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INTRODUCTION

Approximately 41 million Americans 18 years and older wear contact lenses. This accounts for 16.7% of all adults in the United States (U.S.). Females account for two-thirds of the contact wearers, and the average contact lens wearer is approximately 31 years old.¹ Contacts present appealing benefits over eyeglasses, including the fact that contact lenses sit directly on the eye and move with the eye, which offers flexibility, convenience, and unobstructed peripheral vision.² Other advantages of contact lenses include perceived improvement in self-image and personal appearance, the ability to achieve an equal image when there is refractive disparity between the eyes, and the provision of certain therapeutic necessities that will be discussed further in the "Type of Contact Lenses" section.³ People who live active lifestyles may benefit from the advantages of contact lenses. Additionally, a variety of vision disorders, including myopia, hyperopia, astigmatism, and presbyopia, can be corrected with contact lenses. Other uses of contact lenses include the correction of refractive errors, the superficial change in the appearance of eye color, or the treatment of diseases of the cornea.⁴

Certain patient populations are not candidates for contact lenses or should follow additional precautions prior to initiating contact lens use. Patients who should not wear contact lenses include those who are monocular and those who have certain corneal diseases or injuries (e.g., active pathology of the lids, cornea, or conjunctiva).⁵ The following populations should apply additional precautionary measures before contact lens use: patients with dry eyes, patients who are pregnant or who are using oral contraceptives, patients with diabetes, patients with glaucoma, active smokers, or anyone who is not likely to care for their contact lenses.⁵

Typically, an optometrist and/or ophthalmologist writes a prescription for a contact lens at the conclusion of an eye examination and fitting; patients may then purchase contacts from multiple sources, including pharmacies.⁶ Since the passage of the 2003 Fairness to Contact Lens Consumers Act, patients have the ability to send a contact lens prescription to any legitimate source, including mail-order or internet sites. While previous data suggested that patient adherence to care regimens may have been greater if the contact lenses were purchased online, other studies suggest this may not be a big factor.^7,8 Research suggested that certain patients self-reported an increased risk of eye-related complications when contact lenses were purchased online, however, these risks are amplified if the patient utilized a tinted nonprescription contact lens through an unlicensed distributor.⁷ Patients who purchased their contact lenses from an online or telephonic resource tended to have less frequent follow-up with their eye care practitioner.⁸ Additionally, there is a lower cost associated with purchasing contact lenses online or telephonically.⁸

Overall, it is estimated that half of contact lens wearers experience complications related to contact lenses at some point.⁹ These complications may result from the type of lens a person wears, the wearing schedule, or a person's adherence to the care regimens.⁹ Tools for preventing these complications are targeted at improving patient hygiene and safe contact lens wear—both of which pharmacists have the opportunity to impact directly.¹⁰ Pharmacists, specifically pharmacists practicing in the community setting, have approximately 35 face-to-face encounters with each patient every year,¹¹ which makes them the most accessible members of the health care team: pharmacists contribute skills as strong patient educators, and they have the most extensive education and training in medication use, management, and problem solving of any other member of the health care team, which makes them well-placed and well-suited to help patients achieve positive outcomes of contact lens wear.¹²

TYPES OF CONTACT LENSES

Two general types of contact lenses are available: hard and soft; they are created with rigid or flexible plastic, respectively, that allows oxygen to pass to the corneal surface.¹³ Both of these lens types are classified as Class II medical devices and are regulated by the U.S. Food and Drug Administration (FDA).¹⁴ A summary of the differences between soft and hard lenses is listed in Table 1.

Table 1: Comparison of Hard and Soft Contact Lenses14-19
Lens type	Advantages	Disadvantages
Hard (gas permeable) lenses	Excellent visual acuity15 Fit customized to patient17 Useful for irregular corneas18	Initial discomfort; long adaptation period required15 May shift from center of the eye15 Require specific fit18 Increased likelihood of debris under lens18 Intricate cleaning process17
Soft (hydrophilic) lenses	More comfort initially19 Simple fitting15 Ease of care15 Less likely to trap debris or fall out during activity15 Available in tints15 Certain lenses do not need to be cleaned (e.g., daily-disposable varieties)15	Less visual acuity for all patients15 Visual changes depending on temperature, humidity, and hydration20 Lenses are not fit for a specific patient15 Increased risks and complications (e.g., hypoxia)15

Gas permeable contact lenses

Hard contact lenses, also known as rigid gas permeable or, simply, gas permeable (GP) lenses, account for 10% of new contact lens fits and refits in the U.S.¹⁴ GP lenses are made of a slightly flexible plastic that holds a specific shape. Polymethylmethacrylate (PMMA) was the plastic material that was previously used to manufacture hard lenses. Today, newer plastics that allow more oxygen to pass through to the eye are used to manufacture contact lenses and, therefore, PMMA is not used frequently for newer contact lenses.¹⁵

Advantages of GPs compared to soft lenses include better visual acuity, resistance to deposit buildup, lower cost, and ease of handling. GPs also have a lower likelihood of lens damage or tear, since they offer increased durability compared to soft lenses.¹⁵ GP lenses can help patients with keratoconus (a condition in which the cornea progressively thins and loses its shape) achieve optimal vision, and GPs can be advantageous for patients with dry eyes.¹⁶ Additionally, GPs offer improved visual acuity, especially when compared to eyeglasses, for patients with irregular astigmatism.¹⁷ GPs are ordered by an eye care practitioner and created specifically for a particular patient, which offers a degree of personalization for the patient. Some disadvantages of GPs are that they are initially less comfortable and take consistent wearing for the patient to adapt to the contact lens. Additional disadvantages are that they might shift from the center of the eye or that debris might get under the lens, which may increase risk of an abrasion since the lens is designed to move when the patient blinks.^15,18 Also, compared to soft contact lenses, GPs require a more intricate cleaning and disinfection process since GPs require specific types of solutions for wetting, cleaning and disinfecting systems.¹⁹

Soft (hydrophilic) contact lenses

Soft (hydrophilic) contact lenses dominate the contact lens market, with 93% of contact wearers using soft lenses.¹⁵ Soft contact lenses offer more comfort on initial insertion and allow for incredible flexibility in wear compared to GPs. Soft lenses are now made with materials such as silicone hydrogels, which provide improved oxygen flow to the eye during contact lens wear to minimize complications of contact lenses.¹⁹ Soft contact lenses are available to correct presbyopia, myopia, hyperopia, and astigmatism. Daily-wear, extended-wear, extended-wear disposable, and planned-replacement lenses are available.¹⁵ Daily-wear contact lenses offer the wearer a very short adaptation period, tinted options and do not need to be cleaned. Daily-wear contact lenses, however, do not correct all vision problems, have less visual acuity and must be replaced daily. Extended-wear contact lenses may be worn overnight and have FDA approval for up to 7 days or 30 days.¹⁵ However, extended-wear contact lenses do not correct all vision problems and if these contact lenses are properly cared for, it could increase the risk of complications. Extended-wear disposable able to be worn one to thirty days then discarded.¹⁵ These lenses often require little cleaning and have a decreased risk of eye infections (when instructions are followed), however, these also do not correct all vision problems and handling may be more difficult.¹⁵ Planned replacement lenses offer patients an option that the lens is replaced on a planned schedule (two weeks, monthly or quarterly) that promote good eye health, simplified cleaning and disinfection process, and availability in most prescriptions.¹⁵

Several monomers are used in the manufacture of soft contact lenses: 2-hydroxyethyl methacrylate (HEMA), methacrylic acid (MA), and n-vinvylpyrrolidone (NVP).¹⁹ The principle component of the lens, polyHEMA, has a water content of 38%. Addition of MA or NVP to the composition of the lens increases the water content to 60% or more but decreases the strength of the lens. Other factors that affect hydration of the lens are the temperature, tonicity, pH, and oxidative reactions of lens solutions.²⁰ Initially, soft lenses were intended to allow yearly replacement if cleaned and disinfected daily. However, not all patients adhered to ocular health recommendations and many did not appropriately care for the contact lenses. This resulted in numerous contact lens complications, often secondary to hypoxia of the eye.²⁰ This led directly to the development of soft contact lenses that were intended for more frequent replacement.

Daily-wear soft lenses are worn for 1 day and then discarded. These lenses offer several advantages over GPs: they require a short adaptation period and they are convenient for active lifestyles. These lenses are also available in tints for patients who desire superficial cosmetic changes to eye color.¹⁵ Daily disposable contact lenses are individually packaged so they are sterile prior to insertion into the eye, which is why there are no cleaning requirements. Further, the lenses are replaced daily, so deposit formation is reduced and risks are minimized. Eye practitioners were hopeful that this would help encourage patient adherence and decrease the complications related to contact lens wear. However, while daily-wear contact lens have reduced the incidence of hypoxic effects, infection and inflammation related to contact lens wear still occur as a result of improper hand hygiene or disposal of contact lenses, sensitivities and skin microbes.²¹

Extended-wear disposable soft lenses offer another option to patients. These contact lenses can be worn continuously day and night for 1 to 6 days, and they are discarded on the seventh day. Contacts made from certain materials that allow more oxygen permeability earned approval for up to 30 nights of continuous wear. Advantages of such extended-wear soft lenses include little to no cleaning, and reduced risk of eye infection if proper wearing instructions are followed.¹⁵ Disadvantages of extended-wear soft lenses are that the vision may not be as sharp as it might be with GPs and they cannot correct all vision problems. Though risk of infection is reduced if worn appropriately, when infections do occur, the risk for the most devastating consequences, such as vision loss, are present.²¹

Since none of the soft contact lenses on the market eliminate the risk of complications related to inflammation or infection, patient education regarding care regimens is critical for all patients using these types of lenses. Another disadvantage is that the eye practitioner chooses from among predetermined contact lens parameters, unlike the GPs, which are custom fit for each patient. If the soft contact lens does not fit properly, the patient is at an increased risk for infections.¹⁵

Soft contact lenses have other unique uses aside from vision correction. For example, hydrophilic lenses can be used as bandages that protect the cornea and promote corneal re-epithelialization after injury to the cornea.²² Not all hydrophilic lenses carry this indication, so it is important that eye practitioners note the 4 that do have this indication. Pharmacists should spend time with patients who are using these bandage lenses to educate them on the importance of cleaning and disinfecting the lenses.²¹

Other types of contact lenses

In addition to hard and soft lenses, there are 4 special lens types: hybrid, orthokeratology (ortho-k), scleral, and decorative.¹⁹ Hybrid contact lenses have a rigid gas-permeable center with an "outer skirt" of soft contact lens material. The center provides the visual acuity of a GP lens and the outside allows for comfort and increases the likelihood that the contact will stay centered on the eye. The increased cost and intriquite fitting process limit their use. Ortho-k lenses are a specifically designed hard contact lenses that change the shape of the cornea for patients who are nearsighted. Unlike other contact lenses, these are primarily used when the patient sleeps and then the lens is removed in the morning. Scleral lenses are a larger form of GPs that fit on top of the sclera, not the cornea, to collect fluid and protect the cornea from damage.²³ Decorative lenses are primarily used to change and/or enhance the color of a person's eyes. Though decorative lenses do not correct vision, they still require a prescription from an eye practitioner.

RISKS ASSOCIATED WITH THE USE OF CONTACT LENSES

Roughly half of contact wearers have or will experience some sort of complication associated with contact lens use. An estimated one-third of contact-related complications result in physician visits.¹ Type of lens, wearing schedule, and adherence to a care regimen affect the type and number of complications patients experience.⁹ For example, soft contact lenses tend to have more complications due to the long hours of consistent wearing and GP complications tend to be related to an improperly fit lens.

The health care team can take precautions to prevent contact lens-related complications, including proper fitting and correct prescribing, as well as explaining care regimens. Estimates suggest that between 40% and 90% of patients who wear contact lenses do not properly adhere to care regimens.^23,24 Pharmacists can counsel patients on appropriate care regimens and they can teach preventative measures that target patient hygiene and appropriate contact lens wear. Pharmacists should encourage patients to adhere to the recommended lens-replacement frequency to minimize risks.

Patients who wear contact lenses often experience dry eyes. In fact, dry eyes are the most frequent reason a patient discontinues wearing contact lenses. Treatments for dry eyes include artificial tears, lubricating eye drops before and after contact lens wear, and management of blepharitis (inflammation of the eyelid).²⁵ In addition, the pharmacist could recommend switching contact solutions and/or suggest the patient return to the eye practitioner for refitting of a contact lens and/or consideration of a lens with higher oxygen permeability.

The primary risks of wearing contact lenses include infections and corneal issues.²⁶ In 2015, the Morbidity and Mortality Weekly Report highlighted the incidence of infections from 2005 to 2015 in 1075 contact wearers: 19.8% of patients experienced corneal scars, decreased vision and/or corneal transplant surgery; 25.1% discussed risk factors for corneal infections; and 10% had adverse events that necessitated immediate care.¹

Infections

When people wear contact lenses, the risks for several infections increase. The risk of an infection for patients using contact lenses is directly related to improper care and use of the lens.²⁶ Wearing lenses for an extended time period, sleeping in contact lenses, improperly cleaning and disinfecting lenses, and not maintaining the cleanliness of the contact case may lead to infections.²⁶ If a patient experiences a contact lens infection, he or she might complain of visual changes such as blurry vision or light sensitivity. Contact lens wearers are especially susceptible to infections from Gram-negative Pseudomonas aeruginosa and Gram-positive Staphylococcus aureus and Staphylococcus epidermidis.²⁷ Keratitis (an inflammation of the cornea) is also a result of improper lens use that results in 1 million physician visits and a $175 million cost burden to the health care system.²⁸ An inflammation of the cornea can also be caused by improper care of the contact lens.

The management of corneal ulcers and infections can be accomplished through empiric treatment, but a culture may be collected to guide narrow-spectrum care. Often, the treatment selection is based on the severity of the eye infection.²⁷ Empiric treatment is typically in the form of antibiotic eye drops. If a pharmacist is dispensing antibiotic eye drops for a patient, the pharmacist should counsel the patient on the proper use of the eye drops in relation to the contacts. (This is discussed further in the "Counseling" section.)

Microbial keratitis (MK) is considered the worst-case scenario for contact lens complications and can lead to blindness or necessitate a corneal transplant.²⁹ Severe and rare cornea infections include Acanthamoeba keratitis, which is caused by a single-cell amoeba, and Fusarium keratitis, which is caused by a fungal infection.¹ Typically, a person with MK presents with blurred vision, redness, pain, light sensitivity, and watering that worsens even after lens wear is discontinued.²⁷ A pharmacist should promptly refer a person for specialty ophthalmologic care if a white infiltrate is visible on the cornea.

Other complications of contact lens wear

Other complications related to contact lenses typically result in asymptomatic presentation or mild symptoms.³⁰ These complications include allergies, giant papillary conjunctivitis, corneal abrasion, contact lens-induced acute red eye, corneal infiltrates, and neovascularization.³¹ If symptoms of these complications do not resolve once the contact lens is removed, it is important that the patient be referred to an eye practitioner. Symptoms of serious complications include irritation, worsening pain, light sensitivity, blurry vision, or a watery discharge from the eyes.

TYPES OF CONTACT LENS SOLUTIONS

The FDA recommends that patients who use soft contact lenses disinfect the lenses with solution prior to reinsertion.³² Contact lens solution should be formulated with specified pH, viscosity, and isotonicity with tears, as well as stability and provisions for maintaining sterility.³³ The normal pH of a tear is approximately 7.4, with a range from 6.5 to 7.6^34,35; a weakly buffered solution should adjust to any tear pH to minimize discomfort with use of the solution. Solution stability is also an important factor. Preservatives can improve the stability of a solution and several examples of preservatives used in soft lens disinfection solutions are listed in Table 2.³³ Since each type of contact solution is formulated with a unique buffer and pH system, solutions from different manufacturers should not be mixed together because a precipitate may form.³⁶ Often, patients who experience an allergic reaction related to contact lens wear are not allergic to a specific lens but rather to a solution or ingredient within the solution. If a patient uses RGP lenses, they should utilize products specifically labeled for RGP use as they vary in viscosity, wetting agent and preservatives.³³

Table 2: Preservatives Used in Contact Lens and Eye Care Solutions33
Ingredient	Common uses
Edetate disodium and sorbic acid	Saline solutions, daily cleaners, wetting drops
Benzalkonium chloride	Disinfecting agents for soft contact lens solutions: effective against certain bacteria, fungi, and yeast
Polyhexamethylene biguanide	Disinfecting agents for soft contact lens solutions: effective against certain bacteria and yeast

Other products that patients may inquire about include surface-active cleaning solutions, enzymatic cleaning products, preservative-free saline products, saline solutions, rewetting solutions, and generic solutions. Surface-active cleaning solutions are more effective in removing lipid deposits and enzymatic cleaners are more effective in removing protein debris; however, for the enzyme cleaner to be effective, the pharmacist should counsel the patient to utilize the surface-active cleaner first.³³ Since contact solutions need to remain hydrated with a solution isotonic to tears, isotonic normal saline is an optional method of rinsing, thermally disinfecting and storing soft contact lenses.³³ Saline solution is offered in a preservative free formulation for patients who have preservative sensitivities. Rewetting solutions offer patients an option for on-the-eye cleaning, which improves lens comfort. These agents may be a good option for patients who utilize highly hydrated lenses (i.e.: continuous-wear contact lenses), when patients are in windy areas or higher temperatures that may dehydrate the contact lens.³³

It is important to note that soft lens care and GP lens care products are not interchangeable.³³ Pharmacists should pay attention to the type of lenses patients wear when helping to select cleaning agents and solutions for patients to use with their lenses. The eye care practitioner should always be consulted if there are any concerns regarding proper care of a patient's lenses. A comparison of the care processes for soft and GP lenses is provided in Table 3.³³

Table 3: Lens Care for Soft and Hard Lenses33
Soft lens care	Hard lens care
Wash hands Remove lens from eye Clean with surface-active cleaner or multipurpose solution Rub the lens between the forefinger and palm of opposite hand (even if a no-rub product) Clean weekly with an enzymatic cleaner(This step may be skipped if the lens is a planned replacement or disposable lens) Disinfect lens with chemical or peroxide disinfection Rinse with saline (optional) Insert lens Rewet lens if needed	Wash hands Remove lens from eye Clean lens with surface-active cleaner Rub the lens between the forefinger and palm of opposite hand Clean weekly with an enzymatic cleaner Soak and/or condition/store lens Wet lens Insert lens Rewet lens if needed

Multipurpose solutions

The process of caring for contact lenses involves solutions for cleaning, rinsing, disinfecting, storing, and removing protein deposits. Multipurpose solutions combine active ingredients from each of these steps in a biocompatible solution that can directly contact the eye. These solutions have the goal of improving patient adherence to contact lens care.³³ A concern with multipurpose solutions is the incompatibility of the purposes of the ingredients (e.g., cleaning, removal of protein, and disinfection of lens). For example, if the multipurpose solution adequately kills bacteria with preservatives, this may result in ocular discomfort due to the preservatives. Pharmacists should be aware of the chemicals included in the multipurpose solution, and if a patient complains of irritation, the pharmacist can recommend an alternative product.³⁷

Certain multipurpose solutions market themselves as "no rub" products, but this is an important area that pharmacists should address with patients. The typical sequence for cleaning a contact lens (discussed in the "Use of Various Contact Lens Solutions" section) is rub, rinse, then soak. Though the multipurpose solution may be marketed as "no rub," it still requires rinsing. However, the FDA, the American Academy of Ophthalmology, the American Optometric Association, and the American Academy of Optometry agree that "rubbing" should still be completed during routine lens care, regardless of what solution is used.³⁸ These organizations recommend rubbing each side of the contact lens for at least 5 to 10 seconds. Multipurpose solutions are most useful for patients with planned replacement lenses, since the lesnes will be discarded prior to significant protein/lipid buildup on the lens.³³

Generic versions of brand-name multipurpose solutions are available, but they may be obsolete formulations. For example, as contact lens solutions evolve to improve the integrity of the contact lenses while minimizing irritation, the formulation ratios of products may change. It is important to utilize the proper formulation with the specific contact lens that was prescribed by the practitioner. This is another area of opportunity for pharmacists to educate patients. Generics may not be the same formulations as brand name alternatives, so if a patient is interested in a generic product, the ingredients and compositions should be carefully considered and compared to the recommended brand-name multipurpose solution and lens care regimen.³³

Hydrogen peroxide solutions

Hydrogen peroxide solutions can be used for patients with soft contact lenses who have a sensitivity to the preservatives found in multipurpose solutions since hydrogen peroxide is preservative free.³⁹ Hydrogen peroxide solutions require an extra neutralization step and may require storage for up to 6 hours before wear.⁴⁰ Table 4 highlights key advantages and disadvantages of multipurpose solutions and hydrogen peroxide solutions.

Table 4: Advantages and Disadvantages of Contact Lens Solutions33,37,39
Solution	Advantages	Disadvantages
Multipurpose solution	Convenient33 Improves adherence to contact lens care33 Available in a single bottle39 Readily available33	Ingredients for optimal performance may not be compatible37 Contain preservatives33
Hydrogen peroxide	Preservative free39	Requires a neutralizer 39 Never used directly on eyes or lens39 Difficult for travel33 Eye irritation can occur if solution contacts the eye directly39
Saline	Available with or without preservatives33 Option for rinsing contact lenses after cleaning33 May loosen debris on lenses33	Not a standalone cleaning/disinfecting process (require heat, chemicals or hydrogen peroxide as prescribed by eye care practitioner) 33

USE OF VARIOUS CONTACT LENS SOLUTIONS

The FDA highlights "Dos and Don'ts for Contact Lens Wearers."³² General principles of care are listed in Table 5.

Table 5: Dos and Don'ts for Contact Lens31
DO:	DO NOT:
Always wash hands prior to handling the contact lens Remove contact lens if you notice any complications Use the appropriate contact lens solution and follow the directions listed on the bottle Discard leftover contact lens solution in the contact case after each use Use appropriate care techniques every time the contact lens is removed Replace contact lens storage case every 3 to 6 months	Do not use contact solutions beyond the expiration/discard date Do not "top off" solutions in the case Do not allow your contacts to come into contact with tap, bottled, or distilled water or lake or ocean water (due to an increased risk of Acanthamoeba keratitis) Do not use saliva to wet contact lenses Do not transfer contact lens solutions into smaller travel size containers

Procedure for using multipurpose products

Multipurpose contact solutions are the most commonly used lens care solutions, since they are available as convenient, "all-in-one" products. Multipurpose contact solutions can be used to rinse, clean, disinfect, and store lenses during the the night.⁴¹ The "rub and rinse" method should be adapted for multipurpose solutions, even with no-rub products. The process starts with the patient washing his or her hands. The lens is placed on the palm of the hand and solution is poured on the lens. The first step is to rub the lens: the patient should use the index finger of the opposite hand to rub the solution over the contact surface lens for 5 to 10 seconds. This process should be repeated on the other side of the lens. The second step is to rinse the lens: a strong stream of the multipurpose solution is sprayed over both sides of the lens to remove any additional debris. Completing both the rinse and rub steps contributes to better hygiene.³²

Procedure for using hydrogen peroxide products

Hydrogen peroxide solutions should not be used directly on the eyes because the solution can cause stinging, burning, and temporary corneal damage. To use hydrogen peroxide products, a neutralizer must be added to the solution to turn the peroxide into water and oxygen, making the solution safe for putting the lens back into the eye.⁴⁰ The neutralization process is either a 1-step or 2-step process. The 1-step process neutralizes the lenses during the disinfecting stage and the 2-step process neutralizes the lenses after the disinfecting stage. It is important that a patient not change disinfecting methods without consulting his or her eye practitioner.

When using hydrogen peroxide products, it is important to use the lens case that comes with the product. Each time a new bottle is purchased, the patient should also use the new case; old cases should never be reused. The contacts must be in the solution for a minimum of 6 hours to allow the neutralizing process to finish. Hydrogen peroxide solutions have a red cap as a safety feature to remind people that this should never be used to rinse the lenses and never used directly in the eyes.⁴⁰

MEDICATION USE WITH CONTACT LENS WEAR

Both prescription and over-the-counter medications have the potential to change tear film composition and production, lens color, tonicity, lid and/or corneal edema, refractivity, and pupil size. Pharmacists should be familiar with medicines that can affect contact lens use³³ and should educate patients who are taking these medications. Table 6 lists medicines that have the potential to interfere with contact lens use.⁴²

Table 6: Medicines that May Affect Contact Lens Use*42
Medication class	Effect	Recommendation
Systemic medications
Estrogens (e.g., Premarin)	Dry eyes, corneal sensitivity	Use a preservative-free lubricant; use a lens with  higher gas diffusion and solubility
Antihistamines (e.g., loratadine, ranitidine)	Dry eyes resulting from reduced lacrimal secretion and decreased volume of precorneal tear film	Use ocular lubricants
Beta-blockers	Dry eyes	Use ocular lubricants beginning at the point-of-dispensing of a beta-blocker
Psychotropic medications (e.g., benzodiazepines [alprazolam]; selective serotonin reuptake inhibitors [fluoxetine, sertraline])	Dry eyes and reduced contact lens tolerance	Use ocular lubricants
Anti-cholesterol medications (e.g., atorvastatin)	Dry eyes, blurred vision (typically in beginning of treatment)	Ocular lubricants and occasional punctual occlusion
Medications that cause lens discoloration (primarily in soft lenses)
Phenazopyridine +/- nitrofurantoin	Orange-colored soft lenses	Counsel patients, consider not wearing lenses during treatment period
Tetracycline	Grayish-brown lens discoloration	Counsel patients, consider not wearing lenses during treatment period
Rifampin	Pink-colored tears, orange-colored soft lenses	Counsel patients, consider not wearing lenses during treatment period
*Not an all-inclusive list

Topical medications

Pharmacists should counsel patients to avoid using any ophthalmic solution, suspension, gel, or ointment in the eye while the contact lens is in place.³³ Soft lenses, in particular, have a tendency to absorb compounds from topically administered products in the eye that may damage the lens.⁴² The only exception to this rule is rewetting agents that are described above. When a patient requires a nonpharmacologic ophthalmic solution, the pharmacist should carefully review the medication labels and instructions and counsel the patient to wait a certain time frame (typically 5 to 15 minutes depending on the product) before reinserting the contact lens.³² If the patient uses a topical ointment, gel, or suspension, the pharmacist should recommend that the contact lens not be worn until the eye care practitioner can be consulted about how much time should elapse before inserting the contact lens after the topical product is instilled.

COUNSELING

It is crucial for pharmacists to educate patients on proper care and handling of contact lenses, as well as methods for minimizing the risk of infection. The American Academy of Ophthalmology recommends 6 steps to avoid contact lens complications: rub, rinse, replace, rest, renew, reserve.⁴³ After the "rub and rinse" steps previously discussed, "replace" stresses the importance of replacing the contact lenses with adherence to the recommended timeframe: disposing contact lenses daily for the daily wear, on the seventh day for weekly disposables (or every 2 weeks for the 2-week disposables and monthly for the monthy continuous wear) or at least 3 times a year for other extended-wear contact lenses. "Rest" involves a period of not wearing contact lenses: resting eyes from contact lens wear improves eye health, and sleeping in contact lenses increases the risk for infection. "Renew" reminds patients of the importance of getting new contact lenses as at the recommended frequency depending on the type of lens. Finally, pharmacists should encourage patients to "reserve" and keep regular appointments with eye care practitioners.⁴³

Handling of contact lenses

The care of contact lenses depends on if it is a soft lens or a GP lens. For care of both types of lenses, patients must understand the importance of washing hands with soap and water. Patients should remove lenses before swimming or going in a hot tub. Contact lenses should never come into contact with tap or even sterilized water. Rewetting and saline solutions are inappropriate for disinfecting lenses. Contact lenses should never come in contact with saliva, since it is not sterile. Pharmacists should encourage patients to carefully follow the scheduled routine for replacing contacts. The contact lens case should be replaced at least every 3 months.⁴⁴ Additionally, patients should never "top-off" the solution in a lens case or transfer solution into smaller travel-size containers. The lenses should be discarded by the expiration date or discard date.⁴⁴

Prevention of eye infections

The single best way to decrease the risk of infections related to contact lens wear is to follow the appropriate care routines prescribed by the eye practitioner.⁴⁴ Using appropriate solutions can minimize contact lens-related complications. Product selection should be based on whether or not the lenses are soft or GP lenses. Pharmacists should educate patients on the importance of using high-quality products to achieve positive outcomes with contact lens wear. Pharmacists should be prepared to compare ingredient lists on contact lens solutions to ensure a high-quality product for the patient. In addition, pharmacists should ask patients about their contact lens care routines to ensure optimal adherence.

CONCLUSION

Similar to medications, contact lenses are not "one size fits all." A patient must receive a prescription for contact lenses from an eye care practitioner, but the lenses can be purchased at an optical retailer, from an internet source, or at a retail pharmacy. The risk of infection for patients using contact lenses is high if the lenses are not handled, worn, or cared for appropriately. Therefore, an important role of pharmacists is counseling patients on proper care of contact lenses and selection of contact lens solution. Product selection for eye care products is essential to minimize infection risk, to decrease the risk of negative outcomes, and to favor vision and eye health.³³

REFERENCES

1. Cope JR, Collier SA, Rao MM, et al. Contact lens wearer demographics and risk behaviors for contact lens-related eye infections--United States, 2014. MMWR Morb Mortal Wkly Rep. 2015; 64(32):865-870.
2. Contact lenses vs. eyeglasses: which are best for you? All About Vision website. http://www.allaboutvision.com/contacts/faq/contacts-vs-glasses.htm. Updated April 25, 2017. Accessed May 18, 2017.
3. Pesudovs K, Garamendi E, Elliott DB. A quality of life comparison of people wearing spectacles or contact lenses or having undergone refractive surgery. J Refract Surg. 2006;22(1):19-27.
4. Nichols JJ. Contact lenses 2016. Contact Lens Spectrum. http://www.clspectrum.com/issues/2017/january/contact-lenses-2016. Published January 1, 2017. Accessed April 19, 2017.
5. Laurent JM, Li Y. Optimizing lens wear in cases of pre-existing ocular conditions. Contact Lens Spectrum. http://www.clspectrum.com/issues/2013/december-2013/optimizing-lens-wear-in-cases-of-pre-existing-ocul. Published December 1, 2013. Accessed June 1, 2017.
6. FTC issues final rule implementing Fairness to Contact Lens Consumers Act. Federal Trade Commission. www.ftc.gov/opa/2004/06/contactlens.htm. Published June 29, 2004. Accessed May 18, 2017.
7. Fogel J, Zidile C. Contact lenses purchased over the internet place individuals at risk for harmful eye care practices. Optometry. 2008;79(1):23-25.
8. Chalmers RL, Wagner H, Kinoshita OD, et al. Cont Lens Anterior Eye. 2016;39(6):435-441.
9. Forister JFY, Forister EF, Yeung KK et al. Prevalence of contact lens-related complications: UCLA contact lens study. Eye Contact Lens. 2009;35(4):176-180.
10. Wu Y, Carnt N, Stapleton F. Contact lens user profile, attitudes, and level of compliance to lens care. Cont Lens Anterior Eye. 2010;33(4):183-188.
11. Pharmacists as influencers of patient adherence. Pharmacy Times. http://www.pharmacytimes.com/publications/directions-in-pharmacy/2014/august2014/pharmacists-as-influencers-of-patient-adherence-. Published August 21, 2014. Accessed May 22, 2017.
12. Manolakis PG, Skelton JB. Pharmacists' contributions to primary care in the United States collaborating to address unmet patient care needs: the emerging role for pharmacists to address the shortage of primary care providers. Am J Pharm Educ. 2010;74(10):S7.
13. Boyd K. Contact lens types. American Academy of Ophthalmology website. https://www.aao.org/eye-health/glasses-contacts/contact-lens-types. Published March 1, 2016. Accessed May 22, 2017.
14. Device classification. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm. Updated June 19, 2017. Accessed June 24, 2017.
15. Advantages and disadvantages of various types of contact lenses. American Optometric Association. http://www.aoa.org/patients-and-public/caring-for-your-vision/contact-lenses/advantages-and-disadvantages-of-various-types-of-contact-lenses?sso=y. Accessed May 18, 2017.
16. Lipson MJ, Sugar A, Musch DC. Overnight corneal reshaping versus soft disposable contact lenses: vision-related quality-of-life differences from a randomized clinical trial. Optom Vis Sci. 2005; 82(10):886-891.
17. Jupiter DG, Katz HR. Management of irregular astigmatism with rigid gas permeable contact lenses. CLAO J. 2000;26(1):14-17.
18. Types of contact lenses. U.S. Food and Drug Administration. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts
    /ContactLenses/ucm062319.htm. Updated September 3, 2015. Accessed May 18, 2017.
19. Contact lens types. Centers for Disease Control and Prevention. https://www.cdc.gov/contactlenses/fast-facts.html. Updated July 23, 2015. Accessed May 18, 2017.
20. Jones L. Modern contact lens materials: a clinical performance update. Contact Lens Spectrum. Available at: http://www.clspectrum.com/issues/2002/september-2002/modern-contact-lens-materials-a-clinical-performa. Published September 1, 2002. Accessed May 18, 2017.
21. Soft lens material choices and selection. Contact Lens Spectrum. http://www.clspectrum.com/issues/2012/may-2012/soft-lens-material-choices-and-selection. Published May 1, 2012. Accessed May 20, 2017.
22. Therapeutic applications of contact lenses. Contact Lens Spectrum. http://www.clspectrum.com/issues/2010/may-2010/therapeutic-applications-of-contact-lenses. Published May 1, 2010. Accessed May 20, 2017.
23. van der Worp E, Bornman D, Ferreira DL, et al. Modern scleral contact lenses: a review. Cont Lens Anterior Eye. 2014; 37(4):240-250.
24. Bui TH, Cavanagh HD, Robertson DM. Patient compliance during contact lens wear: perceptions, awareness, and behavior. Eye Contact Lens. 2010;36(6):334-339.
25. McDonald M, Schachet JL, Lievens CW, Kern JR. Systane® Ultra lubricant eye drops for treatment of contact lens-related dryness. Eye Contact Lens. 2014; 40(2):106-110.
26. Contact lens-related eye infections. American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/contact-lens-related-eye-infections. Published March 1, 2017. Accessed May 20, 2017.
27. Optometric clinical practice guideline: care of the contact lens patient. American Optometric Academy. https://www.aoa.org/documents/optometrists/CPG-19.pdf. Updated June 2006. Accessed May 18, 2017.
28. Collier SA, Gronostaj MP, MacGurn AK, et al.; Centers for Disease Control and Prevention. Estimated burden of keratitis--United States, 2010. MMWR Morb Mortal Wkly Rep. 2014;63(45):1027-1030.
29. Stapleton F, Edwards K, Keay L, et al. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology. 2012;119(8):1516-1521.
30. Chalmers RL, Keay L, Long B, et al. Risk factors for contact lens complications in US clinical practices. Optom Vis Sci. 2010;87(10):725-735.
31. Other complications. Centers for Disease Control and Prevention. https://www.cdc.gov/contactlenses/other-complications.html. Updated March 14, 2014. Accessed May 18, 2017.
32. Ensuring safe use of contact lens solution. U.S. Food and Drug Administration. www.fda.gov/forconsumers/consumerupdates/ucm164197.htm. Published June 16, 2009. Accessed June 1, 2017.
33. Krinsky DL, Ferreri SP, Hemstreet BA, et al., eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-care. 18th ed. Washington, D.C.: American Pharmacists Association; 2015.
34. Norn MS. Human tear pH. Arch Ophthalmol. 1977;95(1):170.
35. Abelson MB, Udell IJ, Weston JH. Normal human tear pH by direct measurement. Arch Ophthalmol. 1981;99(2):301.
36. Mayers M. The dangers of mixing solutions. Review of Cornea & Contact Lenses. http://www.reviewofcontactlenses.com/content/c/26326/. Published January 24, 2011. Accessed May 20, 2017.
37. Bowling EL. Laying the groundwork for successful lens wear. Contact Lens Spectrum. http://www.clspectrum.com/issues/2011/june-2011/laying-the-groundwork-for-successful-lens-wear. Published June 1, 2011. Accessed June 1, 2017.
38. FDA letter to firms with marketing clearance for no rub multipurpose contact lens solutions. U.S. Food and Drug Administration. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/
    ContactLenses/ucm154976.htm. Published May 19, 2009. Accessed June 1, 2017.
39. Contact lens solutions and products. U.S. Food and Drug Administration. http://www.fda.gov/medicaldevices/productsandmedicalprocedures/homehealthandconsumer/consumerproducts/
    contactlenses/ucm062584.htm. Updated September 24, 2015. Accessed May 18, 2017.
40. Hydrogen peroxide solution. U.S. Food and Drug Administration. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/
    ContactLenses/ucm482480.htm. Updated April 6, 2016. Accessed May 18, 2017.
41. Koffler BH, Karpecki PM. Positive aspects of the use of multipurpose disinfection solutions. Arch Ophthalmol. 2009; 127(11):1540-1543.
42. Silbert JA. Medications and contact lens wear. Contact Lens Spectrum. http://www.clspectrum.com/issues/2002/may-2002/medications-and-contact-lens-wear. Published May 1, 2002. Accessed May 18, 2017.
43. Boyd K. 6 steps to avoid contact lens infections. American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/6-steps-to-avoid-contact-lens-infections. Published March 1, 2017. Accessed May 18, 2017.
44. Proper care of contact lenses. American Academy of Ophthalmology. https://www.aao.org/eye-health/glasses-contacts/contact-lens-care. Published March 1, 2016. Accessed May 18, 2017.

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