Eye, Glasses and Contact Lenses: Soft Contact Lens Solutions part 2
Premixed Preserved Saline Solution. These contain just the right proportion of salt, plus preservatives (such as thimerosol, chlorhexidine, or sorbic acid) to ensure that the solution stays sterile, plus buffers so the pH (acid balance) more closely resembles that of human tears. All well and good, except these solutions cost more than homemade saline, and some users become allergic (eyes become red or itchy) to the preservatives. When this form of saline was the only one available, many members of the captive audience protested—and rightly so—that this “cure” was worse than the “disease” it sought to cure. (Especially since the preserved solutions merely reduce the chance of eye infection, but don’t eliminate it completely.)
It is obvious, though, that preserved saline minimizes the possibility of patient error and is more convenient (there’s nothing to mix). It definitely inhibits the growth of bacteria and fungi, so there’s no need to replace it with a fresh batch every day. I have found that approximately 20 percent of my patients eventually become allergic to the preservatives in this type of saline, but for the remaining 80 percent preserved saline is highly effective and has no side effects. If a patient should develop an allergic reaction, I merely switch him to the unpreserved solution.
Premixed Unpreserved Saline Solution. To solve the dilemmas posed by the other two forms, a third type of saline now exists. Sterile, premixed, preservative-free saline in vials or packets is available to satisfy the cautious and / or sensitive few who can’t tolerate the preservatives but who like the convenience and want to reduce the risk of possible bacterial contamination. Unfortunately, saline in this form must necessarily be packaged in small, individual doses to be opened, used, and discarded daily. (Once opened the packets are no longer sterile, the way Band-Aids are contaminated upon opening, but can safely be used for up to twenty-four hours.) That makes this form even more expensive than the preserved solutions—and it is not as widely available. The small packets, however, travel well to the office, or farther from home. On trips you can transport the exact amount of saline you need, and discard the empty packets as you go along.
Using Saline Solution. To clean the lens with preserved or unpreserved saline, a simple method is to place the lens in the palm of the hand and fill the cupped palm with saline. Rub each side with the index finger of the other hand for twenty to thirty seconds. Then rinse with more saline.
To rinse the lens with saline after cleaning, disinfecting, or enzyming, place the lens in the palm of the hand or hold it between index finger and thumb. Direct a steady stream of the solution at the lens using either the entire packet or equivalent (about one ounce) for both lenses. Be generous with the saline; this is not the place to skimp. Rinsing will remove potentially harmful agents that could adversely affect your lenses and your eyes. After heat sterilization the lenses may be kept stored in the case in which they were sterilized, covered with saline solution, until you’re ready to insert them. As a precaution, you should disinfect the lenses if you’ve left them in saline for more than a few days.
A lens with embedded deposits will be uncomfortable, less pliable, permit less oxygen to pass through, and result in reduced visual acuity. If stubborn deposits cannot be removed with the conventional cleaning and enzyme methods, I recommend that my patients use either fine table salt or baking soda along with saline solution. Put a few drops of saline in the palm and add a pinch of the salt or soda. Place the dirty lens in the salt bath and rub gently with the index finger of the other hand for a few minutes. You can safely perform this cleaning method once a week if needed. Admittedly this is a last-ditch effort; the method may prove fruitless and a new lens may have to be ordered.
Cleaning Solutions
The very characteristic that makes soft lenses so comfortable —their ability to absorb moisture—is a two-sided coin. Unfortunately soft lenses will also absorb just about everything else they come into contact with, including cigarette smoke, deposits from your own tears, makeup, and aerosol sprays such as deodorants, room fresheners, hair sprays, etc. If these deposits are not removed daily, when still “fresh,” they may harden and lead to cloudy, damaged lenses that will be uncomfortable and unable to correct your visual defect properly. Lenses badly cared for will need to be replaced more often than those that are kept scrupulously clean. I often see patients in my office with “spoiled” soft lenses—full of deposits that they failed to remove, marred by pits and cracks, or tainted with bacteria. Once deposits have taken hold, they become embedded in the lens material; even if they could be removed, the lens would be left pitted.
Special soft-lens surfactant cleaning solutions are meant (but not guaranteed) to remove surface deposits. In addition to detergents they contain preservatives to inhibit the growth of microorganisms, and cushioning agents that keep the lens from becoming damaged during the rubbing. In all cases the mechanical rubbing plays a very important role in the effectiveness of a surfactant cleaner.
To use the cleaning solution, apply a few drops to each surface of the lens and either rub between your index finger and thumb or massage in the palm of your hand with the index finger of the other hand. Rub each side for at least twenty seconds, making sure you clean the outer edges as well as the center. Make sure the lens is well hydrated before applying the cleaning solution. Always rinse off the cleaning solution thoroughly with saline because it can leave a film that will eventually cloud the lens, especially if you use thermal disinfection afterward. Any deposits or impurities on the lens can be permanently baked into it by the heat method. Therefore it is imperative that the lens be absolutely clean before heating. Studies have also shown that a dirty lens absorbs more preservatives than a clean lens, another reason for thorough lens cleaning before storage and disinfection.
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