Contact Lens 1: SCL Care

Question 1

Contact Lens Types

1. Soft: 2 types of Material?
2. 2 Types of Replacement Schedules?

Answer 1

1. Hydrogel and Silicone Hydrogel (Si Hy)
2. a. Disposable (1-day, 1-week, bi-weekly, monthly)
   b. Conventional: Quarterly and Yearly

Question 2

CL Types

1. Gas-Permeable: Size (2)?
2. Hybrid: 2?

Answer 2

1. Corneal and Scleral

2. GP Center and Surrounding Soft Skirt

Question 3

CL Types

1. Implantable CLs
   a. Verisyse: Sits where?

b. Visian: Sits where?

Answer 3

1. a. Sits ANTERIOR to IRIS (AC ICL)

b. Sits b/w Iris and Crystalline Lens (PC ICL)

Question 4

Lens Contaminants: Multiple things…name a bunch?

Answer 4

1. Microorganisms
2. Viruses
3. Prions
4. Cell Debris
5. Air-borne Contaminants
6. Tear Components (Proteins, Mucus, Lipids)
7. Skin Lipids
8. Finger-Borne Debris
9. Cosmetics
10. Care Products
11. By-products of any interactions b/w lens, care products and Contaminants

Question 5

CL Care

1. Three Main Components and what they do:
   a. Clean
   b. Rinse
   c. Disinfect

Answer 5

1. a. Removes Loosely Bound Foreign Matter
   b. Removes Loosened Deposits
   c. Kills/Deactivates Potential Pathogens

Question 6

1. What does CRADLE Stand for?

a. Analagous to what?

Answer 6

1. Clean, Rinse, And Disinfect Lenses Everyday

a. Diswasher Analogy (Clean dishes, rinse them, put them thru the dishwasher)

Question 7

CL Care

1. Nature of SCL Materials: Susceptible to what?
2. Prevent Contamination with what?!
   a. Critical if not replacing lenses when?
   b. Daily Disposable lenses avoid the need for what?

Answer 7

1. to CONTAMINATION!
2. with DISINFECTION!
   a. Daily
   b. for Care Solutions

Question 8

CL Solution Paradox

1. Solutions need to be 2 things.

Answer 8

1. STRONG enough to KILL MICROBES, AND Mild Enough NOT to harm Corneal Cells

Question 9

SCL Disinfection

1. Physical (4)
2. Chemical (2)

Answer 9

1. Thermal, Microwave, UV, and Ultrasound

2. Multipurpose and Oxidative

Question 10

1. Thermal Disinfection: Requires what 2 things?
2. Saline
   a. Solution of what?
   b. Substitute for CL Solution?
   c. What is added to OPTIMIZE pH?
   d. Saline can be 1 of 2 things?
   e. Non-Preserved must be discarded how many days after opening? Unless it’s what?

Answer 10

1. Heat Unit + Soaking Solution (SALINE)
2. a. of Salt Water
   b. NO!
   c. A Buffer
   d. It can be Preserved or Non-Preserved

e. 30 days after opening; Unless it’s AEROSOL

Question 11

Thermal Disinfection: Advantages

1. Cost?
2. Effective against what forms of Bacteria?
   a. What 3 things dis she have listed?

Answer 11

1. CHEAP!
2. ALL forms of bacteria
   a. Acanthamoeba (cyst and Trophozoite forms); HIV; Pseudomonas

Question 12

Thermal Disinfection: Disadvantages

1. Bakes on what?
2. What does it do to the life of the CL?
3. Contraindications? (3)

Answer 12

1. on Deposits (increased complications?)
2. Shortens the Lens life (Yellowing)
3. a. GPs
   b. Lenses w/MORE than 55% Water Content
   c. Silicone Hydrogel Lenses

Question 13

Microwave Disinfection

1. Is it good?
2. Power level needed?
3. Time needed?
4. Lens Parameter changes may occur, but are generally what?
5. What buildup has been reported?

Answer 13

1. Rapid and Effective
2. Low Power (10%)
3. 15 Minutes Max
4. generally small
5. Salt Crystal Buildup
   * More studies are needed

Question 14

UV Disinfection

1. Purilens System
   a. Amt of time?
2. Mechanism of Action?
   a. How does it work?
   b. What light?

Answer 14

1. *Only currently available system
   a. 15 minute exposure to UV-C Radiation
2. Agitation + Light
   a. Shear Waves –> Whirlpool Effect –> Debris Removal

b. UV-C Light = Germicidal

Question 15

UV Disinfection: Purilens

1. Advantage?
2. 2 Disadvantages?

Answer 15

1. Preservative Free

2. a. Not Si-Hy approved and Not GP approved

Question 16

Purilens: Steps

1. Rinse lenses with what solution. Then place them in what?
2. Place this into what?
3. Fill it with what?
4. Place top on Unit and let it run for how long?
5. Lenses are shielded from direct what?

Answer 16

1. with Purilens Solution; Place in Lens Holder
2. into Cleaning Chamber
3. with Purilens Solution
4. for 15 minutes
5. from Direct UV Exposure

Question 17

Chemical Systems (2)?

Answer 17

1. Multipurpose Solutions (MPS)

and

2. Oxidative Systems

Question 18

CL Solution Components

1. Surfactant does what?
2. Wetting Agent does what?
3. What other component?

Answer 18

1. Lowers Surface Tension b/w Liquid and Solid
2. Enhances Lens Wettability
3. Disinfectant

Question 19

Disinfection standards are determined by what 2 organizations?

Answer 19

ISO (International Organization for Standardization)

and

FDA (US Food and Drug Administration)

Question 20

Disinfection Standards

1. Standard Strains?
2. 2 Types of Testing?

Answer 20

1. 3 bacterial and 2 fungal
2. a. Standalone (Solution alone)

and

b. Regimen (Rub, Rinse, Soak according to label)

Question 21

Organisms used in all Testing

1. 3 Bacterial strains?
2. 2 Fungal Strains?

Answer 21

1. a. Pseudomonas Aeruginosa
   b. Serratia Marcescens
   c. Staphylococcus Aureus
2. a. Candida Albicans
   b. Fusarium Solani

Question 22

Multipurpose Solutions (MPS)

1. Combination of what 3 things?
   a. Bottle care?
   b. No-rub is promoted by manufacturers to what?
   c. Different Biocide in what?
   d. Different what?

Answer 22

1. Cleaning, Rinsing, and Disinfection
   a. 1 Bottle Care
   b. to Lens Wearers
   c. in Each Brand
   d. Different Soaking Times

Question 23

Disinfectants

1. Quarternary Ammonium Compounds (1)
2. Alcohols, Acids and Related Compounds (1)
3. Mercurials (1)
4. Biguanides (2)
5. Oxidizers (1)
6. Chelating Agents (1)

Answer 23

1. PQ-1
2. Sorbic Acid
3. Thimerosal
4. PHMB and Alexidine
5. Hydrogen Peroxide
6. EDTA

Question 24

Quarternary Ammonium Compounds (eg BAK, PQ-1)

1. BAK
   a. Has what 2 types of actions?
   b. Cytotoxic to what?
   c. Binds to SCL matrix and could be released into what?
   d. NOT used in SCL solutions due to what?
2. PQ-1
   a. found in what 3 solutions?
   b. Minimal Tissue response at what concentration level?

Answer 24

1. a. Antifungal and Antibacterial Actions
   b. to Corneal Epithelium
   c. and could be released into tears
   d. due to this potential toxicity
2. a. Opti-Free, Biotrue, and Revitalens
   b. Minimal Tissue Response at Low Concentration

Question 25

Alcohols, Acids and Related Compouns (Sorbic and Boric Acids) 1. Mostly used in what solution? 2. What is it?

Answer 25

1. in Saline | 2. Bacteriostatic (Not Bacteriocidal)

Question 26

Mercurials 1. Thimerosal a. Type of compound? b. DOES NOT BIND to Lens Material Strongly, BUT what does enhance binding? c. Bacterio-what? d. Spectrum? e. How fast does it act? f. Risk of Sensitivity?

Answer 26

1. a. Organic Mercury Compound b. But Organic Surface Deposits Enhance Binding c. Bacteriostatic d. Wide Spectrum e. Slow Acting f. HIGH RISK

Question 27

Biguanides 1. Chlorhexidine a. Can cause Toxicity similar to what? b. Led to development of what? 2. Polyaminopropyl Biguanide a. What is it? Fount in what 2 solutions? 3. PHMB? 4. Alexidine Dihydrochloride: Used in what? 5. Used in LOW CONCENTRATION to minimize what?

Answer 27

1. a. similar to Thimerosal b. to Development of Higher MW Derivatives 2. a. DYMED; in Renu Fresh and Renu Sensitive 3. Widely used today 4. Revitalens 5. To minimize Ocular tissue response

Question 28

Others 1. EDTA a. Toxicity? b. Used in combo with what agents? 2. Myristamidopropyl Dimethylamine: Aldox in what?

Answer 28

1. a. Relatively Toxic b. with other agents 2. in Opti-Free Line of Products

Question 29

Solution Sensitivity 1. Caused by various solution characteristics? (6) 2. Symptoms? (6)

Answer 29

1. Buffering System, Disinfectant, Osmolarity, pH, Preservatives, and Viscosity 2. Burning, Discomfort, Itching, Photophobia, Redness, and Tearing

Question 30

Solution Sensitivity: Signs (7)?

Answer 30

1. Corneal Edema 2. Corneal Infiltrates 3. Chemosis 4. Follicles 5. Hyperemia 6. Microcysts 7. Superficial Punctate Keratitis

Question 31

Controversy in Corneal Staining and MPS 1. A Study done to differentiate b/w MPS-associated staining and "true" corneal staining, measure cellular toxicity, and risk factor for corneal inflammation. a. All preservatives are taken up by ALL SLCs during soak; After application, lens releases the preservative into the tear film. Tears SLOWLY DISSIPATE the Preservatives b. In the Presence of PHMB, is the Corneal Membrane Affected? c. PHMB adheres strongly to what? d. What causes the Punctate appearance of the cornea? 2. PHMB Release form SiHy lens is greatest B/w what time period?

Answer 31

1. b. NO! (At body temp, up to 100x's the concentration of PHMB found in marketed solutions does not damage cell membranes) c. NaFl (It's affinity for PHMB is up to 50x's greater than that for PQ-1) d. From Many PHMB molecules aggregating and binding with NaFl, resulting in a BENIGN, TRANSIENT FLUORESCENCE * This phenomenon is called MPS-Associated Transient Fluorescence! 2. B/w Application and 2 Hrs

Question 32

How do we measure BIOCOMPATIBILITY? (3)

Answer 32

Symptoms; Immune Response; and Cell Response

Question 33

What solutions are okay to use with what contact lens? 1. What reacts differently than Hydrogels?

Answer 33

1. Si-Hydrogels. So Solutions must Get FDA approval to be used w/Silicone Hydrogels!

Question 34

CCLR/Global Staining Score 1. Each Zone is Graded on a 1-100 point scale for each of the following. a. 1 Represents what? 100 Represents what? b. Extent of staining in terms of what? 2. The Product of those 2 numbers, provides what? 3. The sum of the 5 ZSS can be divided by 5 to provide what score?

Answer 34

1. a. finest punctate staining; Confluent staining b. of the % of the zone exhibiting the staining. 2. Type and Extent (are the 2 numbers) which Provides the INDIVIDUAL "Zone Stain Score" (ZSS): Max of 10,000 3. to provide the "Global Corneal Stain Score" (GSS...also out of 10,000)

Question 35

MPS Procedure How do you do it?

Answer 35

Wash hands; Remove lens; Place in palm of hand. Rub each side w/MPS for recommended time; Rinse w/MPS; Fill Case w/Fresh MPS; Place lens in case; Soak for recommended time

Question 36

Clean, Rinse... 1. Oxysept Ultracare 2. ClearCare 3. OCuSOFT 4. Sauflon One Step

Answer 36

1. Use a separate Daily Cleaner (6hrs disinfection time); AMO 2. Pluronic 17R4 (6 hrs); Ciba 3. None (6 hrs); OCuSOFT 4. Poloxamer (6 hrs); Sauflon

Question 37

...and Disinfect 1. Use of what? 2. Oxysept Ultracare 3. ClearCare 4. OCuSOFT 5. Sauflon One Step

Answer 37

1. of Hydrogen Peroxide for disinfection along w/a method of neutralization 2. Neutral method: Tablet (7 days long-term storage time); AMO 3. Platinum Disc (7 days); Ciba 4. Platinum Disc (24 hrs); OCuSOFT 5. Platinum Disc (24 hrs); Sauflon

Question 38

Oxidative System Procedure 1. What do you do?

Answer 38

Wash hands, remove lens, depending on the brand, either: use daily cleaner, or do pre-rinse; Place lens in case w/platinum disc or neutralizing tablet. Soak for recommended time.

Question 39

In-Office Disinfection 1. Most diagnostic Conventional Soft Lenses are used in-office one time, then what happens to them? 2. Conventional Soft Lenses are Reused after what? 3. Several methods have been proposed, but most involve the use of what? a. STORE in MPS and Re-Disinfect every what?

Answer 39

1. then they're either dispensed or Discarded 2. after being disinfected 3. of an Oxidative System a. every 30 DAYS!!

Question 40

Daily Cleaners 1. Not used much anymore. Why? 2. What do they do? 3. Reserved for what lenses? 4. Rub cleaner into lens; rinse w/Saline or MPS; then disinfect as what?

Answer 40

1. Cuz MPS contain cleaning agents 2. Removes Debris, Unbound Protein, Lipid, and some Microbes 3. for "Conventional Lens" Patients 4. then Disinfect as normal

Question 41

Enzymatic Cleaners 1. 3 types of enzymes can be used? 2. Break down Peptide bonds, allowing protein to be what? 3. Placed in Disinfection solution and allowed to do what? 4. Not used much anymore. Why? 5. Reserved for what patients?

Answer 41

1. 2. to be rubbed off mechanically 3. to soak overnight 4. cuz MPS contain agents for protein removal 5. for "Conventional Lens" Patients

Question 42

Importance of Proper CL care 1. AKA? 2. % of Non-Compliance in some way? 3. Examples of Non-compliance?

Answer 42

1. COMPLIANCE 2. 40-90% 3.

Question 43

Lens Case Care 1. Significantly higher number of non-contaminated lens cases were found in the group of cases aged what? 2. Contamination of lens case is a risk factor for what? 3. Most common non-compliant behavior among CL wearers?

Answer 43

1. Aged less than 9 months compared to the group of cases aged more than 9 months 2. for Microbial Keratitis 3. Inadequate Lens Case Care

Question 44

CL Complications 1. What is the Most serious Complication of CL Wear? 2. Incidence a. DW GP b. DW SCL c. EW SCL 3. Risk of vision loss from CL-Related MK is what? 4. Overnight wear increases the risk of what?

Answer 44

1. MK 2. a. 1 in 10,000 b. 3-4 in 10,000 c. 10-20 in 10,000 3. 0.3 to 3.6 per 10,000 4. of MK, as does non-compliance (poor hygiene and lens care)

Question 45

What CL solution was associated with an Outbreak of FUSARIUM KERATITIS?

Answer 45

1. Bausch & Lomb's ReNu with MoistureLoc

Question 46

What CL Solution was associated with an Outbreak of Acanthamoeba Keratitis?

Answer 46

Advanced Medical Optics MoisturePlus Multipurpose Solution for CLs.