Optometry

Thomas G. Quinn

Practitioners say these new products are improving wearing time and creating patient loyalty.

To keep up with advancing technology in contact lenses, manufacturers have scrambled to develop matching multipurpose disinfecting solutions for enhanced efficacy and patient comfort that translate into better compliance.

Outbreaks of Fusarium keratitis in 2006 and Acanthamoeba shortly thereafter were eventually linked to noncompliance with contact lens solutions. As a result of these industry scares, certain manufacturers have reformulated some of their solutions, according to Thomas G. Quinn, OD, a practitioner from Athens, Ohio.

AMO: RevitaLens OcuTec

“As these companies have undertaken the reformulations, they have tested them under more real-world conditions,” he said. “Prior to these outbreaks, the testing requirements for U.S. Food and Drug Administration approval were fairly artificial, such as in a laboratory setting.”

Dr. Quinn points to RevitaLens OcuTec (Abbott Medical Optics) as a contact lens solution that has undergone rigorous testing. Any soft lens patient is a candidate for the product, assuming they have no sensitivities to the ingredients, he told Primary Care Optometry News.

“It works with the new silicone hydrogel material as well as the old hydrogel material,” he said. In addition, the solution has been shown to be comfortable and is very effective in killing bugs, even if the patient does not care for the contact lenses or the storage case as he or she should.

“I have seen no adverse events with the solution,” said Dr. Quinn, who has been prescribing RevitaLens for about 6 months.

Patients who choose to “top-off” the solution in their contact lens case to save money in today’s trying economy “causes a change in the chemical characteristics of the disinfectant – a partial evaporation – which was one of the reasons for the Fusarium keratitis crisis,” Dr. Quinn said.

However, when test conditions subjected lenses to a partial evaporation process with RevitaLens, “the solution still maintained a high level of disinfection,” he said.

One of the disinfecting agents, polyquaternium-1 (PQ-1) “is not taken up by the contact lens itself, so it is more available and stays active when the lens is stored in the case,” Dr. Quinn said.

RevitaLens became commercially available last October, according to Thomas M. Arens, an associate marketing director at Abbott.

“Our solution allows contact lens wearers to have greater satisfaction with their contact lenses,” he told PCON. “The overall formula was developed for silicone hydrogel lenses, and we consulted with more than 600 eye care professionals to bring the newest technology to the market.”

Within a few years, this new type of lens material is expected to be recommended by 80% to 90% of eye care professionals, Mr. Arens said.

“The unique next-generation formula contains only ingredients that really work hard synergistically to clean lenses and disinfect,” he continued. “There was a need to develop a more efficacious solution that would overcompensate for noncompliance.”

Additionally, he said that RevitaLens provides patients with up to 16 hours of end-of-day lens wearing comfort.

Alcon: Opti-Free PureMoist

Mile Brujic

Opti-Free PureMoist (Alcon) multipurpose solution also has “the ability to enhance the patient’s wearing experience with their contact lenses,” Mile Brujic, OD, a partner at Premier Vision Group, a four-location optometric practice in northwest Ohio, told PCON.

Although the solution did not debut in the U.S. until June, Dr. Brujic was involved in clinical trials.

“One of the ingredients that is certainly different than anything else we’ve ever seen in a solution is the molecule HydraGlyde (compound name polyoxyethylene-polyoxybutylene),” he said.

The HydraGlyde moisture matrix has a strong affinity to the lens surface. It allows the contact lens to remain wet for up to 16 hours.

“This is truly a new surfactant that seems to be showing a lot of promise,” Dr. Brujic said.

A double-masked trial of symptomatic patients who were uncomfortable wearing contact lenses consisted of randomizing subjects in a double-masked fashion to either PureMoist or a controlled solution for 1 month.

“A number of patients in the PureMoist group experienced significant improvement in comfort that we didn’t see in the control group,” said Dr. Brujic, one of the investigators, who will likely position the product as first line for all soft contact lens wearers. He said he expects comfort to typically last up to 16 hours.

A separate study of PureMoist, in which Dr. Brujic did not participate, recruited patients who were not symptomatic for dry eye symptoms with their contact lens wear. The randomized trial found a statistically significant difference favoring the group using PureMoist.

“Products that work more efficaciously are ideally positioned to keep patients more compliant and to minimize switching solutions,” Dr. Brujic said.

According to product information provided by Alcon, Opti-Free PureMoist bolsters soft contact lens comfort via a new scientifically engineered block copolymer platform. The product also causes minimal corneal staining (correlated to comfort), reduces lipid deposition and has demonstrated biocompatibility. Furthermore, the dual disinfection system “provides proven efficacy against a wide range of microorganisms.”

According to the company, scientists began developing PureMoist 7 years ago, before the Fusarium and Acanthamoeba outbreaks. More than 50 scientists were involved in this work.

Bausch + Lomb: BioTrue

BioTrue (Bausch + Lomb) contact lens solution was launched June 2010.

“The reception by eye care practitioners and patients to BioTrue has been overwhelmingly positive,” Chris Snyder, OD, FAAO, director of Bausch + Lomb professional relations, North American Vision Care, said. “The unsurpassed disinfection efficacy from the dual-disinfectants (polyhexamethylene biguanide [PHMB] and PQ-1) in the product is certainly noteworthy.”

In addition to these two disinfectants being in “very low concentration compared to competitive products,” Dr. Snyder told PCON, BioTrue is a bio-inspired formulation, in that it matches the pH of healthy tears and contains hyaluronan (HA), a natural lubricant of the eye and the body.

“This translates into incredible continuous comfort for up to 20 hours,” he said.

BioTrue is also formulated with a component that helps manage the proteins naturally found in tears. “This part of the formulation will actually protect the proteins in their native state, to keep them from denaturing,” Dr. Snyder said.

This component breaks down and clears the denatured proteins as well, primarily while the lens is soaked in the solution.

“Contact lens solutions typically don’t have a lot of loyalty by patients, or doctors for that matter,” Ami A. Epstein, OD, a private practitioner from Birmingham, Ala., said in an interview. “But BioTrue has so much patient and doctor loyalty and enthusiasm. Rarely do you hear about someone having enthusiasm about a contact lens solution.”

Dr. Epstein attributes this loyalty to the effectiveness of the product. “End-of-the-day comfort with the contact lens is improved,” she said.

One patient was so impressed with the “magic solution” that she referred her sister.

“It made her contacts feel like they weren’t there – that they disappear. To have a contact lens in your eye that you are unaware of is ultimately the goal of every patient who wears contacts,” Dr. Epstein said.

By using BioTrue, Dr. Epstein’s patients can now comfortably wear their lenses all waking hours. “When you first put the contact lens in it is comfortable because the pH is pH-balanced to match your tears,” Dr. Epstein said. Likewise, HA “brings moisture to the contact and stays with it, whether it is a hydrogel or silicone hydrogel lens, for up to 20 hours.”

Dr. Epstein, who has been dispensing BioTrue since June 2010, noted “this is not a ‘me-too’ product. This is totally different than anything else on the market.”

In fact, some of Dr. Epstein’s daily disposable contact lens patients rinse their lenses with BioTrue before placing them into the eye for easier insertion and longer comfortable wearing duration. – Bob Kronemyer

• Ami A. Epstein, OD, can be reached at 2206 Cahaba Valley Dr., Suite B, Birmingham, AL 35242; (205) 981-9441; eyedoc@bellsouth.net.
• Thomas M. Arens is an associate marketing director at Abbott Medical Optics. He can be reached at 1700 E. St. Andrew Place, Santa Ana, CA 92705; (714) 247-8459; tom.arens@amo.abbott.com.
• Mile Brujic, OD, can be reached at Premier Vision Group, 1222 Ridgewood Dr., Bowling Green, OH 43402; (419) 352-2502; brujic@prodigy.net.
• Thomas G. Quinn, OD, can be reached at 416 W. Union St., Athens, OH 45701; (740) 594-2271; tgquinn5@gmail.com.
• Chris Snyder, OD, FAAO, is director of professional relations, North American Vision Care, Bausch + Lomb. He can be reached at 2133 Partridge Berry Road, Birmingham, AL 35244; (585) 451-6502; christopher.snyder@bausch.com.
• Disclosures: Dr. Epstein has no direct financial interest in any products mentioned in this article. She is a paid consultant for Bausch + Lomb. Dr. Brujic has no direct financial interest in any products mentioned in this article, nor is he a paid consultant for any companies mentioned. Dr. Quinn has no direct financial interest in any products mentioned in this article. He has received support in the form of research funds, speaking honoraria and/or advisory panel honoraria from AMO and Bausch + Lomb.
• RevitaLens OcuTec is available from Abbott Medical Optics, www.amo-inc.com.
• Opti-Free PureMoist is available from Alcon Laboratories, www.opti-free.com.
• BioTrue is available from Bausch + Lomb, www.biotrue.com.