View Poll Results: For my contact lens patients generally I prefer

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  • A peroxide based cleaning system

    3 20.00%
  • A all-in-one system

    12 80.00%
  • The patient ought to decide themselves

    0 0%
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Thread: Peroxide or all-in-one

  1. #1
    Bad address email on file QDO1's Avatar
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    Peroxide or all-in-one

    What contact lens cleaning systems do you all recommend for soft lens users. Do you prefer the peroxide based systems, or the all in on systems. Is the level of preservatives in all in one systems too high? Is it right that patients can chop and change soloutions, leaving the practitioners to unpick the mess

    i.e. should the soloution market be practitioner lead, or consumer lead, and finally, who is leading the consumer, is this right?

  2. #2
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    Peroxide is a disinfection, not cleaning system. It is probably the best especially for lenses that are not disposable but lenses should be thoroughly cleaned manually before any form of disinfection.

    Chip

  3. #3
    Master OptiBoarder
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    Quote Originally Posted by QDO1
    What contact lens cleaning systems do you all recommend for soft lens users. Do you prefer the peroxide based systems, or the all in on systems. Is the level of preservatives in all in one systems too high? Is it right that patients can chop and change soloutions, leaving the practitioners to unpick the mess

    i.e. should the soloution market be practitioner lead, or consumer lead, and finally, who is leading the consumer, is this right?

    I've seen more damage done from solution mismanagement both by the patient and the practitioner then from bad lens fitting. (Well, almost) I used to be a big believer in peroxide based systems. I still use them occasionally on non-disposable lenses. Although it was the best on disinfection, I got more complaints with this system from patients related to DRYNESS. Compliance and useage of the daily cleaner and enzyme were also issues. Hated it when patients would put AOSept in their eyes in spite of written and verbal instructions, as well as the red tip on the bottle.

    The multi purpose solutions are MUCH better these days. They kill germs well and rarely cause sensitivity reactions. A big key here, though, still is LENS CASE HYGIENE. I spend a lot of time instructing patients in this. In the morning, I have them wash their case out with warm water AND DRY IT!!. I have seen many cases of corneal ulcer/keratitis where the case had "bio-scum" in it from lack of cleaning. I also instruct them to change the case every time they start a new bottle. Giving away free lens cases is the BEST way to prevent red eye and infection problems. It is also a decent practice builder. Patients love to get "something for nothing". When you stop to think about it, we really should be recommending case replacement at the same interval of disposable lens replacement. Which is cheaper to make, the lens or the case? Would it hold up in a court of law if a patient lost a cornea due to a contaminated case that could have been replaced for 2 cents?

    I like ReNu with MoistureLock and the new, not yet released Alcon OptiFree Replenish solution. We have been doing a pre-release study with this solution. It supposedly reduces wetting angle to 5 degrees (unheard of) for up to 12 hours. Patient response cards are very favorable so far. The stuff might even turn out to be a good rewetting drop.

    RGP patients still are the worst with lens case hygiene. I still use a separate daily cleaner and overnight wetting/disinfecting solution. I like Boston here.

    I've often said that solutions should be an Rx item so that the patient would need a prescription from the fitter to buy them. Not gonna happen though. Today, consumers want to buy buy their lenses without an exam, fitting, and prescription.

  4. #4
    What's up? drk's Avatar
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    I harp on solutions, and they are at best strong OTC recommendations.

    Alcon's OFX has performed well for years. Incidence of frank sensitivity have been close to zero. Infiltrative keratitis is a higher, but still relatively low consequence.

    If someone has issues with OFX, I change to Ciba's peroxide system as well. It works to eliminate solution sensitivity, except the cleaning is dubious, especially with lipid removal on SiH lenses, and it is a little cumbersome, in ways, for patients to use, and is generally not liked.

  5. #5
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    I have had very positive experiences overall with the peroxide system (Clear Care), yet I don't usually start out recommending it. I have known a few cases were the patient used Clear Care after the expiration date and burned the crap out of their eyes. Also, I like for a patient to have the option to take out their lenses and give them a quick rinse with multipurpose when needed so why have more than one care system siting around the house? Most importantly, multipurpose solutions are getting much better in terms of comfort and preservative tolerance (particularly Renu with moisturloc) which makes my decision to start with them much easier.

    Side note - I have had the opposite response to fjpod in terms of comfort with Clear Care. Every time I recommend it I hear that the comfort is great! That is just in my experience though.

  6. #6
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    Quote Originally Posted by SpecialT

    Side note - I have had the opposite response to fjpod in terms of comfort with Clear Care. Every time I recommend it I hear that the comfort is great! That is just in my experience though.
    With the older multipurpose solutions, peroxide definately reduced red eyes due to solution and/or preservative toxicity/allergy. But, with the newer ones, I was starting to notice more complaints against peroxide compared to the MPs. The complaint was just dryness. Not really conjunctival/limbal injection with corneal infiltrates the way we used to see.

    Have you found this?

  7. #7
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    I definately agree that roles are starting to reverse, but the only multipurpose I have seen beat out Clear Care in terms of comfort is the Renu moisturloc. I am looking forward to the new Optifree product, which looks to be promising.

  8. #8
    Bad address email on file QDO1's Avatar
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    Quote Originally Posted by fjpod

    A big key here, though, still is LENS CASE HYGIENE. I spend a lot of time instructing patients in this. In the morning, I have them wash their case out with warm water AND DRY IT!!.
    this is what I bang on about too. and I advise leaving the case open to air dry through the day. case hygine is particularlary imortant with the newer more viscous soloutions, which do seem to build up a layer of grunge quickly on the case. I think there is a definate need to look at case design - to reduce the surfaces, get rid of the sharp edges and make them easier to use and clean

  9. #9
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    I go a step further on cases, and have never had a patient who did t his come up with and infection that could be traced to the case or cultured from same.

    I have for 40 years had all patients scrub the case out with a toothbrush and Johnson's Baby Shampoo weekly. Hard, soft or HGP.

  10. #10
    Master OptiBoarder ikon44's Avatar
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    Quote Originally Posted by chip anderson
    I go a step further on cases, and have never had a patient who did t his come up with and infection that could be traced to the case or cultured from same.

    I have for 40 years had all patients scrub the case out with a toothbrush and Johnson's Baby Shampoo weekly. Hard, soft or HGP.
    hope they have,nt just brushed their teeth beforehand Chip:bbg:
    To find out what,s happening in the UK optical market:
    http://theOptom.com

  11. #11
    Optical Clairvoyant OptiBoard Bronze Supporter Andrew Weiss's Avatar
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    I recommend multipurpose solutions with 2-week to 1-month disposable lenses. Compliance is generally better with the multipurpose than with the ClearCare, and that really is an issue, especially with teenagers and young adults. I also recommend the new ReNu, especially with older patients, and with younger ones I recommend Alcon's OptiFree Express. I also still recommend rubbing the lens, even if only for 5 or 10 seconds, to help the cleaning process along. I recommend ClearCare for those with preservative sensitivities and also for planned-replacement lenses (6 month or 1 year). I have no doubt the two-step cleaning and disinfecting does a more effective job in the long run, but with the disposable lenses the patient usually doesn't wear the lenses long enough to notice the consequences of deposit build-up.
    Andrew

    "One must remember that at the end of the road, there is a path" --- Fortune Cookie

  12. #12
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    Quote Originally Posted by QDO1
    this is what I bang on about too. and I advise leaving the case open to air dry through the day. case hygine is particularlary imortant with the newer more viscous soloutions, which do seem to build up a layer of grunge quickly on the case. I think there is a definate need to look at case design - to reduce the surfaces, get rid of the sharp edges and make them easier to use and clean
    I used to recommend that the patient leave the case open to air dry during the day. I know longer recommend this because most people keep their cases in their bathrooms. Most people don't close the lid on the toilet before flushing. Several studies have shown that spray from the toilet lands on everything in the bathroom. I think it is safer to keep the case closed or put away.

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