When it comes to soft contact lens care, options abound. But don't let your patients choose. Prescribe the one that works best with their lenses and lifestyle.

Choosing the system

Today, soft lens cleaning systems fall into three main categories:

�        Multipurpose solutions. These clean and disinfect; some also remove protein. They're very convenient and make compliance more likely. However:

o       disinfecting takes several hours.

o       manual cleaning must be thorough, so patient education is important.

�        Two-bottle systems. These consist of a separate cleaner and disinfectant. They provide more robust cleaning than multipurpose solutions, and some disinfect in as little as 20 minutes.

�        Hydrogen peroxide. Hydrogen peroxide is preservative-free and highly effective against bacteria, viruses and fungi (even Acanthamoeba). However, this system requires extra effort; the hydrogen peroxide must be neutralized before the lens is placed on the eye.

Matching your patient's needs

Consider the following factors:

�        The replacement cycle. Frequent replacement lenses are less likely to require heavy-duty cleaning. A multipurpose solution is probably sufficient.

�        Ability to follow instructions. Elderly patients or distracted young patients (i.e., college students) may need the simplicity of multipurpose solutions.

�        Frequency of lens wear. Less frequent wear means less protein buildup. A multipurpose solution is probably fine.

�        Deposit formation. Heavy deposits require serious cleaning. A multipurpose solution is probably a poor choice.

�        Potential for allergic reaction. Hydrogen peroxide is non-allergenic. However, some systems use catalase to neutralize the peroxide, and a few patients may react to the catalase.

�        History of herpes simplex or fungal infections. These patients need to use hydrogen peroxide.

�        Lifestyle and occupation. Potential significant factors include:

o       Workers who are subjected to more airborne particles and women who wear a lot of makeup may require more serious lens cleaning.

o       Working in a nursing home or hospital environment, around swimming pools or with soil may mean exposure to microorganisms, including Acanthamoeba, making hydrogen peroxide a good choice.

o       Some professionals must be available to work on short notice; rapid disinfection can be an advantage.

Resolving solution problems

To determine whether a symptom is caused by a solution or the lens, ask whether the problem occurs when the patient first puts on the lens. (If so, it's probably a solution problem.)

If the answer still isn't obvious, have the patient discontinue lens wear until the eye quiets down. Then put a few drops of solution directly into the eye and look for a reaction.

Other signs that the current solution may be a problem:

�        low-grade follicular conjunctivitis

�        toxic keratitis with punctate staining

�        limbal infiltrates

�        corneal infiltrates.

If the cleaning solution is the problem, try switching brands. (Different systems use different preservatives.)

Also, if a patient complains about redness and irritation, have him bring in all the solutions and drops he's currently using. Patients sometimes change solutions on their own, or they may be using an antihistamine or decongestant eyedrop without your knowledge.

Dr. Koffler is director of the Kentucky Center for Vision in Lexington, Ky., and associate clinical professor of ophthalmology at the University of Kentucky Medical Center. He currently serves on the board of directors of the Contact Lens Association of Ophthalmologists, and is past president of the Kentucky Academy of Eye Physicians and Surgeons.