As practitioners, we must be aware that our contact lens brand and modality choice, as well as the solution combination, are vital to patient comfort. Patient discomfort (burning, stinging) can directly correlate with staining of the cornea. Since today’s practitioners are fitting dailies at increasing rates, the battle between market contact lens solutions has dwindled somewhat.
The following list represents the opinions of the author and not Eyes On Eyecare®. For more information on this topic, please check out our other content on contact lenses!
Since 2002, Dr. Andrasko’s staining grid has been the standard for assessing which contact lens solution to prescribe to a patient based on their contact lens brand. The staining grid looks at market solutions vs. corneal staining with various lens brands. Dr. Andrasko looked at the biocompatibility of more than 100 lens and solutions combinations.
The main outcome of the staining grid studies was that multi-purpose solutions containing polyquad and aldox consistently showed less staining on corneas no matter the brand worn. Hydrogen Peroxide solution results were similar. Polyhexamethylene biguanide (PHMB)-based solutions showed less consistency, and more staining and discomfort was noticed by practitioners and patients respectively.
Overnight, as the lens is soaked in the solution, the lens matrix absorbs the solution’s preservatives. When the patient wears the lens, the preservatives are released into the tear film, and if high enough may cause toxicity. These cells appear hyperfluorescent underneath the slit lamp and indicate that the living membranes of the epithelium cells are being affected.
While it is helpful to use the historic staining grid when prescribing, find it’s also vital to consider the individual patient’s needs and lifestyle when making a final recommendation.
Best contact solution for monthly lens wearers
CLEAR CARE®
CLEAR CARE actively cleans and removes debris from lenses without the patient’s participation. This is extremely important because it prevents lens discomfort and dryness and, by extension, results in less contact lens wearer dropouts. We all know as a patient wears a lens, they will start to feel the dryness at weeks 3-4 due to debris on the lens, and if we can keep the lens clean, we will impact the dry eye experienced by the patient.
What’s in it?
- High-grade H202 for superior cleaning and disinfecting (3%)
- Propriety Pluronic 17R4- surfactant that cleans & removes protein deposits
- Basket-mount platinum disc- optimized neutralization
- CLEAR CARE® PLUS is the only peroxide solution that has HydraGlyde® Moisture Matrix, which is a special wetting agent designed to recondition soft lenses and surround them with long-lasting moisture.
Best contact solution for eye sensitivity or preservative allergies
CLEAR CARE®
Personally, CLEAR CARE is my only choice for patients with previous sensitivities to lens solutions or to certain preservatives. The end result after neutralization is saline which most patients can tolerate.4
What makes it unique?
- CLEAR CARE AND CLEAR CARE PLUS Solutions do not contain added preservatives
- CLEAR CARE and CLEAR CARE PLUS result in a gentle saline solution that is similar to natural tears
Note: I am still a fan of the original CLEAR CARE over the CLEAR CARE PLUS. When I began receiving the “Plus” version, I had several cases of reported blurriness. I am attributing the blurriness to the Hydraglyde moisture matrix as that is the only difference between them. I did not see any correlation between a specific brand of lens, blurred vision, and the CLEAR CARE PLUS solution.
Best contact solution for Bausch & Lomb brand lens wearers
Biotrue®
In my practice, for Bauch & Laumb contact lens brand wearers, I recommend Biotrue.
What’s in it?
A sterile, isotonic solution that contains:
- Hyaluronan
- Sulfobetaine
- Poloxamine
- Boric acid
- Sodium borate
- Edetate disodium
- Sodium chloride
- Dual disinfection system
- Polyaminopropyl biguanide 0.00013%
- Polyquaternium 0.0001%
What makes it unique?
- pH of 7.5 matches the corneal tear film pH of 7.6 for improved comfort
- Keeps lysozyme active maintaining the tear film’s natural antimicrobial activity
- Contains hyaluron (HA) which is found naturally in tear film and provides additional hours of moisture
Biotrue is produced by Bausch & Lomb so research has been conducted to show that Biotrue is effective with Bausch & Lomb brand contacts.
Best contact lens solution for biweekly lens wearers
OPTI-FREE® Puremoist®
In my experience, this is a great lens solution for bi-weekly lens wearers. Most bi-weekly wears do not struggle with comfort because replacement occurs more often. Lenses are comfortable, but we must be most concerned with disinfection. The Optifree brand has a proven track record of patient comfort and safety. As mentioned in the staining grid research, polyquad and aldox dual disinfectants reduce harmful microorganisms that can cause eye infections.
What’s in it?
OPTI-FREE Puremoist solution is a sterile, buffered, aqueous solution containing:
- Sodium citrate
- Sodium chloride
- Boric acid, sorbitol
- Aminomethylpropanol
- Disodium EDTA
- Two wetting agents
- TETRONIC® 1304†
- HydraGlyde® Moisture Matrix [EOBO-41®- polyoxyethylene-poly- oxybutylene] with polyquad (polyquaternium-1) 0.001%
- Aldox (myristamidopropyl dimethylamine) 0.0006% preservatives.
HydraGlyde® Moisture Matrix is a proprietary multi-functional block copolymer that is primarily designed for wetting and lubricating silicone hydrogel lenses.
What makes it unique?
- Exclusive dual disinfectants of polyquad and aldox get rid of microorganisms without causing corneal staining
- Hydraglyde Moisture Matrix provides all-day comfort
Best contact solution for outdoor enthusiasts/global travelers
ACUVUE RevitaLens MPDS kills Acanthamoeba trophozoites. Acanthamoeba are a type of amoeba found worldwide in water and soil. They are very common in both oceans and lakes. For this reason, if you have an active patient who may be into water activities such as swimming or water-skiing, Revitalens may be the best choice.
Acanthamoeba are resilient organisms that “ . . . can be found in soil, air, and water. They have the ability to survive in diverse aquatic environments.” They can thrive anywhere from water bottles to AC units to hospitals and even to contact lenses and cerebrospinal fluid.
Additionally, for world travelers or those participating in mission work, I strongly believe RevitaLens may be the best choice. In less developed countries of the world or in places with less access to a clean water supply, travelers may be at an increased risk of encountering Acanthamoeba.
What’s in it?
ACUVUE RevitaLens MPDS is a sterile, buffered aqueous solution with:
- Two preservatives/disinfectants
- Alexidine dihydrochloride 0.00016%
- Polyquaternium-1 0.0003%
- Boric acid
- Sodium borate
- TETRONIC 904
- Edetate disodium
- Sodium citrate
- Sodium chloride
- Purified water
What makes it unique?
- Several in-vitro studies suggest ACUVUE RevitaLens® MPDS performs favorably versus leading multi-purpose solutions against Acanthamoeba
- Provides greater than 99.9% kill rate of Acanthamoeba
- Per these studies, it is gentler on patient eyes because of a 3x lower rate of corneal staining when compared to another MPDS brand
- Provides broad-spectrum disinfectant against FDA/ISO standard-panel organisms
In conclusion, hydrogen peroxide solutions such as CLEAR CARE are always my first recommendation for patients. If a patient objects or, for some reason, lifestyle doesn’t allow for 6 hours of soaking, other multi-purpose solutions may be considered.
As an eyecare practitioner, I also feel it is my responsibility to educate patients on avoiding PHMB-based solutions such as renu (Bausch & Lomb) and many of the off-label brands produced by Target and Walmart.
