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Archive for March, 2010

I love talking to patients about how to clean and store their contact lenses. I spend a lot of time with new patients going over the proper techniques to ensure their safety and success with contacts. I especially like to talk to people who already wear contacts and ask them about their contact lens care regime. Many of them were not educated properly on how to clean and store contacts when they first began wearing them and they have picked up even worse habits or shortcuts along the way.

Contact Lens care is the opposite of ‘quick and dirty.’ Contact lens cleaning takes time, albeit maybe only one solid minute of your time, but you would be surprised at how a little bit of rubbing and rinsing can dramatically improve your comfort and decrease your risk of infection. You could have the best contact lens in the world, but  if it isn’t clean, it is not comfortable. Proteins and oils from your eye’s natural layer of tears and from the glands of the eyelids can build up, embedding themselves into the lens as you wear and re-wear it. Sometimes these proteins can actually be seen with the naked eye, other times your optometrist will see them under the magnification of the biomicroscope when looking at your lenses as part of your yearly contact lens re-evaluation. It is essential to thoroughly clean the lenses each and every time they come out of your eyes (unless of course, you wear daily disposable contact lenses which are worn for only one day and then thrown away).

To keep your lenses clean, you should follow these basic steps (source 1) :

  • WASH AND DRY YOUR HANDS each and every time you handle your contact lenses. That means before taking them out at night, before putting them in first thing in the morning and any other time you have to insert or remove the lens from your eye throughout the day. Your hands are a host for bacterias, viruses, dirt, dust and debri. You must ensure that they are clean! This decreases your risk of contaminating the lenses and dramatically drops your risk of getting an eye infection. period.

    Clean, Clean, make sure it's Clean!

  • PRE-RINSE, RUB, RINSE AGAIN. This may sound like a lot of steps but it takes under one minute to do each night after you take the lenses out but before storing them in the case. Place one lens in the palm of your CLEAN hand, “power wash” or pre-rinse the lens with the solution your doctor directed you to use. Take the pointer finger of your free hand and use it to gently rub the inside of the contact lens (the contact lens remember should be sitting in the palm of your hand, covered in contact lens cleaning solution and should be ‘belly side up,’ meaning it should look like a soup bowl sitting right side up in your palm). Rub the lens in a circular motion, ten times clockwise, this mechanical rubbing of the lens helps to loosen oil, debri and dirt that may have stuck to the lens over the course of the day while you were wearing them. (In my opinion, even if the cleaning solution you are using says ‘NO RUBBING NEEDED’ or NO-RUB, YOU SHOULD STILL RUB YOUR LENSES). Then you will rinse again, which now power washes off the debri you just loosened. Repeat in the same way with the second contact lens.
  • STORE THE LENSES in the clean case with FRESH SOLUTION DAILY. The contact lens case should be stored DRY and CLEAN during the day while you have the contacts in your eyes. When you come home at night and get ready to use the case again, fill the case half way full with FRESH contact lens solution and put the newly rinsed, rubbed and cleaned lens into the fresh solution. You do NOT want to reuse the same solution that was in the case already. The longer the solution is in your case, the greater the opportunity for bacteria to stew, grow and multiply leading to an  increased risk of infection. Please also note that your case should be changed at least every three months (about as often as you should be changing your toothbrush) and also if you have been sick (again, same rule as the toothbrush so it should be easy to remember).
  • WEAR AND DISPOSE OF YOUR CONTACT LENSES CORRECTLY in compliance with your doctor’s prescribed and customized wearing schedule. If you try to stretch the recommended lifetime of the contact lenses past what the doctor prescribed for you, you are setting yourself up for disaster. The matrix or material of the lens can actually start to break down if worn far past its recommended time and little holes form in the lenses which can act as new pockets for bacteria, oil and other contaminants to latch onto. Discuss with your doctor how often you should be changing your lenses and why! Your doctor is here to help and answer all questions you may have. Your continued safety and diminished risk for infections and problems with your contacts are two of the reasons why your doctor helps you establish a wearing schedule. Adhere to it!

There are a few other rules or points regarding wearing contacts that you should be aware of:

  • One of which is you should not swim or sit in a hot tub with your contact lenses in. Water can contain a wide variety of microorganisms, one being Pseudomonas aeruginosa . These pathogens can cause a very bad infection in the eye, complications of which can even lead to permanent vision loss!
  • Also, do not sleep in your contact lenses unless your doctor prescribes this type of wearing schedule for you outlining specific scheduling and guidelines.
  • Discuss with your doctor which contact lens cleaning and storing solutions are right for you and which are compatible with your lenses.
  • NEVER use saliva or tap water on your contact lenses, I always cringe when I hear of people doing this. I don’t even want to begin to tell you all of the bacteria and contaminants in each. Let’s just leave it at this, saliva and tap water on contact lenses is not sanitary and can lead to tremendously bad infections of the eye.
  • Saline also, is unacceptable to ‘clean’ contact lenses with as it has no cleaning solvent in it. Saline can be used to rinse lenses but should never replace your cleaning solution and should not be used in the contact lens cases as a storing solution.
  • Wearing contact lenses is a great alternative to, but not a substitute for an accurate, up-to-date pair of glasses.
  • If you feel you want a more low maintenance contact lens care regime, consider daily disposable contact lenses. Then you won’t have to worry about cleaning or storing contact lenses, you will just wash your hands and put in a clean, fresh pair each day. Daily lenses are also great for kids, athletes, medical professionals and people who only wear contacts once in a great while.

Visit your eye care professional and ask them what type of contact lenses are right for your lifestyle. Also, be sure to ask them how to properly clean and store the lenses and what contact lens solutions they would prescribe for you. I think you will find that most doctors would love to review this with you because it keeps your eyes safe and healthy and that is their number one goal!

Take care of your contact lenses, clean them and follow the directions of your doctor to ensure your continued health and success in contacts.

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Retinoblastoma (RB), although rare, is the most common type of eye cancer in children under the age of five. (source 1) About 300 children and young adults are diagnosed with Retinoblastoma (RB) each year in the United States. (source 2)

Retinoblastoma begins to occur when the eyes are first forming while the child in still in the womb. Specialized cells called retinoblasts divide and begin to fill in the eye to form the sight-seeing tissue that lines the inner eye called the retina. At a certain point, the retinoblasts are  programmed to stop dividing; in the case of retinoblastoma, they do not stop dividing. This uncontrolled cell growth in the retina is Retinoblastoma. (source 3)

RB has been linked to an abnormality in the RB or RB1 gene. This mutation of the RB1 gene is either inherited, congenital (hereditary) retinoblastoma and occurs in every cell in the body (germline mutation), or it can be a new mutation in only one cell, sporadic (non-hereditary) retinoblastoma.

Congenital or hereditary retinoblastoma means that the abnormality in the gene is present at birth and affects all cells in both eyes.  They usually have bilateral retinoblastoma and multifocal tumors. Only 25% of these children inherit the gene abnormality from one of their parents, 75% of the time it occurs for the first time during the early development of the eye while in the womb. (source 3)

Sporadic or non-hereitary retinoblastoma means the mutation is new and occured on its own in one cell of one eye. The reason the one cell mutated while dividing is unknown. The net result is only one tumor in one eye. (source 3)

Retinoblastoma is a life-threatening disease, particularly if the undetected cancer spreads, but due to early detection, raised awareness and appropriate treatments and follow-ups, in the United States, the survival rate is very high, over 90%. (source 4) Yet in order to treat it, you must first detect it. Here are some signs and symptoms of Retinoblastoma. If you see something or suspect anything is wrong with your child’s eyes, schedule an appointment with an eye care professional right away, within one week.

Symptoms  and Signs of Retinoblastoma: (source 5)

  • visible whiteness or reflex in the pupil, particularly when a color photo is taken with a flash (a white reflex can also occur under certain lighting conditions or if the eye is turned 15 degrees toward the nose, in that case you may be getting a white reflection off of the normal optic nerve inside the eye instead of the “red” retina (“red eye”). Only with an examination by an eye care professional can you deteremine if it is a true white pupil (leukocoria) or just an image artifact of the photography.)
  • glint of whiteness behind pupil in dim lighting
  • crossed eyes/turned eye
  • persistent pain or redness
  • poor vision

When in doubt, have it checked out!

Many eye care professionals participate in INFANT SEE, a no cost public health care program which gives you a one time, comprehensive eye exam for your infant under the age of one year at no charge, regardless of income. To find a participating doctor in your area, visit the InfantSee website or call 1-888-396- EYES (3937). In cases where a white pupil is suspected, a pediatric ophtalmologist would be your best option, only because if Retinoblastoma is truly suspected, additional testing such as ultrasound of the eye can be done there to gather further information and time is crucial if it is indeed eye cancer.

Inspiration behind this article:

Photo by C. Murphy; Example of white pupil as artifact of photography; eye normal.

This is a picture of my daughter that I took with a digital camera with flash. Even after using the ‘fix red eye’ feature with photoediting software, the pupil of the right eye appeared white. As an optometrist, I knew of Retinoblastoma and how important it was to have it checked out very quickly. After extensive testing with an pediatric ophtalmologist all was determined to be normal and the white pupil was one of those “one in a million” pictures where the eyes are normal but the lighting hits the eye, lens and retina in such a way that causes a white reflection. As a mother, who would do anything at any time to save my child’s life, I want to help other mothers out there by raising the awareness of Retinoblastoma. Together, let’s make that over 90% survival rate in the U.S. closer to 100% and let’s improve the survival rate worldwide. To learn more, visit the links below and consider making a donation.

Daisy’s Eye Cancer Fund

Retinoblastoma International

A very informative video for doctors on what to do if a child has a white pupil by Dr. Carol Shields, MD, Wills Eye Institute

SPECIAL THANKS TO MY FRIEND, LORI BOLLINGER, FOR POSTING THE DAISY’S EYE CANCER FUND VIDEO AND INTRODUCING ME TO A FRIEND WHOSE DAUGHTER WAS DIAGNOSED WITH RETINOBLASTOMA. I HAD TAKEN THAT PICTURE OF MY DAUGHTER ONE WEEK PRIOR.  I CALLED FOR THE APPOINTMENT FOR MY DAUGHTER IMMEDIATELY AFTERWARD.

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