But one thing is for sure: it is not something the patient has done! After all, these are the same lenses they have worn for 30 years, and this is the first time this problem has ever occurred. These patients believe it is your responsibility to honor a warrantee (be it real or imagined) and exchange the lens.
Fortunately, there are a number of early signs that indicate improper lens care. Being well aware of these behaviors can help to prevent costly remakes.
The Telltale Signs of Lens Abuse
• The crazed lens. A spiderweb-like pattern on the surface of the lens (Figure 1) is caused by the material coming in contact with alcohol, acetone, ammonia and—yes, I have seen this—paint thinner. Sometimes patients think they are disinfecting or ‘super cleaning’ (or, in some cases, actually removing paint) when they use these products to maintain their lenses. Other times, these chemicals are introduced inadvertently, usually through sprayed perfume or introduced in the lens case well when the patient cleans the bathroom.
• Deep lens scratches. Dropping the lens and sliding it across a counter will cause deep, ‘swoosh-like’ scratches on the lens surface. Educate patients about the many ways they can avoid this complication, such as wetting a finger and lightly touching the surface of the lens to pick it up by capillary action, using a plunger or floating the lens in a puddle of solution to lift it from the counter surface before actually picking it up.
Fig. 1. A spiderweb-like crack on the surface of a GP lens as a result of chemical contact.
Rough hands or the presence of microbeads in the cleaner will cause lighter, diffuse scratches with a more random pattern. Today’s lenses made of silicone-containing, high-oxygen materials are much softer than the materials of the past. As such, you should recommend cleaners that do not contain microbeads and use a deep cleaner, such as Progent (Menicon), which does not require mechanically scrubbing the lens surface.
• Warped or distorted optics. A number of factors can lead to a warped lens. The most common is an irregular cornea—over time, the constant lid forces flexing the lens over the corneal surface will result in warpage. This complication seldom distorts the optics, though it may induce cylinder.
Typically, distorted optics are the result of ‘pressure cleaning’ the lens between the thumb and pointer finger. This process causes flexure of the plastic and may actually invert the lens.
Another lens distorting no-no is exposing the lens to extreme heat. So, be sure to inform your patients to avoid leaving their contact lenses in the car.
• Lens deposits can arise from a variety of behaviors. The most common cause is simply not cleaning the lenses using an appropriate care regimen. Many GP wearers have deep-seated cleaning habits, which include using dish soap and water. I’ve seen other strange GP care behaviors, which include removing lenses with odd things such as honey or chewed up tootsie rolls—I kid you not. It’s best not to assume a long-time wearer knows how to properly clean and maintain their lenses, so it is essential to periodically review the correct care habits.
• Non-wetting lenses may be the result of coatings that form on the lens from either exogenous or endogenous sources. Glycerin and other moisturizers, as well as waterproof makeup, can stick to the hydrophobic surface and prevent the lens from wetting. Other sources of non-wetting, which tend to be more common in my experience, are endogenous to the wearer, such as meibum from the lids.
There are many ways for patients to destroy their lenses, none of which are not the doctor’s fault, but can end up (repeatedly) being the doctor’s financial responsibility. Such behaviors can be avoided entirely, so long as they are discussed with each patient.