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Official reprint from UpToDate www.uptodate.com 2012 UpToDate

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Sec i Edi Jonathan Trobe, MD De Edi H Nancy Sokol, MD

A h Michael J Lipson, OD, FAAO Di c e

All topics are updated as new evidence becomes available and our peer review process is complete. Li e a e e ie c e h gh: thg 2 2012. | Thi ic a da ed: thg 11 9, 2011. INTRODUCTION An estimated 40 million people in the United States wear contact lenses, with approximately 38 million soft lens wearers and 2 million rigid gas-permeable lens wearers [1]. Surveys show that in recent years the number of new contact lens users is almost equal to the number of contact lens failures. Contact lenses may be categorized by their compositional material, wearing schedule, disposal schedule, permeability, water content, and type of correction (table 1). With many new lens types available, there are alternatives to help most patients achieve comfortable lens wear with clear vision. New types of contact lenses are continually being introduced with the intent to decrease risks of infection, inflammation, and conjunctival trauma while maximizing vision correction and convenience of use [2]. The types of available contact lenses, indications for their use, and appropriate care to decrease the risk of infection or trauma will be reviewed here. The complications with contact lens use are discussed separately. (See "Complications of contact lenses".) HYDROPHILIC/SOFT LENSES Soft lenses account for more than 90 percent of prescribed contact lenses in the United States (table 1) and worldwide (table 2) [3,4]. Soft lenses are used to correct a variety of refractive errors, including myopia, hyperopia, astigmatism (toric lenses), and presbyopia (multifocal lenses). Not every prescription is available in every material or brand. Certain refractive errors, caused by keratoconus or other corneal distortions, may not be correctable with soft lenses. Soft lenses are generally quite comfortable and easier to adapt to than rigid lenses. Patients wearing soft lenses need regular follow-up care and must be compliant with lens care regimens to avoid serious eye problems. (See 'Guidelines for prevention of infectious keratitis' below.) Patients who discontinue wearing lenses most commonly complain of lens awareness or dry feeling while wearing lenses. Other reasons include inadequate visual acuity, allergic reactions, and difficulty handling lenses [5]. C i i Soft lenses are made of various plastic polymers that absorb water (hydrophilic). These materials differ in terms of oxygen permeability (expressed in Dk units, where D stands for diffusion and k for solubility), water content (varying between 20 and 70 percent water by weight), surface quality (wettability), ultraviolet absorption, and structural consistency (stiffness or modulus). The US Food and Drug Administration (FDA) has developed a system for classifying soft lenses (table 3). All soft lenses absorb water, as well as a variety of other substances: chemicals in contact lens solutions, tear secretions, makeup, and airborne chemicals or vapors. Oily substances from the eyelids or facial creams that come in contact with the lens can coat the lens surface. Prior to 1996, the polymer in all soft lenses was primarily 2-hydroxyethyl methacrylate (HEMA) based, which is still used in several current lenses. Polymers with silicone hydrogel (SH), which are more highly oxygen permeable, were introduced in 1999 and are now more common in newer types of lenses [1]. Lenses with higher oxygen permeability are generally considered a healthier option [6], although case control studies did not demonstrate that SH lenses decreased the risk of microbial keratitis [7] or of nonulcerative contact lens related disorders seen in an emergency setting [8].
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Physical characteristics of different SH lenses are detailed in a table (table 4). Dk/t is a measure specific to the individual lens, rather than its material, and refers to the oxygen permeability (Dk) of the material normalized for the thickness of the lens (t). The higher the Dk/t value, the more breathable the lens. Patients using higher Dk/t lenses develop less corneal edema during all-day or overnight wear, compared to HEMAbased lenses [6]. Other material characteristics include water content, surface quality (wettability), ultraviolet absorption, and modulus (stiffness). The higher modulus lenses will feel stiffer, and lower modulus lenses floppier, when handled. Soft lens materials provide a good medium for microbial growth. Additionally, if patients are not compliant with care techniques, red-eye reactions, discomfort and allergic reactions can occur. Proper disinfection procedures are essential. (See 'Lens care and lens solutions' below.) Other sources of eye irritation are lens deposits (chemical or mechanical), foreign bodies trapped under the contact lens, and allergic reactions to preservatives in the care solutions. (See "Complications of contact lenses".) Le g h f ea The absorption characteristics of soft lenses and their tendency to accumulate surface deposits can affect oxygen permeability and surface quality. Therefore, soft lenses allow only a limited time of safe and healthy usage and should be worn and disposed of on an individually prescribed schedule. O e da e e These lenses are designed for one day wear and are dispensed in a large supply (30 or 90 pair). They are ideal for people who want to wear contact lenses intermittently, for those who place convenience as a high priority, and for those who have sensitivity to disinfecting solutions since they do not require use of disinfecting solutions. T ee di ab e These lenses are the most commonly prescribed in the United States and are worn for a maximum of two weeks. Most should be removed each night and cleaned and disinfected, but some have FDA approval for six days and nights of continuous wear. M h di ab e Most of these lenses are also worn during the day and removed each night, although some have approval for 30 days of continuous wear. Q a e di ab e These lenses, designed to be replaced every three months, are generally custom-made lenses for high prescriptions. S ecia Ti ed e f f e e e e Soft lenses can be tinted for cosmetic, therapeutic or prosthetic purposes.

Cosmetic tints Many soft lenses can be made in a variety of colors. The tints may be transparent to enhance natural eye color or can be opaque to dramatically change the color of the iris. Therapeutic tints These special tints are used for highly light-sensitive patients or to enhance color perception in patients with color deficiencies. Though these lenses do not fully compensate for color blindness, they are tinted red and worn to help color-deficient patients identify reds and greens more readily. Prosthetic tints Soft lenses can be tinted or hand-painted to improve cosmesis in patients with scarred corneas or to create an artificial pupil in patients with aniridia, albinism or damaged/distorted pupils. Ba dage e e Soft lenses are used as bandage lenses in cases of corneal laceration, corneal exposure injury, and during the healing phase after some ocular surgery such as photorefractive keratectomy (PRK). Pigg bac fi i g In cases of highly irregular corneal curvature, as in keratoconus, a soft lens is placed on the cornea and a rigid contact lens is placed over it. The soft lens provides a more regular surface for the rigid gas-permeable (RGP) lens to ride upon and also acts to protect the cornea from irritation due to excessive movement of the RGP lens. RIGID GAS-PERMEABLE LENSES Rigid gas-permeable (RGP) contact lenses hold a specific shape although
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they do have a small amount of flexure. Compared to soft contact lenses, RGP lenses generally provide better visual acuity and are more durable but require longer periods for adaptation. Most wearers can achieve excellent comfort after four to seven days of wear. RGP lenses are generally replaced after two to three years of use. Prior to the development of RGP lenses, "hard" lenses were made of a plastic material, polymethylmethacrylate (PMMA). This material provided no oxygen permeability and depended on tear circulation to provide oxygen to the cornea. With the development of RGP lenses, PMMA materials are now rarely used. Because of their rigidity, RGP lenses are often used to achieve optimal visual acuity in patients who have not had satisfactory acuity with soft lenses. RGP lenses are also generally better for those who have some degree of "dry eyes." RGP lenses are also used for overnight corneal reshaping to improve daytime acuity (orthokeratology) [9-11]. RGP lenses comprise about 5 to 10 percent of all contact lens fits in the US, including 1 percent for overnight corneal reshaping [1]. There are more than 40 different RGP materials used today. As with soft lens materials, each type of RGP lens has unique characteristics in regards to wettability, oxygen transmission, and flexure [5]. Many of these lenses are more gas permeable than soft lenses. Most RGP wearers use their lenses during the day. Some lenses are approved by the US Food and Drug Administration for one week of continuous wear and at least one brand has approval for 30 days of continuous wear. RGP lenses are ordered by the eye care practitioner and made on a custom basis by an RGP lab. Providers can specify various parameters to optimize fit and comfort including diameter, base curve, power, peripheral curves, thickness, edge design, optical zone, as well as material and color. Within the last 15 years, computer-guided lathes have been developed that allow manufacture of highlycustomized lenses. RGP lenses can be ordered to fit the inter-palpebral opening (7 to 9 mm), the corneal diameter (10.0 to 11.5 mm), the corneoscleral area (12 to 15 mm), or the sclera (16 to 24 mm). Custom RGP designs may be the only vision correction option for patients with irregular corneal topography who are not correctable with soft lenses or spectacles. Specialty RGP designs include: Reverse geometry steeper curvature peripherally than centrally Quadrant specific curves different curves in each quadrant of the lens Toric/bitoric different curves horizontally versus vertically (on front and/or back surface) Aspheric curves placed on front or back surface Multifocal lenses eg, aspheric, segmented, concentric Corneal reshaping reverse geometry lenses of custom or proprietary design to temporarily change the corneal curvature to improve unaided acuity H b id c ac e e Hybrid contact lenses have an RGP central portion fused to a peripheral soft skirt. The first lens of this type (SoftPerm) was made of very low permeability materials and had limited parameters. A newer version of this innovative design (Synergeyes/Duette) is comprised of more permeable materials (both central RGP and peripheral soft) and with various parameters to allow fitting over a large range of unique corneal shapes [12,13]. These lenses are worn during the day and disposed of after six months of use. The various designs of hybrid lenses can be made to correct for myopia, hyperopia, astigmatism, presbyopia (multifocal design), keratoconus, post-surgical eyes, and other irregular astigmatism cases. Advantages of hybrid lenses are excellent acuity, greater comfort compared with RGP lenses, and a wide range of parameters and designs. Disadvantages of hybrid lenses are more difficult insertion and removal, and higher costs than other lenses. LENS CARE AND LENS SOLUTIONS Ca i i c ac e ea Contact lens wear and/or lens care solutions can provoke many eye reactions. Infection risk can be minimized by following proper procedures for contact lens care.
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Common problems include [7,14]: Redness Itching Dryness Allergic reactions Conjunctivitis (microbial, mechanical, allergic or inflammatory) [14] CLARE (contact lens-induced acute red eye) CLARE refers to a sudden red eye reaction in a contact lens wearer of unknown etiology. Possible causes are lens deposits, low grade infection, chemical sensitivity to solution or external chemical contamination of the contact lens. Patients experiencing minor redness or itching without pain or blurred vision should be treated initially with removal of contact lenses and lubricating eye drops (artificial tears or over-the-counter antihistamine drops). They should be advised to report any increase in severity of symptoms or development of blurred vision or pain. After resolution of minor irritations, future episodes may be prevented by changing the replacement schedule, reducing wearing time, or a change in the lens type or disinfection regimen. Consultation with the eye care provider should be arranged promptly if patients experience blurred vision, pain, or photophobia. More serious conditions associated with contact lenses include corneal ulcers [7], corneal abrasions, and infectious keratitis. (See "Complications of contact lenses".) Solutions are used to clean and disinfect contact lenses. Reports of serious infections have been related to contaminated lens cases and inadequate patient disinfectant technique [15]. (See "Free living amebas", section on 'Amebic keratitis' and "Clinical manifestations and diagnosis of Fusarium infection", section on 'Keratitis'.) S f e i

M i e i Multipurpose solutions (MPS) are the most commonly used, accounting for 89 percent of solutions used in the US versus 11 percent for peroxide systems in 2008 [1]. MPS are intended to be "all-in-one" solutions that are used to rinse, clean, disinfect, and store lenses during their overnight soaking. Success with MPS depends on patient compliance with directions, particularly in regard to sufficient rinsing or, preferably, using a rub technique to achieve adequate disinfection [16,17]. Individual patient tolerance is variable, and some find that multipurpose solutions provoke an allergic or toxic reaction when exposed to the eye. Available multipurpose solutions in the US are shown in a table (table 5). Generic versions are also available at various retailers. While MPS offer several conveniences compared to other contact lens solutions (ready availability, one bottle, ease for travel) MPS are also more likely to cause allergic or sensitivity reactions, and corneal staining is more prevalent than with peroxide systems. Pe ide e Peroxide systems have gained in popularity over the last few years. They use hydrogen peroxide to disinfect and passively oxidize surface deposits. These systems require that the peroxide solution be "neutralized" prior to lens use, and different techniques (one or two-step) are used for accomplishing this. Commercially available peroxide systems in the US are shown in a table (table 5). Peroxide disinfection, compared to MPS, provides no direct exposure to preservatives and there is a lower likelihood of sensitivity reactions. Lens cleaning is passive, by oxidation, and there is less risk for noncompliance resulting in infection. However, peroxide systems lack the convenience factors of MPS, are more difficult to travel with, and pose the potential for irritation from accidental exposure to non-neutralized solution. G ide i e f e e i f i fec i e a i i Following national and international reports of Acanthamoeba keratitis and Fusarium keratitis, the US Food and Drug Administration (FDA) reviewed proper care of contact lenses. Citing the risk of eye infections and corneal ulcers, with the potential to cause blindness, the FDA has issued recommendations and guidelines for the safe use of contact lenses and associated care products [18]. These recommendations follow:

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Always wash your hands before handling contact lenses to reduce the chance of getting an infection. Remove the lenses immediately and consult your eye care professional if your eyes become red, irritated, or your vision changes. Always follow the directions of your eye care professional and all labeling instruction for proper use of contact lenses and lens care products. Use contact lens products and solutions recommended by your eye care professional. Do not use contact lens solutions that have gone beyond the expiration or discard date. Rub and rinse your contact lenses as directed by your eye care professional. Clean and disinfect your lenses properly following all labeling instructions provided with your lens care products. Do not "top-off" the solutions in your case. Always discard all of the left over contact lens solution after each use. Never reuse any lens solution. Never use non-sterile water (distilled water, tap water or any homemade saline solution). Exposure of contact lenses to water has been associated with Acanthamoeba keratitis, a corneal infection that is resistant to treatment and cure. Do not put your lenses in your mouth to wet them. Saliva is not a sterile solution. Clean, rinse, and air-dry your lens case each time lenses are removed. You may want to flip over your lens case while air drying so excess solution may drain out of the case. Contact lens cases can be a source of bacterial growth. Replace your contact lens storage case every three to six months. Do not transfer contact lens solutions into smaller travel size containers. This can affect the sterility of the solution which can lead to an eye infection. Transferring solutions into smaller size containers may also leave consumers open to accidentally using a solution not intended for the eyes. A synopsis of these recommendations is presented in a table (table 6). Rigid ga - e eab e i Solutions to be used with RGP lenses vary in viscosity, wetting agent, and preservatives. One to three bottles contain solutions designed for wetting/conditioning, disinfecting, and cleaning. Available solutions in the US are shown in a table (table 5). L b ica i g d There are numerous brands of drops that are designed to be used with contact lenses as lubricants at frequencies varying from once per day to hourly. These may be labeled as "contact lens drops," artificial tears, or lubricating drops. Available lubricants differ in their viscosity and whether or not they are preserved, and individual patient preference and tolerance will determine which is most acceptable. Compatibility with patient's eyes, individual contact lens brand, and other solutions patients use are also factors. CONTACT LENS FITTING Contact lens fitting should be done by experienced clinicians who may be optometrists or ophthalmologists. A thorough pre-fitting evaluation can identify risk factors and target the best lens and lens care combination to provide long-term comfort, good vision, and easy maintenance. A thorough pre-fitting evaluation should include: Refraction and visual acuity Keratometry Corneal topography Biomicroscopic evaluation of the cornea, conjunctiva, and eyelids Empirical and/or diagnostic fitting Instruction about insertion/removal, lens care, and solutions
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After initial dispensing, follow-up evaluations should include: Biomicroscopic evaluation of the cornea, conjunctiva, and eyelids with and without contact lenses in place Visual acuity Review of care, handling, and disinfection procedures F f e e c New contact lens wearers should generally be seen within the first week, at one month, six months, and annually thereafter. This frequency may vary with the type of lens, wearing schedule, and condition being treated. INSERTION AND REMOVAL TECHNIQUE Insertion of all types of lenses involves, with clean hands, placing the prepared lens directly on the center of the cornea while holding the lids and lashes to create an opening large enough to clear the diameter of the lens. Removal techniques vary with the lens type: Soft lenses are removed by pinching the edges of the lens at the four and eight o'clock positions with the thumb and index finger while holding the upper lid out of the way. Inserting a drop of wetting solution or artificial tears makes removal easier. If the lens is not readily removed, it is possible the lens is in the eye but not on center. The most likely place to find the dislocated lens is under the upper lid (usually folded). To check for this, have the patient look straight down while holding the upper lid up as high as possible. If found, the lens can be pinched out from there. It may be necessary to evert the lid to find a lens that has adhered to the inner surface of the upper lid. Rigid gas-permeable lenses can be removed with a rubbery contact lens removal tool (suction cup) or by manipulating the upper and lower lid simultaneously together against the edges of the lens. If an RGP lens is off-center, it is best to try to manipulate the lens position through the closed lids to a position of easy access, usually the temporal sclera, and then use the suction cup device. Hybrid lenses are removed similar to soft lenses, except that the area of pinching must be smaller, at the edge of the soft portion of the lens. Pinch the soft portion with both fingers at the six o'clock position. With this lens, it is critical that the upper lid be held away from the surface of the lens to allow for removal. Again, lubricating drops inserted in the eye can help remove a lens that is not coming out easily. FUTURE DEVELOPMENTS contact lenses. Investigation is ongoing to develop new designs, materials, and applications for

Drug delivery systems Lenses impregnated with drugs for slow sustained release are being evaluated for anti-infective, anti- inflammatory, and pressure-lowering indications [19-21]. Newer coatings Different coatings are under investigation to make lenses more resistant to bacterial adhesion and to minimize mucous or protein deposits [22,23]. Multifocal lenses vision [24,25]. New lens designs in various materials aim to improve acuity for distance and near

Aberration-correcting contact lens Based on wavefront refractive and corneal analysis, these lenses are wavefront-generated to provide a customized correction and improve visual acuity over traditional optics [26-28]. SUMMARY AND RECOMMENDATIONS Contact lenses may be categorized by their compositional material, wearing schedule, disposal schedule, permeability, water content, and type of correction (table 1). (See 'Introduction' above.)

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Soft lenses can be classified by a number of properties, including oxygen permeability, water content, and structural consistency (table 3). Silicon hydrogel lenses, with increased oxygen permeability, are often considered preferable. (See 'Hydrophilic/soft lenses' above.) Rigid gas-permeable (RGP) contact lenses hold a specific shape although they do have a small amount of flexure. Compared to soft contact lenses, RGP lenses generally provide better visual acuity and are more durable but require longer periods for adaptation. (See 'Rigid gas-permeable lenses' above.) Multipurpose solutions are the most commonly used solutions in the United States to rinse, clean, disinfect, and store lenses during their overnight soaking. Compared to other solutions, MPS are more convenient but more likely to cause allergic or sensitivity reactions. Peroxide disinfection systems provides no direct exposure to preservatives, though are somewhat less convenient. (See 'Multipurpose solutions' above and 'Peroxide systems' above.) Proper use of contact lenses and hygienic recommendations were issued in a guideline from the US Food and Drug Administration, after review of the factors contributing to outbreaks of Acanthamoeba keratitis and Fusarium keratitis. These recommendations include hand washing, discarding outdated solutions, following instructions for disinfection, only using manufacture-prepared solutions in their original bottles, not saliva, as a lubricant, cleaning cases and replacing them every three to six months. (See 'Guidelines for prevention of infectious keratitis' above.)

Use of UpToDate is subject to the Subscription and License Agreement. REFERENCES 1. Nichols J. Contact Lenses 2008. Contact Lens Spectrum 2009; 1:24. Available at: http://www.clspectrum.com/article.aspx?article=102473 (Accessed on November 01, 2011). 2. Foulks GN. Prolonging contact lens wear and making contact lens wear safer. Am J Ophthalmol 2006; 141:369. 3. Mack C. Contact Lenses 2007: A look back at contact lens events of 2007 including prescribing trends, product recalls and launches, compliance issue, mergers and corneal staining. Contact Lens Spectrum 2008. Available at: http://www.clspectrum.com/article.aspx?article=101240 (Accessed on November 01, 2011). 4. Morgan PB, Woods CA, Knajian R, et al. International Contact Lens Prescribing in 2007: Our annual review of international prescribing trends reports on close to 20,000 prospectively conducted fits in 27 countries. Contact Lens Spectrum 2008. Available at: http://www.clspectrum.com/article.aspx? article=101241 (Accessed on November 01, 2011). 5. Soft Contact Lenses: Hydrogel and Silicone Hydrogel Lens General Considerations. Contact Lens Spectrum 2008. Available at: http://www.clspectrum.com/article.aspx? article=&loc=archive\2008\july\supplements\cls_class\cls_july_class_suppl_a02.html (Accessed on November 01, 2011). 6. Stern J, Wong R, Naduvilath TJ, et al. Comparison of the performance of 6- or 30-night extended wear schedules with silicone hydrogel lenses over 3 years. Optom Vis Sci 2004; 81:398. 7. Dart JK, Radford CF, Minassian D, et al. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology 2008; 115:1647. 8. Radford CF, Minassian D, Dart JK, et al. Risk factors for nonulcerative contact lens complications in an ophthalmic accident and emergency department: a case-control study. Ophthalmology 2009; 116:385. 9. Jupiter DG, Katz HR. Management of irregular astigmatism with rigid gas permeable contact lenses. CLAO J 2000; 26:14. 10. Swarbrick HA, Wong G, O'Leary DJ. Corneal response to orthokeratology. Optom Vis Sci 1998; 75:791. 11. Lipson MJ, Sugar A, Musch DC. Overnight corneal reshaping versus soft disposable contact lenses: vision-related quality-of-life differences from a randomized clinical trial. Optom Vis Sci 2005; 82:886. 12. Lipson MJ, Musch DC. Synergeyes versus soft toric lenses: vision-related quality of life. Optom Vis Sci 2007; 84:593.
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13. Nau AC. A comparison of synergeyes versus traditional rigid gas permeable lens designs for patients with irregular corneas. Eye Contact Lens 2008; 34:198. 14. Lemp MA. Contact lenses and allergy. Curr Opin Allergy Clin Immunol 2008; 8:457. 15. Patel A, Hammersmith K. Contact lens-related microbial keratitis: recent outbreaks. Curr Opin Ophthalmol 2008; 19:302. 16. Koffler BH, Karpecki PM. Positive aspects of the use of multipurpose disinfection solutions. Arch Ophthalmol 2009; 127:1540. 17. Cohen EJ. Contact lens solutions: part of the problem. Arch Ophthalmol 2009; 127:1544. 18. FDA Website. Available at: www.fda.gov/cdrh/contactlenses/lenslist.html (Accessed on November 01, 2011). 19. Hiratani H, Alvarez-Lorenzo C. The nature of backbone monomers determines the performance of imprinted soft contact lenses as timolol drug delivery systems. Biomaterials 2004; 25:1105. 20. Gulsen D, Chauhan A. Ophthalmic drug delivery through contact lenses. Invest Ophthalmol Vis Sci 2004; 45:2342. 21. Ciolino JB, Hoare TR, Iwata NG, et al. A drug-eluting contact lens. Invest Ophthalmol Vis Sci 2009; 50:3346. 22. Valint, PL, et al. Plasma Surface Treatment of Slicone Hydrogel Contact Lenses with a Flexible Carbon Coating. US Patent # 6,213,604 B1 April 10, 2001. 23. Carney et al Medical Devices Having Antimicrobial coatings. Theron US Patent application # 10/722,256 July 15, 2004. 24. Guillon M, Maissa C, Cooper P, et al. Visual performance of a multi-zone bifocal and a progressive multifocal contact lens. CLAO J 2002; 28:88. 25. Pujol J, Gispets J, Arjona M. Optical performance in eyes wearing two multifocal contact lens designs. Ophthalmic Physiol Opt 2003; 23:347. 26. Guirao A, Porter J, Williams DR, Cox IG. Calculated impact of higher-order monochromatic aberrations on retinal image quality in a population of human eyes. J Opt Soc Am A Opt Image Sci Vis 2002; 19:620. 27. de Brabander J, Chateau N, Marin G, et al. Simulated optical performance of custom wavefront soft contact lenses for keratoconus. Optom Vis Sci 2003; 80:637. 28. Thibos LN, Cheng X, Bradley A. Design principles and limitations of wave-front guided contact lenses. Eye Contact Lens 2003; 29:S167. Topic 6906 Version 4.0

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GRAPHICS
2010 US
B e

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Pe ce
66 25 8 1

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Silicone hydrogel Soft hydrogel RGP Hybrid

Pe ce
53 21 11 6 1 1 1

Soft spherical Soft toric Soft multifocal RGP spherical RGP multifocal RGP toric Ortho-K

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13 2 36 42 4 3 m 2011.

Daily Weekly Two weeks One month Three months Annual

RGP: rigid gas permeable. Da a f om: Nichol JJ, e al. Con ac Len e 2010. Con ac Len Spec A ailable a : .cl pec m.com/a icle.a p ?a icle=105083.

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2007

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d ide)
U i ed S a e W
21 33 19 13 5 6 3

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Conventional/PR Daily disposable Silicone/hydrogel HEMA-toric Sil/Hyd toric Cosmetic tinted Multifocal

19 10 33 12 10 7 6

Numbers are percent of total soft lens market. PR: planned replacement. Da a f om: Mo gan PB, Wood
CA, Knajian R, e al. In e na ional con ac len p e c ibing in 2007. Con ac len pec m 2008; 23:36.

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FDA c a
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ifica i

f c

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Low water content (<50 percent) Non-ionic polymer HEMA hydrogels Silicone hydrogels

High water content (>50 percent) Non-ionic polymer HEMA hydrogels only

Low water content (<50 percent) Non-ionic polymer HEMA hydrogels Silicone hydrogels

High water content (>50 percent) Non-ionic polymer HEMA hydrogels only Rep od ced f om: US Food and D g Admini a ion, .fda.go /cd h/con ac len e /len li .h ml.

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Si ic
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36 24 38 47 38 48 46

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Balafilcon A Lotrafilcon A Lotrafilcon B Galyfilcon A Senfilcon A Comfilcon A Enfilcon A

D
91 140 110 60 103 128 100

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101 175 138 86 147 160 125

M d
1.10 1.40 1.00 0.40 0.75 0.75 0.50

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PureVision Air Optix Night and Day Air Optix Acuvue Advance Acuvue Oasys Biofinity Avaira

Bausch and Lomb CibaVision CibaVision Vistakon Vistakon CooperVision CooperVision

Up to 30 days CW Up to 30 days CW Up to 6 days CW DW-2 wk disposal Up to 6 days CW Up to 6 days CW DW-2 wk disp

CW: continuous wear; DW: daily wear.

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C
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Opti-Free Express (Alcon) Opti-Free Replenish (Alcon) Complete (AMO) Aquify (CibaVision) Renu (Bausch & Lomb) Sauflon (Sauflon) RevitaLens (Abott Medical Optics) OptiFree Pure Moist (Alcon) BioTrue (Bausch and Lomb)

Pe

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AOSe (CIBA Vision) - Three bottle system: Miraflow (concentrated cleaner), SoftWear saline (to rinse off the Miraflow) and AOSept (neutralized by a catalytic disc in the storage case). C ea Ca e (CIBA Vision) - Similar to AOSept but a one-step system with cleaner incorporated into the ClearCare solution and neutralized with a catalytic disc in the storage case. U aCa e (Advanced Medical Optics) - Four parts: cleaner, saline rinse, peroxide solution and a neutralizing tablet (solution changes color to indicate neutralization). Sa f O e-S e (Sauflon USA) - One-step system with added wetting agent. Neutralization is with a catalytic disc. Available only through eye care professionals.

S
B O O

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S

/
i

RGP Le

(Bausch & Lomb) - available retail in three forms: Original, Advance and Simplus

iF ee GP (Alcon) - available online and limited retail i (Lobob) - available retail, online and through RGP distributors

Me ica e (Menicon) - available online and through RGP distributors RGP: rigid gas permeable.

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FDA g ide i e f

afe

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Always wash your hands before handling contact lenses to reduce the chance of getting an infection. Remove the lenses immediately and consult your eye care professional if your eyes become red, irritated, or your vision changes. Always follow the directions of your eye care professional and all labeling instruction for proper use of contact lenses and lens care products. Use contact lens products and solutions recommended by your eye care professional. Do not use contact lens solutions that have gone beyond the expiration or discard date. Rub and rinse your contact lenses as directed by your eye care professional. Clean and disinfect your lenses properly following all labeling instructions provided with your lens care products. Do not "top-off" the solutions in your case. Always discard all of the left over contact lens solution after each use. Never reuse any lens solution. Never use non-sterile water (distilled water, tap water or any homemade saline solution). Exposure of contact lenses to water has been associated with Acanthamoeba keratitis, a corneal infection that is resistant to treatment and cure. Do not put your lenses in your mouth to wet them. Saliva is not a sterile solution. Clean, rinse and air-dry your lens case each time lenses are removed. You may want to flip over your lens case while air drying so excess solution may drain out of the case. Contact lens cases can be a source of bacterial growth. Replace your contact lens storage case every 3 to 6 months. Do not transfer contact lens solutions into smaller travel size containers. This can affect the sterility of the solution which can lead to an eye infection. Transferring solutions into smaller size containers may also leave consumers open to accidentally using a solution not intended for the eyes. Da a f om: US Food and D g Admini a ion, .fda.go /cd h/con ac len e /len li .h ml.

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