Technical Report: Guidelines for Handling of Multipatient Contact Lenses in the Clinical Setting

Abstract

SIGNIFICANCE Standardized guidelines that are clinically practical are needed to assist the prescriber in minimizing the risk of conveying infection through multiuse diagnostic contact lens use and reuse. Contact lens prescribers face the specter of transferring potential pathogens from one patient to another when reusing diagnostic (trial) contact lenses on multiple patients because infectious organisms have been recovered from worn contact lenses, although there is no evidence of transmission through this mechanism. These pathogens can be introduced into the system from one patient to another, or they may be introduced by clinician lens handling, storage, or both. These pathogens can cause acute or chronic systemic or ocular infection that can lead to significant morbidity (temporary or permanent) that includes vision loss.

BCLA CLEAR - Scleral lenses

“…Empirical rigid corneal lens fitting using corneal topography has a number of advantages including reduced chair time with higher first fit success rate [141], greater initial patient satisfaction [142], and optimised lens fitting [143]. Empirical fitting may also be a safer approach, since diagnostic multi-use lenses are not required, and the first lens applied as part of the fitting process is customised to the patient's eye [144]. This circumvents lens handling by multiple people, the handling of contaminated materials, and the risk of potential infection.…”

Optometry Australia’s infection control guidelines 2020

“…37 All trial contact lenses used in patients who are known to be infected with diseases, such as active herpes simplex keratitis, hepatitis, HIV, adenovirus, Acanthamoeba keratitis or CJD must be disposed of immediately after use. 5,38,41…”

“…After cleaning, ensure to cap the container and invert and shake vigorously to disinfect beneath the cap. Rinse thoroughly with MPS or saline 41. Contact lens cases for use in practice…”

Intrapatient and Interpatient Contact Lens Disinfection in the Age of COVID-19

“…The disinfection standards are different depending if the intent of the disinfection if for intrapatient or interpatient lens reuse, the latter requiring more stringent efficacy and guidelines. 4 Recently, the antiviral effects of multipurpose contact lens disinfecting solutions against coronavirus were reported for intrapatient disinfection. 1 Although three multipurpose solutions were ineffective against the virus in a stand-alone test, a povidone iodine and a hydrogen peroxide disinfection solution had superior antiviral activity against a coronavirus surrogate of SARS-CoV-2 and reduced the numbers of coronaviruses to below the detection limit.…”

“…Guidelines based on the 2018 ISO Standard were developed by the American Academy of Optometry Section on Cornea, Contact Lenses and Refractive Technologies, and the American Optometric Association Contact Lens and Cornea Section and published in 2020. 4 These guidelines require either moist heat disinfection (for hydrogel lenses alone, a target temperature of 134°C for a minimum of 3 min or 121°C for a minimum of 15 min must be reached) or a minimum 3 hr soak in non-neutralized ophthalmic grade 3% hydrogen peroxide. Practically speaking, peroxide disinfection is used in most specialty lens practices because gas permeable or hybrid lenses are the predominant diagnostic lens types used between patients.…”