If you’re one of 140 million worldwide contact lens wearers, you likely know how dangerous water can be when handling contact lenses. But do you know why?
In The Eye & Ear Foundation’s October 20, 2021, webinar, Contact Lens Safety: Benefits of New Technology, Ellen Butts, OD, Clinical Assistant Professor of Ophthalmology, Department of Ophthalmology, University of Pittsburgh and Scott Drexler, OD, Assistant Professor of Ophthalmology, Contact Lens and Vision Enhancement Service, University of Pittsburgh School of Medicine shared the answer and provided other contact lens safety tips.
It is essential to take care of your contact lenses and practice healthy contact lens habits in order to reduce risk of infection. There are about 2 to 20 cases of infection per 10,000 wearers a year. And some infections are resistant to virtually all antibiotics.
Best Practices for Contact Lens Wear 
To avoid possibility of infection, the single most important thing you can do is wash your hands. Do not forget to dry your hands when you are done!
Think of your contact lens case as your own personal petri dish, Dr. Drexler said. “You really have to make sure you clean it, and daily,” he added. “Everything should be dry.”
Water carries microbes that increase risk of eye infections, which is why it is necessary to be careful with your lenses. And while there are some FDA-approved contacts for sleeping, Dr. Butts said you are welcoming infection if you sleep with your contact lens. “We say skip [the overnight wear], just be safe, take them out,” she said. “It will drastically reduce your chances of getting an infection or serious complications from lack of oxygen reaching the cornea.”
If you are not feeling well, skip the contacts. Anything on your hands gets transmitted to the eye, so you would just be increasing your risk of infection.
Here is a handy list of the best practices for contact lens wear:
- Wash your hands!
- Clean your contact lens case daily
- Replace your case every 1-3 months
- Replace solution in case every day
- Rinse your case with solution & air-dry upside down
- NO water! (Tap, bottled, distilled, lake, ocean, saliva)
- Replace your lenses as scheduled
- Do not wear contacts while sleeping
- Don’t wear contacts when you are ill!
Life with Contact Lenses
Drs. Butts and Drexler are big proponents of daily disposable lenses, as many of the issues covered above are addressed. Regardless of what kind of lenses you use, have a pair of back up glasses. They “don’t have to be a thing of beauty,” Dr. Drexler said. “They just have to be functional.”
Other tips:
- Caution when swimming, showering, and hot tubs
- Rub your contact lens gently with your fingertips before insertion
- Use the right solutions: Multipurpose vs hydrogen peroxide (the latter is better if you have allergies)
- RGP lenses: have two pairs and rotate
- Recycle contact lenses and packaging: Bausch & Lomb One by One program or TerraCycle
Signs of an Eye Problem
Contact lens wearing should not be a painful experience. If you put your lens in and feel discomfort, that is a sign that something isn’t right. Other signs of an eye problem include:
- Excessive tearing
- Light sensitivity
- Burning
- Redness
- Blurred vision
- Swelling
- Pain
Contact Lens Case Contamination
As important as it is to take care of your contact lenses, keeping the case clean is just as important. Biofilms can begin to form in about a week. The doctors recommend using the cases that come with your contact lens solution. Some tips on keeping your contact lens case clean include:
- Clean and disinfect daily (use contact lens solution NOT tap water)
- Dry upside down
- NEW solution each day
- Replace every 1-3 months
Drinking Water
To emphasize the importance of not letting water get near contact lens, the doctors revisited the topic of drinking water. It is safe to drink, but not safe for your eyes.
A rare but serious corneal infection called acanthamoeba keratitis, or AK, can lead to permanent vision loss or blindness. It occurs when the organism enters through small abrasions or scrapes on the eye surface. These scrapes are more common in contact lens wearers. Eighty five percent of patients who contract AK are contact lens wearers. Of those 85 percent, over 80% are soft contact lens wearers.
Rest assured that the acanthamoeba organism must have direct contact with the eye surface to cause AK. You can’t contract it from drinking or inhaling water with the amoeba, nor can it be spread from person to person.
Microbial Keratitis
Bacterial insult is the most common cause of contact lens-related infection. Damage to the corneal epithelium, the first layer of the cornea, is the main reason contact lens wearers are more susceptible to microbial keratitis: hypoxia, mechanical movement of the contact lens, or release of multipurpose solution from the contact lens matrix can all cause damage to the corneal epithelium.
Hypoxia and Overnight Wear
Corneas get oxygen from the air when your eyes are open. When your eyes are closed, they get oxygen from the blood vessels inside the eyelid. During contact lens wear, oxygen reaches the cornea through tear circulation and transmission through the contacts. During sleep, tear circulation is minimal. Hypoxia can lead to numerous, sometimes irreversible complications like an increased risk of ulcers or abrasions, corneal swelling, new blood vessel growth, or increased inflammation.
Dr. Drexler said that 10-20 percent of his patients referred by the corneal department had damage from their contact lens.
Contacts and Cosmetics: Tips for Better Comfort, Vision and Safety
If you want to wear contact lens and eye makeup, Dr. Butts offered some tips for better comfort, vision and safety:
- Always insert lenses with clean hands prior to applying makeup or moisturizers
- Water-based creams
- Eyeshadow? Start with primer
- Eyeliner? Avoid the “waterline. This is where our meibomian glands open to support our tear film with healthy lipids. If this area is covered, you are at risk for discomfort, styes, and infections
- Avoid fiber mascaras!
- Replace eye makeup every 3 months!
- Remove CL prior to removing makeup
- Oil-free makeup removers
There are many cosmetic brands that are safe for contacts, like Almay, Clinique, Estee Lauder, Neutrogena, and Physicians Formula. Dr. Butts said to feel free to contact her for specific product recommendations.
Biofilms: Getting to the Root of the Problem
Biofilms are surface attached communities of microorganisms that like to attack. They usually form on abiotic surfaces like contact lens or a contact lens case, but weak spots in the corneal epithelium are also a target. Not all biofilms are bad, and the healthy eye has a natural microbiome with bacteria, viruses, and fungi.
Bacteria in biofilms are commonly 1,000 times more tolerant to antibiotics than planktonic bacteria, which leads to antibiotic resistance. As a result, treatment of biofilm associated infections needs to be changed. Thank you to Dr. Robert Shanks, working with the Charles T. Campbell Ophthalmic Microbiology Lab at the UPMC Eye Center for sharing his research with us.
As for what’s on the market today, Dr. Butts reviewed a new soft lens material that resists bacteria, protein, and lipid deposits, reducing risks of infection and contact lens-associated discomfort. It is also better for patients with allergies as it does not absorb preservatives from contact lens solution.
Dr. Butts called the surface technology of this contact lens innovative. “We’re really excited about this technology,” she said.
Don’t Let Your Halloween Lenses Haunt You
If you are tempted to wear Halloween contact lenses or costume contact lenses and you do not have a valid prescription, don’t. People who do not normally wear lenses won’t be trained in how to use them. Damage to the cornea can occur on insertion and removal. Additionally, the lenses may fit improperly and lead to insufficient oxygenation of the cornea. Contact lenses sold over the counter do not follow FDA guidelines and may be contaminated or counterfeit. “There are reputable FDA approved Halloween costume lenses we’re happy to fit you with,” Dr. Butts said.
Q&A
The first question was whether daily disposables are available for astigmatism. The answer is absolutely. One of Dr. Butt’s favorite daily disposables just went up to a -2.75 cylinder. “Every year we see something new,” Dr. Butts said. Extended wear lenses lag in technology because eyecare providers want to see their patients in daily disposables for health reasons, so this is where companies spend money on research.
The next question asked about the cost-benefit ratio for daily disposables vs. long wearing lenses. Daily disposables have more of an upfront cost, with a range but it is at least double the price. On the flip side, you are not buying solutions and are less likely to need extra doctor visits due to an infection. Dr. Butts said there are several rebates for daily disposable lenses and a plethora of options.
Other than aesthetics, are there any benefits to wearing contact lenses vs. glasses? Are glasses more effective or the same when it comes to treating vision issues? Dr. Drexler said glasses have peripheral distortion. Contact lenses are right on the eye, which allows for a more realistic or typical vision. If you have astigmatism or keratoconus, contact lenses will give you much better vision.
Once you know your contact lens fits and you are in a routine, a yearly eye exam is sufficient. The burden, of course, falls on the wearer to make sure you are following through on what is needed.
As to whether it is better to have refractive surgery instead of wearing contact lenses, Dr. Drexler said not to bother if your contacts work, and you are happy. If you are in a situation where allergies or astigmatism prevent you from getting contacts, it makes sense to consider a refractive procedure. But it has to be the right thing for the right people done by the right people, Dr. Drexler said. Not everyone is a candidate for refractive surgery.
A new daily disposable came out this year for dry eye. But Dr. Butts said to treat the dry eye first before trying to find the right lens. As for whether there is a daily disposable for every prescription, there is one for most. One that has not come out yet but is available in a monthly is a single daily lens for both astigmatism and multifocal correction. The doctors expect this is on the horizon to come out in the next few years. The technology exists, but the question is whether there is a patient population that wants it, especially since it will be more expensive.
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