Spherical GP Lenses – FAQ 3

Dryness-Related Part 2: My Patient Has Lens Surface
Muco-Protein Coating. How to Manage?

Rule-Outs

Patient-Related

Failure to clean upon removal, use of lanolin-based soft soaps or hand creams immediately before handling lenses, medication-induced decrease in tear volume (see Spherical GP Lenses FAQ 2), post-menopausal female, lid disease (e.g., evaluate for meibomian gland dysfunction and blepharitis).

Lens Design-Related

Inferior decentration, thick edge, high edge clearance. These three causes all can compromise blink quality.

Material-Related

Poorly wetting material, lens dry spots and filming of anterior lens surface, “waxy” film from manufacturer.

Management

Patient-Related

• Advise to clean upon removal in the palm of the hand.
• Use of liquid enzyme once a week, at minimum.
• Do not use a soft soap or hand cream immediately prior to handling lenses.
• See Spherical GP Lenses FAQ 2 for recommended management of dry eye.

Lens Design-/Material-/Care System-Related

• Speak with laboratory consultant about their recommended fluoro-silicone/acrylate material in dry eye cases.
• Order lenses with plasma treatment.
• Recommend use of an extra-strength cleaner such as Progent (Menicon) to maintain a clean surface.
• Can change the patient to a hydrogen peroxide system.
• Inferior decentration: Please see Spherical GP Lenses FAQ 5.
• High edge clearance: Reorder with steeper peripheral curve radius and/or narrower peripheral curve width.
• Edge thickness: Reorder with a lenticular (or similar) edge design (i.e., plus lenticular for high minus powers — typically ≥ -5D; minus lenticular for all plus and low minus — typically ≤ -1.50D powers).

Useful References

GP Lens Institute

• GP Lens Case Grand Rounds Troubleshooting Guide Case 9

Publications

• Bennett E.S., Grohe R., Brown M., Resnick S., Ward M., Louie D. Filmy GPs, Part 1.
• Bennett E.S., Grohe R., Brown M., Resnick S., Ward M., Louie D. Filmy GPs, Part 2.
• Ward M. Resolving GP Surface-Wetting Problems CSI Style.

Acknowledgements

GP Lens Institute Advisory Committee members: Bruce Anderson OD, Marlane Brown OD, Carmen Castellano OD, Walter Choate OD, S. Barry Eiden OD, John Laurent OD, PhD, Derek Louie, OD, MS, Joe Shovlin OD, Frank Weinstock MD, Bruce Williams OD.