To rub or not to rub? – effective rigid contact lens cleaning

Abstract

Purpose To compare the efficacy of cleaning of rigid contact lenses using two care solutions with and without rubbing. Methods A masked randomised trial was conducted. The cleaning efficacy of two solutions recommended for rigid contact lenses, a one‐step hydrogen peroxide solution (HP) and a povidone iodine‐based solution (PI), were evaluated on 64 unworn orthokeratology (ortho‐k) lenses subsequent to cleaning with rubbing (R) with a surfactant cleaner or without rubbing (NR). Either mascara or hand cream was applied as a contaminant to the lenses to simulate stubborn and loosely bounded deposits, respectively. For each type of deposit, the lenses were randomly assigned to four cleaning treatments: R with HP, NR with HP, R with PI, and NR with PI (n = 8 for each group). Each lens surface was assessed on site by a masked examiner under a low‐magnification slit‐lamp and with photo‐documentation. Lenses were graded according to the deposit coverage area using a pre‐set five‐point scale [0 (<20% coverage) − 4 (>80% coverage)]. Results For stubborn deposits (mascara), NR failed to remove deposits from 94% of lenses, whilst R removed more than 80% of deposits from 63% of the lenses. For oily deposits, 25% of NR lenses had >80% coverage, whilst only one R lens had 60–80% coverage, with 19% having 40–60% coverage, and 38% with either 20–40% or <20%. Rubbing improved lens cleanliness for both types of deposits, but only reached statistical significance for the stubborn deposit group. There were no significant differences between the solutions. Conclusion Not Rubbing and using either HP or PI solutions, is not effective in removing stubborn deposits from ortho‐k lenses. It is essential to rub lenses when cleaning rigid lenses to ensure optimal lens hygiene for ocular health, especially as rigid gas permeable (RGP) lenses are intended to be reused for at least a year before replacement. Rubbing with a daily cleaner should be included in the instructions for use of the solutions tested for rigid lenses and practitioners should be encouraged to emphasise the importance of rubbing in lens care.

BCLA CLEAR - Contact lens wettability, cleaning, disinfection and interactions with tears

“…Despite the availability of many MPDS for use with either reusable soft or rigid corneal lenses being approved as 'no-rub' care regimens, studies demonstrate the additional benefit of rubbing lenses [332,381,382]. Furthermore, good lens hygiene and compliance, including proper cleaning and disinfection and maintenance of cases for lens storage, and diligence with wearing and replacement schedules, are essential in minimizing the risk of ocular complications [262,263,276].…”

Contact lens wear and care in Spain during the COVID-19 pandemic

“…Jones et al [5] indicated that in principle the presence of surfactants in multi-purpose solutions together with rubbing/rinsing steps are likely to be effective against SARS-CoV-2 but further work in this area is required. While a recent review suggested (with no cited evidence) that no rubbing/rinsing is required prior to lens disinfection when using hydrogen peroxide solutions [19], the cleanliness (which is linked to comfort and risk of infection) of RGP and soft lenses soaked in multi-purpose or hydrogen peroxide solution is better after rubbing and rinsing [20][21][22][23]. The survey data showed that 55% of the respondents rubbed their lenses prior to soaking with hydrogen peroxide solution.…”

BCLA CLEAR - Orthokeratology

“…The varying chemicals in MPS work to provide different essential steps in successful rigid corneal lens wear, and the contents of these care systems continue to be regularly updated and improved by manufacturers to provide convenience and efficient disinfection, leading to a wide range of formulations available for contact lens wearers. It is advised that patients receive thorough training in contact lens care, with emphasis on the importance of daily rubbing and rinsing to remove stubborn lens deposits [172]. They should also be cautioned about the cytotoxicity of some MPS constituents, such as chlorohexidine gluconate, which may not be advisable to apply directly to the cornea [171].…”

“…Hydrogen peroxide has also shown good efficacy against lens case-based biofilm formation for bacteria [190,191]. Overall, peroxide-based systems can be a good choice for ortho-k patients [192], particularly those who present with sensitivities to components within MPS, although a rubbing step with a daily cleaner, and rinsing with saline is still recommended as part of the care regime [172].…”