Contact Lens Care Goes Back to Basics
It seems likely therefore that the bold promotion of ‘No Rub’ will disappear to be replaced by a recommendation to ‘Rub & Rinse’ contact lenses as part of routine lens care.
At face value, it also seems highly likely that some anti-acanthamoeba requirement for LCPs will also be introduced. Currently, no such requirement exists because of the previous belief that as Acanthamoeba spp. had no access to the contact lens wear and care cycle in a compliant wearer, no consideration of a LCP’s anti-acanthamoeba performance was necessary. The reality has shown otherwise, conclusively.
Confounding factors such as the recommendation by the US Environmental Protection Agency (EPA, visit: http://www.epa.gov/safewater/mdbp/dbp1.html) to decrease the level of chlorine in domestic reticulated mains water supplies to reduce the levels of chlorination byproducts such as trihalomethanes (THMs) (effective Jan 2002), and what contribution, if any, this may have had to the number of contact lens infections, is the subject of current research (visit:http://www.zoominfo.com/people/Joslin_Charlotte_194327162.aspx).
The antifungal performance of many LCPs has also been questioned and in some cases has been found to be borderline at best, especially when lenses are soaked for less than the recommended times, i.e. a simple case of non-compliance. Therefore, since some recent LCP performance issues also involve fungal infections of the eyes of contact lens wearers, it is reasonable to assume that antifungal performance too may make an appearance in any revamping of the minimum performance characteristics that new LCPs must exhibit before being approved.
Because many of the cases of acanthamoeba and fungal infections occurred in the US, the FDA has maintained the highest profile among the world’s regulatory authorities. However, because of the high level of communication maintained between one another by most regulatory authorities, most seem to be taking a wait and see attitude to the issues involved and are likely to fall into line with the direction taken by the FDA if and when it acts on the submissions it has received and the advice of the relevant experts. The manufacturers of LCPs have been and remain an integral part of the process.
In summary: It is reasonable to assume that any changes made will amount to a tightening of the existing regulations along with the probable introduction of additional requirements relating to the performance of LCPs against Acanthamoeba spp. (almost certainly, currently there are none) and fungi (highly likely, currently only two species feature, Candida albicans, and Fusarium solani ).
It is apparent that contact lens wearers will be better served by the resulting generation of lens care products.