoptometry.co.uk Optometry Blog Continuing Education and Training Figure 11 (Left) Single dose preservative free sterile saline from Abatron Ltd. And (Right) Steripod (Molnlyke Healthcase) The tubes are also convenient to practitioners for rinsing eyes after the instillation of Bengal Rose and Fluorescein dyes into the eyes. Saline Used for rinsing lenses e.g. after cleaning and prior to soaking. Currently available saline products in the UK come in plastic squeezy bottles and contain preservatives If a preservative free product is required then saline Minims® or a unit dose product such as Steripods (Figure 11 Left) should be used. Patients should be made aware that these products are not suitable for disinfecting lenses. Sodium Hypochlorite is found in products used for cleaning baby bottles and other baby feeding equipment, such as Milton cleaning fluid. For advice on the re-use and cleaning of trial RGP lenses The College of Optometrists website4 is recommended. Functions of Contact Lens Solution Components Protein Removers Preservatives Protein removers (Figure 11 Right) are used to remove bound protein from lens surfaces. To be effective they need to be used before protein denatures so where use is indicated it needs to be regular e.g. weekly. Lens wearers who will probably need to use protein removers are those that replace their lenses less frequently than monthly, rigid lens wearers would be an example. It is fairly unusual to see patients who replace their lenses at least monthly having problems with protein deposition. The author would actually suspect that monthly wearers who do have such problems might well be making their lenses last rather longer than a month particularly if the patient pays cash for their lenses or purchases from the internet. Those patients on planned replacement schemes are less likely to “make their lenses last”. These are substances or preparations added to a product to destroy or inhibit the multiplication of micro organisms. Subtilisin-A found in Ultrazyme Universal Intensive Cleaner (AMO) can be dropped into either Hydrogen Peroxide or Multipurpose disinfecting solutions as part of the disinfecting cycle. This eliminates the need for a separate protein removal process. Menicon Co. Ltd market a product called Menilab for practice use only. This product contains Sodium Hypochlorite which is effective against prions and viruses and is intended for RGP trial lens disinfection. PolyQuaternium 1 based systems (Polyquad®) act as antibacterials which is used By Alcon in OptiFree Express and OptiFree Replenish. These solutions also contain myristamidopropyl dimethalamine MAPD (Aldox®) which has anti-acanthamoebal and antifungal properties. Polyhexamethaline biguanide PHMB is known by including polyhexanide, several names5 polyaminopropyl biguanide, Dymed and Trischem. PHMB is present in many currently available multipurpose solutions. Chlorhexadine an effective preservative historically used in soft lens solutions caused many solution sensitivity problems due to its small molecular size and has been replaced by chemicals with much larger molecules such as PMBH and Polyquad. There is a reduced uptake of large molecule preservatives into soft lens matrix6 and reduced levels of allergic reactions. Chlorhexadine is still found in Boston RGP lens cleaning products. www.ukoptometry.co.uk Optometry Blog Continuing Education and Training Active Agent / Ingredient: These are the surfactant / cleaning ingredients within the solution. film is maintained the optical quality and performance of the lens will be enhanced. These include the viscosity agents mentioned above. Hygiene Neutralising agents Hydrogen Peroxide is an extremely effective disinfecting agent, will cause a great deal of discomfort if introduced onto the surface of the eye so needs to be neutralised. Currently this is achieved either by the use of platinum introduced into the case as a disc e.g. AOSept PLUS Ciba Vision and EasySEPT Bausch and Lomb, or by use of the enzyme catalase e.g. Oxysept 1-step AMO. By products of the neutralisation process are oxygen and water. Cases have to be vented to allow the oxygen to escape and prevent the case from exploding so patients need to understand that they need to use only the case provided with the solution. Clean hands are an essential starting point to contact lens wear. Patients (and practitioners) need to be taught how to wash hands thoroughly using hand wash. A five second “rinse” with cold water is not enough. Hands will always potentially be a sources of many contaminants which may range from something that causes minor ocular irritation to full blown MK caused by bacterial contamination It is worth remembering that acanthamoeba find limescale a very cosy habitat and that the average face flannel provides a wonderful environment for pseudomonas to breed in. Case Cleaning Chelating Agents EDTA (ethylyne diamine tetra-acetic acid) or its salts acts as a synergist in aiding preservative action and may help to improve product stability through chelating and sequestering metal ions and mineral ions such as calcium and magnesium. Buffers Buffers are elements in solutions that resist pH changes. Currently Borate, Phosphate and Citrate buffer systems are used in contact lens solutions. Change in pH can alter solution properties including biocidal activity of preservatives or disinfectants. Lubricating Agents These constituents are intended to help reduce or eliminate symptoms of ocular dryness and or discomfort. These include hypromellose, Dexpanthanol in Focus Aqua Ciba Vision It seems to be generally agreed that contact lens cases should be replaced frequently, consensus would suggest monthly is the way to go. Cases also need to be cleaned regularly. Various methods of cleaning cases have been suggested: rinsing on a daily basis with cooled boiled water and allowing the case to air dry, cleaning on a weekly basis either using contact lens disinfecting solution or sodium hypochlorite (available as proprietary baby bottle cleaning products) solution then rinsing with cooled boiled water and allowing to air dry. Any sticky debris can be removed by gently brushing with a soft baby toothbrush, one that has been bought for the purpose rather than one previously used by baby. Ciba Vision provide a case containing silver, which has antimicrobial properties, with Focus Aqua solution (Figure 12). Viscosity Agents Increasing the viscosity of a solution will help to improve in-eye contact time and also soothe, help reduce irritation and make surfaces slippery. Polyvinylpyrrolodine PVP, Polyvinyl alcohol PVA and polyethylene glycol PEG are examples of viscosity agents. Conditioning Agents These ingredients are constituent parts of solutions for use with RGP lenses. The solution needs to increase the surface tension of the RGP lens to enable tears to “wet” the lens. The lens will be cushioned and foreign body sensation should be reduced on lens insertion. If a regular pre-lens tear Figure 12 The MicroBlock lens case from Ciba Vision contains the inorganic antimicrobial agent silver to reduce contamination and prevent biofilm formation. The silver is injection moulded into the plastic so efficacy is not affected by surface abrasion. Silver ions are enclosed in a carrier and released only when the case comes into contact with moisture. www.ukoptometry.co.uk Optometry Blog Continuing Education and Training Product Information Tables 1-6 The following tables following include many solutions currently available in the UK. Many retailers sell these solutions including supermarkets and large pharmacy chains as well as many optical outlets so it should not be difficult for patients to purchase lens care products. The list is not exhaustive and cannot take into account any recent introductions, discontinuations or reformatting of products. Ngaire Franklin BSC FCOptom DipCL is currently Professional Practice Manager with Boots Opticians. Previously a Boots Tutor Practitioner and Visiting Lecturer at both Cardiff and Aston Universities, her specialist areas include contact lens practice and legal & professional studies. Ngaire is co-author of two Eye Essential Text books, Soft Lens Fitting and Rigid Gas-Permeable Fitting by Elsevier Health. Further Sources/ Recommended Reading • • • • • • ACLM (Association of Contact lens Manufacturers) www.aclm.org.uk BCLA (British Contact Lens Association) www.bcla.org.uk College of Optometrists www.college-optometrists.org.uk Contact Lenses Ed 5 Anthony J. Phillips, Lynne Speedwell Butterworth Heinemann Elsevier www.staining-grid.com www.ier.org.au References 1. Bausch and Lomb in association with Eurolens Research University of Manchester. The Science of Compliance A Guide for Eye Care Practitioners 2007 2. Brennan NA, Coles M.(1997) Extended Wear in Perspective. Optom Vis Sci74: 609-623 3. Ghormley N, Jones L. Managing lipid deposition on silicone hydrogel lenses. Contact lens Spectrum 2006. 21 4. www.College-optometrists.org.uk 5. Jones L, Christie C, Soft Contact lens Review:Part 2 modern Generation Care system. Optometry in Practice 2008. 9 6. Schlitzer R. Preservative uptake by soft contact lenses. Spectrum 1992 7 www.ukoptometry.co.uk Optometry Blog Continuing Education and Training Table 1: Cleaner/Surfactant Manufacturer Advanced Medical Optics (AMO) Bausch and Lomb (B&L) Bausch and Lomb (B&L) Ciba Vision Peach ethical Product Name Total Care Daily Cleaner Boston Advance Cleaner Daily Cleaner MiraFlow Daily Cleaner Lens Type Rigid Rigid Soft Soft / Rigid Soft / Rigid Discard After 2/12 3/12 1/12 3/12 3/12 Preservative None EDTA Sorbic Acid None None Poloxamine 2% Alcohol BP20% Isopropyl, Poloxamer 407 15% Miranol H2M 10% PEG Cleaning Agent Own Branded by Amphoteric Imidazoline derivative5.1%, Anionic Alkyl ether sulphate 0.64%, Nonionic fatty acid amide2.2% PHMB 0.0005% Chlorhexadine 0.003% Alkyl ether sulphate, ethoxylated alkyl phenol, sodium chloride, silica suspension, sodium phosphate dibasic, triquaternary cocoa base phospholipid Asda Gas Permeable Lens Cleaner Boots Gas permeable Advanced Cleaning Solution D&A GP Excel Precleaner Asda Daily CL cleaner Boots Daily Cleaner D&A One Step Soft lens Cleaner www.ukoptometry.co.uk Tesco Daily Cleaner Optometry Blog Continuing Education and Training Table 2 Soaking/Wetting Manufacturer AMO B&L B&L Lens Type Rigid Rigid Rigid Discard By 2/12 3/12 3/12 Total Care Disinfecting, Storing, Wetting Solution Boston AdvanceComfort Formula Conditioning Solution Boston Simplus Polyhexanide 0.0005% Chlorhexadine 0.003% EDTA 0.05% Chlorhexadine 0.003% PHMB 0.0005% Polyquaternium 10 Polyvinyl alcohol Derivatised polyethylene glycol Glucam 20 Cellulose Viscosfier HPMC Product Name Preservative Conditioning Agent Viscosity Agent Own Branded by PHMB 0.0005% Hydroxyethyl Cellulose 0.6% Hydroxyethyl cellulose (HEC) Asda RGP/Hard lens Conditioner Boots Gas Permeable Advanced Conditioning System D&A GP Excel Conditioning Solution www.ukoptometry.co.uk Optometry Blog Continuing Education and Training Table 3 Disinfection Peroxide (3% Hydrogen peroxide) Manufacturer Lens Type Discard After Product Name Neutralizing Agent Own Branded By AMO B&L Ciba Vision Peach Ethical Sauflon Soft Soft Soft / Rigid Soft Soft 2/12 3/12 3/12 3/12 3/12 Oxysept 1-Step EasySEPT AOSEPT PLUS Catalase 0.1mg tablet Platinum Coated Catalytic Disc Platinum Coated Catalytic Disc Asda One Step Peroxide Soft Boots Single Step Solution www.ukoptometry.co.uk Sauflon Multi Polyphenol Oxide covered by platinum oxide Superdrug One step Contact Lens Solution Platinum Coated Catalytic Disc D&A One Step hydrogen Peroxide System SpecSavers Easyvision 1 Step+Multifunction Peroxide Solution VE Peroxide system Optometry Blog Continuing Education and Training Table 4 Disinfection Systems / Multipurpose Soft Alcon Alcon AMO B&L B&L Ciba Vision Cooper Vision Menicon Peach Ethical Sauflon Sauflon Sauflon Lens Type Soft Soft Soft Soft Soft Soft Soft Soft Soft Soft Soft Soft Discard by 6/12 6/12 3/12 6/12 6/12 3/12 3/12 3/12 3/12 3/12 3/12 3/12 Opti-Free Express Opti-Free Replenish Complete MPS Easy rub Formula Renu MPS Renu Multiplus Focus Aqua Options Multi Menicare Soft All-in –one light Comfort Vue CyClean Poly quaternium-1 0.001% Poly quaternium-1 0.001% PHMB 0.0001% PHMB 0.00005% PHMB 0.0001% PHMB 0.0001% PHMB 0.0001% PHMB 0.0001% PHMB 0.00008% PHMB 0.00008% PHMB 0.0001% Active Ingredient MAPD 0.0005% MAPD 0.0005% Poloxamer 0.05% Poloxamine EDTA/ Chelating agent 0.05% + Citrate Citrate 0.02% 0.01% Yes Yes Yes Boric Acid Sorbitol AMP-95 Borate Phosphate Tetronic 1304 Tetronic 1304 + nonanoyl EDTA Poloxamer 237 Manufacturer Product Name Preservative Buffer Lubricating agent Own Branded by Boric Acid Sodium Borate Phosphate Tetronic 1107 Asda All in One Solution Soft Boots Multipurpose Soft Contact Lens Solution PHMB 0.0001% Macrogol Glycerol Hydroxy stearate 0.01%+ Hydranate 0.025% Boric Acid Sodium borate Sodium Phosphate Tromethamine Tetronic 1107 Pluronic F127 Dexpanthenol Sorbitol Boots All in One solution www.ukoptometry.co.uk Disodium Hydrogen Phospate Dihydrate Glycolic Acid Disodium Edetate 0.00015% Phosphate Phosphate Biopol Propylene Glycol HPMC Poloxamer Poloxamer HPMC Biopol Sainsbury All in one Contact Lens Solution Specsavers Easy Vision Multi Active Tesco All in one solution SpecSaver s Easyvision Multipurpo se Vision Express Multi Purpose M-Lite Optometry Blog Continuing Education and Training Table 5 Saline Solutions Manufacturer AMO B&L Lens Type Soft/Rigid Soft/Rigid Discard by 3/12 6/12 Product Name Lens Plus OcuPure Non Aerosol Saline Sensitive Eyes Plus Sodium Chloride % 0.85 0.9 Preservative Purite 0.005% PHMB 0.00003% EDTA 0.025% Buffer Boric Acid Borate PH 7.6 – 7.9 7.0 -.7.8 Own Branded By - - www.ukoptometry.co.uk Optometry Blog Continuing Education and Training Table 6 Protein Removers Manufacturer Abatron AMO Menicon Menicon Lens Type Soft / Rigid Soft / Rigid Rigid Rigid Discard By See packaging See packaging See packaging See packaging Ultrazyme Universal Intensive Protein cleaner Menilab (Practitioner use only) Progent Subtilisin- A 0.4 mg Sodium Hypochlorite Sodium Hypochlorite Product name Active Agent Amiclair Protease Pronase Lipase Disodium edetate Other Ingredients Form Own Branded by Peach Ethical Soft / Rigid See packaging Trypsin Lipase Amylase as 2 mg multi enzyme complex Potassium bromide Tablet Tablet Liquid Liquid Tablet Boots Protein Remover Tablets Tesco Effervescent Protein Remover Tablets D&A Universal Protein Remover Tablet Disclaimer: the information contained within these tables was obtained from a variety of sources including product packaging, ACLM Yearbook 2008, BCLA website . 10 . The author takes no responsibility for errors, omissions and changes to the table contents and would add that solutions may be subject to discontinuation or change at short notice. www.ukoptometry.co.uk