How to Address Appropriate Compounded Medication Use Among Contact Lens Wearers
A longtime patient went into the pharmacy last week wearing her glasses instead of her usual contacts. When she received a compliment on her frames, she made a face and said her eyes were irritated so she couldn’t get her lenses in that day. “I got contacts when I was a teenager,” she explained. “I was so careful back then to follow all the rules about cleaning them.” She shrugged. “I guess I’ve gotten lazy.”
She’s not alone. A recent study by the Centers for Disease Control shows that risky cleaning and storage conditions have led to serious eye infections. Furthermore, many drug-contact lens interactions have left contact wearers wondering if their lenses are worth the trouble. It’s a tough consideration—contact lenses give many patients an alternative to the exhaustion and discomfort of wearing glasses. Care can become tedious though, and some people may need to adjust their medications simply because they wear contacts. No one wants to come into the pharmacy because her compounded medication and contact lenses are part of the same problem. What do patients need to know in terms of navigating the risk and rewards of their lenses?
Let’s Start with the Avoidable Problems
Roughly 41 million Americans wear contact lenses—in its survey-based study consisting of 1,000 respondents, the Centers for Disease Control reported that 99% of respondents had engaged in a type of hygiene or behavior considered at risk for eye infection1:
- Over half of lens wearers slept overnight in contacts
- Over 87% napped in contact lenses
- Half of the respondents topped off old solution in storage cases with fresh solution rather than emptying and cleaning the cases first
- Nearly half wore their lenses past the recommended life of the lenses
- Over 82% kept their storage cases longer than recommended
- Nearly 85% showered with their lenses in
- 61% swam with their lenses in
- One third of respondents rinsed their lenses in tap water, with half of those patients storing lenses in tap water
The list goes on and the consequences are enough to make anyone’s eyes itch—one full third of contact wearers have gone to the doctor for an eye infection or inflammation from poor handling of their contacts. In fact, the American Academy of Ophthalmology reports that keratitis is the most common infection related to contact lenses and can result not just in inflammation but corneal scarring that impairs vision to the point where corneal replacement is needed.2 Risky contact lens handling translates to about one million U.S. health care visits every year, at a total cost of $175 million.
Luckily, patients can look to their pharmacists for help. The best contact lens disinfectant is one that cleans the lens, removes debris from the lens surface, and prevents protein accumulation on the lens. Pharmacists should help patients choose their care products with respect to:
- Lens type (hard, soft, or extended wear)
- Surface active cleaning needs versus drop-in disinfectant by chemical reaction
- Enzymatic cleaning needed
- Protein removal, especially for patients with allergies
- Preservative-free saline and rewetting solutions
- Need for extra lubrication for dry eyes
Proper lens care includes washing and disinfecting hands before handling lenses, using appropriate solution for cleaning, handling and storing lenses, and to replace lenses and storage cases as recommended. Pharmacists can also direct patients to eye washes for better eye health (in everyone, not just lens wearers!).
Even if patients follow all of these instructions, they may end up with infections caused by fungal, mold or yeast contaminations.3 The contaminants may have crept in due to contaminated stock solutions or may have become trapped in the patient’s eyes via biofilm generated by allergies or other inflammation. For these cases, a compounded medication using amphotericin B and natamycin may be the only disinfectant that will work.
And for Specific Concerns About Compounded Medication and Contact Lenses?
Unique care for problems with compounded medication and contact lenses may be necessary for those patients who suffer from drug-lens interaction. The most obvious interaction can come from topical drops placed in the eye, but some can also come from systemic drugs that change the composition of tear secretion. Such interactions can include:
- Eye irritation and inflammation
- Change in lens color
- Pupil dilation
- Increase or decrease in tear volume
- Increase in or onset of myopia
- Increased reaction to glare or sensitivity to light
- Excessive blinking
- Discharge from eye
Pharmacists can develop uniquely compounded medications for these patients, or help them navigate unavoidable symptoms. Pharmacists can also help improve eye health in a variety of other ways, starting with asking patients if they are comfortable with their current contact lens disinfectant. There are many types of over-the-counter disinfectants, and patients may not be aware of differences between a no-touch solution, for example, and an enzymatic one. Inquire about possible irritation in the eyes, or if a patient has dry eyes, both of which can be helped by rewetting drops. The CDC also offers posters and other materials that can help remind patients how to best care for their lenses.4
Contact lenses aren’t for everyone, but the option for carefree wear should be there for those who want it.
Contact lens wearers shopping for OTC care products may not know what solution is right for them and how to care for their contact lenses best. Pharmaceutica North America recommends that pharmacists educate patients on the serious risks and side effects patients can expect from risky lens use. We are also proud to provide safe and high-quality compounding materials for patients whose contact lenses result in drugs that must be uniquely compounded for them. Contact us today for more information.
- “Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections — United States, 2014,” August 21, 2015, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6432a2.htm?s_cid=mm6432a2_w ↩
- “Contact Lens Care: Getting a Clear Picture ,” May 12, 2014, http://www.pharmacytimes.com/publications/issue/2014/may2014/contact-lens-care-getting-a-clear-picture ↩
- “Even Good Compliance May Not Eradicate Fungi,” May 2015, http://www.reviewofcontactlenses.com/CMSDocuments/2015/5/rcl0515i.pdf ↩
- “Healthy Contact Lens Wear and Care,” June 29, 2015, http://www.cdc.gov/contactlenses/posters.html ↩