Care of Night Lenses (Ortho-K)

Night Lenses (Orthokeratology) are a safe, reversible and effective vision correction solution.1,2 However, incorrect care of contact lenses and solutions can increase the risk for eye infections and corneal ulcers. Risk factors for acquiring an eye infection include improper lens cleaning and disinfection, poor hygiene practices and smoking. Following your practitioner's hygiene regime, along with regular reviews, will minimise this risk.

Safety & hygiene

• Thoroughly wash hands and fingers with an antibacterial based hand wash
• Dry hands with a lint free towel
• Remove lenses while sitting at a table with a lint free cloth
• Avoid bathrooms as they contain more germs than any other room in the house³
• Inspect lenses for scratches, chips or cracks as these can provide surfaces for bacteria to grow^4,5

Always wash and rinse your hands thoroughly and dry them with a lint-free towel/tissue before handling contact lenses. All traces of soap, perfumes, hair-spray, creams and lotions should be removed from your hands and around your eyes. Your lenses should never come into contact with tap water as it contains dangerous microorganisms such as Acanthamoeba.^6,7

Insertion

To avoid confusion make a habit of inserting the same lens - generally the right lens - first. You will notice that the right lens is purple and the left lens blue. Minimise the risk of lens loss by plugging the sink or using a paper towel over the drainage opening.

Step 1. Remove your Night lenses from the cleaning solution case and rinse with saline. If you are using a hydrogen peroxide solution, you can only remove the lenses after a minimum soaking time of sixhours.⁸

Step 2. Place 1-2 drops of lubricating insertion eyedrops into the back of the lens. Place the lens on your index finger and insert directly into the centre (coloured part) of your eye in a face down position. To save confusion, it’s a good idea to insert the right lens first.

Step 3. If you happen to drop your Night lens, use saline solution to rinse the lens clean. To do this place the lens in the palm of your hand and thoroughly rinse for five seconds.⁹

Step 4. Dry and wipe out your lens case with a tissue. Leave the case lid off to air dry while wearing your lenses.

Normal occurrences on insertion

On rare occasions, a lens may become dislodged from the centre of the eye and move to the side. This may be uncomfortable but won’t do any harm.

• Look in a mirror to establish where the lens has moved to.
• Move your eyes in a direction away from where the lens is located. For example, if the lens is on the white of your eye nearest to your nose, look towards your ear.
• Gently nudge the lens back to the centre of your eye using your eyelids. Avoid directly pushing the lens with your fingers as this can damage the surface of your eye.
• Alternatively, remove the lens using your suction tool and reinsert correctly.

Abnormal occurrences on insertion

If on insertion you experience stinging, burning or pain, remove the lens, rinse and re-insert. If problems persist, remove the lens and see your optometrist at your earliest convenience.

Removal

Method 1 – Manual removal. Using your middle fingers, open the lids wider than the lens diameter. Apply pressure to the lid margins, pushing in together to move your lids under the lens and lever it out of the eye.

Method 2 – Suction tool removal. Using your middle fingers, open the eyelids wider than the lens diameter. With the suction tool between your index finger and thumb, align the suction cup so it is positioned in front of and parallel to the lens. When the suction cup touches the lens, apply gentle pressure to adhere the lens to the cup and remove the lens from your eye. After removal from the eye, carefully slide the lens sideways from the suction cup and it will come off easily.

Cleaning

An effective cleaning process is vital to ensure comfortable, hygienic and infection-free contact lens wear. With correct cleaning, contact lenses will feel better on your eyes, allow better eye health and vision, and dramatically reduce the risk of infection. Always clean your lenses after wear, and NEVER RINSE OR STORE YOUR LENSES INTAP WATER.³ The acanthamoeba microorganism is plentiful in tap water and can cause a severe, painful and sight-threatening infection.

Peroxide cleaner (AO Sept with Hydraglyde)

• To clean, disinfect and condition: Fill the case up to the line, place your lenses in the correct cage-holder, then submerge the case and screw closed. Over the course of a 6 hour period the catalyst in the case converts the disinfecting hydrogen peroxide solution into water and oxygen gas. The solution also includes Hydraglyde, an ingredient which improves the wettability of your contact lenses.

This cleaning solution requires no rubbing step, which decreases the risk of accidental breakage. The lenses do not need to be rinsed after the clean, as the solution neutralises to sterile water. The case can be left to air dry when not in use, and should be replaced with each new bottle of solution. Take care when transporting the cases as sometimes the small gas-release hole can leak solution. Do not remove the lenses from the case before 6 hours, as the un-neutralised hydrogen peroxide in your eyes will sting painfully. If this occurs, rinse thoroughly with water and contact your optometrist if the pain persists or your vision is affected. Find AOSept at our shop here.

Multipurpose solutions (Menicare and Boston Simplus)

• To clean: Place a few drops of rigid contact lens solution on the palm and the lens, then rub with your finger-pad for at least 10 seconds on each side. The back surface(concave) is best cleaned by moving your thumb across the surface. This step removes material that deposits on the lens during wear.
• To disinfect and condition: Place the lens in fresh solution in your lens case, ensuring the lens is completely submerged. This step kills microbes on your lenses and prepares the surface of your lens to stay wet throughout wear, increasing comfort. Store your lenses in this solution for at least 4 hours for the cleaning process to be complete.

Whilst Night Lenses are strong, with incorrect technique or too much force they can break, so take care during the cleaning step.

Regular protein removal (Progent)

• To use: Place the lenses into the contact lens case holders. Open vial A and B by twisting the cap and pour the contents into the contact lens case. Replace the lid and tighten. Leave the lenses in the solution for 30 minutes, then remove and rinse thoroughly with saline.

An intensive cleaner like Menicon Progent cleans and maintain the wettability of your lenses. After rinsing the lenses, they can be worn following this protein clean or can be disinfected with the daily cleaner.

First night of wear

• You should not experience any discomfort from the lens while you are sleeping; however, it is not usual to experience some discomfort with your eyes open as you get used to Night lens wear. This generally improves with time.
• When you wake up, insert a drop of preservative free artificial tear solution into the eye to increase moisture and assist in the lens movement on the eye. If the lens is bound it will not move - this means it may be necessary to manually loosen the lens.
• Upon removal of the Night lens you should notice some improvement in your unaided vision. This improved vision will last most of the day. After approximately two weeks vision should be stable all day for most forms of orthokeratology vision correction.

Follow-up care

Follow-up appointments are vital to the monitoring and success of your new Night Lens procedure. The first follow up appointment will be scheduled for the day after your first night of wear. The other follow up appointments will be determined by your Ortho-K practitioner based on your response to the first night of orthokeratology therapy and the severity of your vision correction.

Normal occurrences during the first 2 weeks include:

• Foreign body sensation and slight discomfort while wearing the lenses.
• Mild dryness and slight crusting in the corners of your eyes on waking.
• Blurred vision during the first week of Ortho-K lens wear. Take note of the changes in your vision and to report to your optometrist.
• Glare and halos at night especially during the first few months of Night Lens wear. The process where this clears up is called neuroadaptation. In some cases, as with myopia control, some glare can persist. However, due to the lifestyle of younger patients, these rarely bother them.

Abnormal symptoms (contact us immediately) include:

• Pain, light sensitivity, burning, stinging, and excessive watering on lens insertion. Remove the lens, rinse with preservative-free saline and re-insert if this occurs.
• A persistent redness, pain or light sensitivity of the eyes which doesn’t resolve after lens removal.
• Feeling like the lens is suctioned onto the eye and experiencing difficulty removing the lens in the morning.

Breakage

Night Lenses are made of a strong polymer which resists damage in normal wearing circumstances. It is very rare for a lens to break in your eye unless something hits your eye or your removal technique is incorrect/very forceful. The solutions you use to clean your lenses will not weaken or degrade them ‒ not even the powerful Progent fortnightly deep cleaner. However, they can still break if mishandled. There are some tricks you can learn to minimise this chance.

Habits that may cause a lens to break include:

• Pressure on the lens. If the lens lands on a mirror or flat surface. Gently slide it off to the edge of the surface or use a suction tool to remove it from the surface.
• Pulling the lens too firmly from the suction tool. Slide the lens off the suction point instead.
• Forcing the lens to bend excessively while cleaning. Some friction force is required to clean an ortho-K lens using your cleaning solution, but not too much. The resistance from your skin surface will be sufficient to clean the lens. If too much force is applied on both sides of a ortho-K lens, the lens will flex and eventually snap.

 It is very rare for a lens to break in your eye unless something hits your eye, or your removal technique is incorrect/very forceful. The solutions you use to clean your lenses will not weaken or degrade them ‒ not even the powerful Progent fortnightly deep cleaner.

In case of breakage

We understand that when you are learning how to use your lenses you may be inadvertently forceful during insertion, removal or cleaning. Because of this we offer a 1 month manufacturer’s replacement warranty on accidental breakages. Outside of this period, your lens is not covered by a warranty and the lens will need to be replaced at your cost if damaged or lost.

Normally a lens will take less than one week to arrive from the lab when ordered. If you are very dependent on the lens, we will of course ask our lens company to manufacture it as soon as possible. Because of the inevitable waiting time, we encourage all Ortho-K lens wearers to have a spare set of lenses available for a situation where a lens is lost or broken.

If you do lose or damage a lens, please don’t fret, just give our friendly team a call and we will arrange a replacement as quickly as we can.

Things to remember!

• Do not modify the recommended cleaning routine or solutions without consulting your optometrist. Other solutions may not be compatible with your eyes and lenses and may cause discomfort or allergic reactions.
• Do not heat solutions.
• Shortcuts with cleaning solutions may appear to save money but can result in ineffective lens cleaning and disinfection. Incorrect cleaning solutions may damage your lenses or lead to an eye infection which can result in vision loss.
• Never clean or store your Night Lens with soft contact lens solutions. These products work in a different way to the ortho-K lens solutions and will not clean and condition your Night Lenses.
• Replace the contact lens case every time you start a new bottle of lens cleaner to avoid microbial contamination.
• To avoid contamination do not touch the tips of solution bottles. Replace caps after use.
• If your eyes are very painful after hours, consult your local hospital or emergency eye clinic.
• If you notice scratches and chips or misplace a lens, contact your optometrist for a replacement.

Do not use your Night Lenses in the following cases:

• Acute inflammation or infection of the anterior chamber of the eye
• Any eye disease, injury, or abnormality that affects the cornea, conjunctiva or eyelids.
• Severe insufficiency of tears or inflammatory dry eye
• Corneal hypoesthesia (reduced corneal sensitivity)
• Any systemic disease which may affect the eye or be exacerbated by wearing contact lenses
• Allergic reactions to ocular surfaces or adnexa which may be induced or exaggerated by wearing contact lenses or use of contact lens solutions
• Allergy to any ingredient, such as peroxide and hydraglyde in a recommended cleaning solution
• Any active corneal infection (bacterial, fungal or viral)
• Red or irritated eyes

Remember, your eye must: look good, feel good, see good - if in doubt, take them out

References:

1) The Safety of Orthokeratology—A Systematic Review. 2016 Jan;42(1):35–42.

2) Efficacy, Safety and Acceptability of Orthokeratology on Slowing Axial Elongation in Myopic Children by Meta-Analysis. 2016 May;41(5):600–8.

3) Wu YT, Zhu H, WillcoxM, Stapleton F. Impact of air-drying lens cases in various locations and positions. Optom Vis Sci. 2010 Jul;87(7):465-8

4) Sweeney, D., Holden,B., Evans, K., Ng, V. and Cho, P. (2009), Best practice contact lens care: A review of the Asia Pacific Contact Lens Care Summit. Clinical and Experimental Optometry, 92: 78–89. doi:10.1111/j.1444-0938.2009.00353.x

5) Choo JD, Holden BA,Papas EB, Willcox MDP. Adhesion of Pseudomonas aeruginosa to orthokeratology and alignment lenses. Optom Vis Sci. 2009 Feb;86(2):93–7.

6) Yepes N. Infectious Keratitis After Overnight Orthokeratology in Canada. 2010 Oct 19:1–4

7) Bullimore MA, SinnottLT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci. 2013 Sep;90(9):937–44.

8) Sweeney, D., Holden,B., Evans, K., Ng, V. and Cho, P. (2009), Best practice contact lens care: A review of the Asia Pacific Contact Lens Care Summit. Clinical and Experimental Optometry, 92: 78–89. doi:10.1111/j.1444-0938.2009.00353.

9) Cho, P., Cheng, S. Y.,Chan, W. Y. and Yip, W. K. (2009), Soft contact lens cleaning: rub or no-rub?Ophthalmic and Physiological Optics, 29: 49–57