RGP CL Care Flashcards
Who are RGP lenses best for?
- Those w/ astigmatism, as they offer a more rigid fitted lens
- People w/ eye conditions that cause irregularity to the shape
- SCLs wearer who find their vision is not sharp enough
Why is cleaning an important part of CL wear?
Cleaning is one of most important aspects of CL wear
It can influence success of wear & px’s satisfaction w/ CL
Aftercare depends on how well px has cared for lenses
What are the characteristics of RGP material?
- Small matrix
- Deposits remain on lens surface (more so than SCL so stronger detergents are used for RGPs)
- Complex surface chemistry
- Silicone element decreases wettability
o Tend to need more products involved in the care of RGPs due to this
What is the purpose of care and maitenance of RGP lenses?
- Cleans lens – of microbes, protein deposits, debris
- Good vision
- Good comfort
- Safe lens wear by:
o Minimising deposit accumulation
o Decreasing microbial contaminants
o Increasing lens wettability – RGPs are less wettable so need to try to maintain this
Similar principles to SCL Care
A solution must be able to eliminate microbes w/o being dangerous to ocular surface
RGP solutions are slightly more toxic to ocular surface than those for SCL – need something little stronger to strip away microbes, debris, protein deposits as they tend to adhere slightly more to an RGP than to SCL
Proteins adhere to RGPs slightly more because they are more sticky
What are the 6 components to care and maintenance of RGP lenses?
- Cleaning solutions
- Rinsing solutions
- Disinfecting solutions
- Protein removers (weekly)
- Rewetting lubrication solution
- Lens storage case
Describe step 1 of RGP CL care - Cleaning?
o Completed straight after lens is removed from eye
o Function:
To remove loosely bound foreign matter, cell debris, protein, lipid, mucous, cosmetics, etc
These would be toxic to ocular surface if instilled to eye directly – communication w/ px is really important
a. Important that this solution is not mixed up with any of the other solutions
b. Place cap back on once finished this step
c. Keep this solution out way of children etc
o E.g.s Blink TotalCare, Bausch & Lomb Boston, CooperVision Delta, Menicon Spray & Clean
Describe step 2 of RGP CL care - Rinsing?
o Function:
To remove daily cleaner, loosened deposits & microorganisms
Rehydrate lens (i.e. add water)
Dissolve enzyme tablets
o Type:
Saline (non/preserved)
MPS
o Rinse, rinse, rinse, rinse…. -> when in doubt rinse again
o Make sure to rinse BOTH sides of lens
Saline – a pH-balanced saltwater (NaCl) solution to rinses lenses before inserting them
Describe step 3 of RGP CL care - Disinfecting Systems?
o This step does not need completed when it is the 1st time the px is putting the lens in but does need completed at end of day after cleaning & rinsing
o This helps the lens interact w/ tear film well
o Function:
Physical or chemical process that destroys pathogenic microorganisms
Kills or deactivates microbes left on lens including:
a. Bacteria
b. Viruses
c. Fungi
d. Amoeba
Restores & maintains lens hydration
o Types:
Heat (thermal unit, microwave) – rare – more in industry
Chemical:
a. Oxidative – hydrogen peroxide, H2O2 (v effective, most commonly used, good for px w/ allergies) or chlorine
b. Cold chemicals – lots of disinfectants including bezalkonium chloride (BAK), chlorhexidine (CHX), thiomerosal, dymed, polyquad (PQ1) – lots of these can be used as preservatives
* E.g.s Bausch & Lomb Boston, CooperVision DeltaPlus, Blink TotalCare – Make sure these products are specific for RGPs - some of these can also be used for wetting solutions and storage solutions & also as conditioning solutions – more than 1 role
Give an example of standard RGP care system directions?
- Wash hands with mild soap
- Rub both sides of lenses carefully w/ 2-4 drops of Boston Cleaner in palm of your hand for 20 seconds
- Rinse each side of lens for at least 5secs to remove cleaner w/ a saline indicated for care of gas permeable CLs
o DO NOT USE TAP WATER TO RINSE LENSES - Place lenses in empty lens case & fill w/ fresh Boston Original Conditioning Solution
o Soak lenses for at least 4 hours (or overnight) before wearing – use fresh solution & storing lenses (DO NOT TOP IT UP) - Wash hands – after removing lenses from lens case, apply fresh conditioning solution to wet lenses for additional cushioning, if desired, & insert
- Discard solution from lens case – rinse lens case with fresh, sterile disinfecting solutions (nerve use water) & wipe lens case w/ a fresh, clean tissue
o Avoid air-drying or recapping lens case lids after use w/o using any additional cleaning methods
o If air drying, be sure that no residual solution remains in the case before allowing it to air dry - Conditioning solution has about 90-day shelf life – record date opened on bottle label
- Then complete the protein remover step
- Replace lens case frequently (at least once every 3 months) to avoid microbial contamination & ocular irritation
Get px to repeat the steps back to you
Describe Hydrogen Peroxide-Based Disinfection?
- One step (e.g. EasySept, AOSept) – oxidative – oxygen helps clean the RGP
o Catalytic disc
o Delayed-release neutralising tablet - Two step
o Dilution
o Catalytic disc
o Neutralising agents (after disinfection)
o Catalase (enzyme, catalyses H2O2 breakdown to H2O + O2) - Refer to ACLM to tell you if a solution is for soft or RGPs
- There is only one hydrogen peroxide (H2O2) system listed for RGPs (AOSept)
- Recommended minimum 3 hours in 3% H2O2
o Bacteria 10-15mins
o Fungi 1 hour
o Acanthamoeba 3-6 hours - Powerful cleaning & disinfecting – good for atopic px & those w/ preservative allergies (e.g. BAK)
- AO Sept has added agent for comfort
Describe step 4 of RGP CL care - Protein Removers?
o Function:
To aid in removing/loosening tightly bound protein deposits
o Enzymes (proteins that breakdown/digest proteins - proteinases) include:
Papain
Subtilisin
Pronase
Pancreatin
o Done weekly
o Lenses MUST be cleaned & rinsed after enzymatic tx
o E.g. Ultrazyme Universal (can be used for all lens types, must be dissolved in solution e.g. saline), Bausch& Lomb Boston Protein Remover (specifically for RGPs, already in solution)
Give an example of enzyme steps in RGP CL care?
DIRECTIONS (USE WEEKLY):
1. After daily cleaning (w/ Boston Cleaner or Boston ADVANCE Cleaner) & rinsing, place lenses in lens case & fill to top with fresh solution
a. It is important that lens case is completely filled with fresh solution to ensure proper dilution of the Boston One Step Liquid Enzymatic Cleaner & reduce any chance of irritation
2. Detach one container from the strip by pulling tab toward you from top to bottom
a. To open, twist tab off single-use container
b. Squeeze container to release 2 drops of Boston One Step Liquid Enzymatic Cleaner into each lens well
c. Soak lenses for at least 4 hours (or overnight) before wearing to ensure proper cleaning & disinfecting
d. Always use fresh solution for soaking & storing lenses
e. Discard container immediately after use
3. After removing lenses from lens case, rub & rinse lenses for ~5 secs w/ any Boston Conditioning Solution to ensure the enzymatic cleaner is thoroughly rinsed off the lenses
a. DO NOT USE TAP WATER FOR THIS FINAL RINSE
4. Apply fresh conditioning solution to wet the lenses for additional cushioning, if desired, & insert
5. Discard solution from lens case & immediately & thoroughly clean interior of lens case with a sterile disinfecting solution & air dry after each use
Describe step 5 of RGP CL care - Rewetting & Soaking?
o E.g. Boston ADVANCE Comfort Formula Conditioning Solution
o Function:
Disinfection, wetting & storage
To alleviate insufficient lubrication from tear film
Rehydrate
Flush debris
Maintain wettability
o May see some reflex tearing on 1st time px uses it – normal
o Composition:
Anti-microbial agents
Wetting agents (e.g PVA (polyvinyl alcohol), PVP (polyvinyl pyrrolidone) & polysorbate)
Viscosity-enhancing agents – thickness enhancing agents
Buffer
Salts
o This solution is also used just before lens insertion
o Helps with initial comfort when lens is inserted
Describe step 6 of RGP CL care - Lens Storage?
o CL should be stored in a clean case w/ fresh (NEVER TOP UP) disinfecting solution
Should be replaced monthly (ideally)
Describe RGP MultiPurpose Solutions (MPS)?
- These also exist & are similar to a soft lens MPS (i.e. they combine cleaning, disinfection & soaking functions into a single bottle)
- Need to read packaging carefully to check which lens they are suitable for
- E.g.s Avizor GP multi, Menicon MeniCare Pure
Px MUST NOT use saliva as a lubricant due to the microflora & fauna in saliva
