How should I handle poor initial wettability?
“There is a large segment of contact lens wearers who are female and either menopausal or post-menopausal. Hormonal shifts can certainly impact tear chemistry and result in decreased surface wettability, even if this has not been a problem with previous lenses. In addition, be sure to determine what medications they are taking and determine if this could be impacting their tear quality and volume. Also, be sure to always inform patients to use any creams or perfumes after lens insertion.” (Keith Parker, Advanced Vision Technologies)
“When this occurs, it is often as a result of either the patient or the staff member checking in the lenses using a hand cream or soft soap; these can have lanolin or emollients such as coconut oil that can leave a residue on the surface.” (Mike Johnson, Art Optical)
“Poor initial wettability can be caused from lack of proper cleaning and conditioning prior to dispensing. There is also the possibility of transfer of releasing agents to the contact lens surface when lenses are dry-shipped. For this reason, most labs offer and encourage use of the option of having lenses wet-shipped to your office.” (Alika Mackley NCLE-AC, Firestone Optics)
“Poor initial wettability is caused by a hydrophobic surface of a contact lens. Manufacturing substances that remain on the lenses or transference of oil or lipids in handling will cause the water to bead up on the lens. Having lenses plasma-treated prior to dispensing will fix this issue. In absence of that, clean the lenses with an appropriate surfactant cleaner.” (Susan Faul, Paragon Vision Sciences)
If poor wettability occurs over time, what should I do?
(A list of GP solutions is available on this website.)
“Review the patient’s care regimen, hand soaps, creams, lotions, and cosmetics. Have the patient use a multi-step solution system rather than a one-step system. Verify that the patient cleans the lenses on removal at night, conditions them overnight, and does not rinse off the conditioning solution before insertion. Make sure that the patient is not using a hand soap with moisturizers and that they wash their hands prior to removing lenses from the case and inserting them. Wettability issues tend to be more prevalent during the winter when people are more likely to use lotions to alleviate dry skin problems.” (Alika Mackley NCLE-AC, Firestone Optics)
“Upon removal, the use of an effective and compatible in-office cleaner is helpful, followed by the use of a conditioning solution that can be rubbed into the surface of the lens. In the morning, the lens should be removed directly from the case and inserted. Rinsing at that time could negate the effect of conditioning and impact wettability and comfort. In addition, if the lenses are shipped in the wet state, this is beneficial in optimizing both sterility and initial wettability. If shipped in the dry state, the lenses should be soaked, at minimum, for four hours in conditioning solution prior to dispensing.” (Janice Adams, Valley Contax)
“Menicon has Progent, which will take off coatings and is now approved for consumer use. It is available via their website and comes with a rinsing saline. It is especially beneficial for cleaning the deposits off the back surface of both scleral and corneal reshaping lenses. Using Optimum by Lobob and then conditioning the lenses at night is also a good plan. Patient use of a compatible hand soap such as that made by Lobob is also a good idea.” (Keith Parker, Advanced Vision Technology)