No Rub Contact Lens Solutions Can Cause Serious Infection

Contact lens solutions have evolved drastically over the past 50 years. They started as a multi-procedure activity that included cleaning, disinfecting, and soaking. These procedures could take hours to complete, and compliance was poor while the cost was high. As technology improved, so did the solutions. First, multiple steps were combined. The cleaner was incorporated into the rinsing and soaking step, but enzyming still was required. Recently, the solutions were able to incorporate an enzymatic component so all the wearer had to do was use one bottle of liquid.

This combination of elements dramatically improved wearer compliance since individuals needed to perform only one step. They did however; still have to rub the contact lens in the solution prior to letting it soak for several hours. Complacency resulted in many non compliant wearers that did not rub the lenses, and consequently did not fully clean their lenses. This resulted in an increased number of infections, ulcers and cornea complications. Additionally, solution manufacturers were conce
ed with the tearing of contact lenses which was caused by the manual handling of the contacts during the cleaning process.

The next step was the NO RUB solutions. They essentially were the one step type, but required only to rinse, and drop the lens in the solutions. It eliminated the need to rub and thereby reduced tearing, and increased compliance since there was nothing the wearer had to do that required effort. The NO RUB solutions have been used for several years, but recent studies conducted by doctors working on behalf of the FDA have demonstrated that this process may not fully clean the contact lenses well enough to fully kill all the infectious agents that are present on the contact lenses. As such, the FDA Ophthalmic Devices Panel which met on June 10, 2008, has recommended elimination of the No Rub instruction on all soft contact lens solutions. The FDA felt that the failure to manually rub the contact lenses with solution during the cleaning and disinfection procedure increases the incidence of Acanthamoeba and Fusarium keratitis infections. They further concluded that the increased incidence of Fusarium infections were largely due to poor compliance in cleaning the contact lens case, and poor hygiene in handling the contact lenses.

Another study performed on Acanthamoeba patients in Chicago concluded that wearers were reusing their solution, and failed to rub the lenses during cleaning, in addition to poor contact lens case hygiene. The FDA panel members all agreed that rubbing the lenses while cleaning should be included in the solution instructions, but did not determine the time required that the lenses must be rubbed. Further, the process of rubbing the contact lenses resulted in a decrease in the number of microbes on the contact lens surface.

In short, contact lens success relies on maintaining a clean, hygienic case, as well as digitally rubbing the lenses during the cleaning procedure. Following these simple steps will assure the wearer a healthy, infection free experience.