نبذة مختصرة : Contact lens comfort has been the focus of many clinical studies and review articles.1–6 This is not surprising as it is estimated that, while there are 3.5 million new contact lens wearers each year, approximately two to three million established lens wearers drop out of contact lens wear. Dryness and discomfort are cited as key reasons.7,8 For those who remain in contact lenses, ocular dryness continues to be a significant complaint, with up to four out of five lens wearers affected,3 and one in four contact lens wearers finding that it adversely affects their wearing time.9 Comfort in successful contact lens wearers should not be taken for granted.9 A patient who wears their lenses on a full-time basis over a certain wearing period is commonly considered to be a successful lens wearer. Comfort is a dependent variable and therefore subject to fluctuations during contact lens wear. Patient-specific factors as well as external factors can influence subjective comfort to varying degrees, even in successful full-time contact lens wearers.9 Most commonly, successful contact lens wearers experience a decrease in comfort towards the end of the day.2,10 While it may or may not be enough to reduce wearing time, this decrease in comfort is undesirable nonetheless. Maintaining and optimizing lens-wearing comfort for successful contact lens wearers is crucial to minimize contact lens dropout, and is the focus of the current study.5 Contact lens practitioners have an important role in supporting and maintaining the success of their contact lens wearers. This can be particularly difficult when patients do not voice complaints during their annual exams. Effective questioning at contact lens visits can elucidate otherwise unrecognized issues and generate possible opportunities for improvement in patient comfort. Similarly, a solid understanding of a patient’s medical history, environment and lifestyle are valuable tools for predicting and managing a patient’s ongoing success. In addition, thoughtful choice of a contact lens and its partner solution contribute to contact lens-wearing success. Advances in contact lens material technology, providing greater flexibility in lens wear schedules and improved health benefits, allow practitioners to choose lenses ideally suited to a patient’s individual requirements. These new materials have demonstrated tangible improvements in patient comfort, as well as in a patient’s overall satisfaction.11–16 While the optimal choice of contact lens is directly related to a patient’s satisfaction, it is very important to consider the synergistic relationship between contact lens and lens care solution. Multipurpose solutions comprise different formulations that may provide additional benefits, extending contact lens-wearing success.17 In this investigation into lens-wearing comfort, two polyhexamethylene biguanide (PHMB) (0.0001%)-preserved lens care solutions, Complete® Multi-Purpose Solution (MPS) Easy Rub® (AMO, Santa Ana, CA, USA) and ReNu MultiPlus® MPS (Bausch & Lomb, Rochester, NY, USA), were compared with a third solution, OPTI-FREE® RepleniSH® Multi-Purpose Disinfecting Solution (MPDS; Alcon Laboratories Inc, Fort Worth, TX, USA), preserved with Polyquaternium-1 (POLYQUAD®) and myristamidopropyl dimethylamine (ALDOX®) 0.0005%. PHMB is a broadspectrum cationic antimicrobial agent. It electrostatically binds to (and in turn destroys) the cytoplasmic membranes of microbes, disrupting metabolic activity and resulting in irreversible loss of intracellular components.18 POLYQUAD® is a quaternary ammonium compound. An antimicrobial agent with attenuated toxicity, it reduces the surface tension at interfaces and denatures microbial cell wall proteins, causing microbial cell death.18 ALDOX®, a cationic amidoamine, is an antifungal/anti-amoebic that works in synergy with POLYQUAD® in OPTI-FREE® RepleniSH® MPDS to meet the highest standard of ISO and FDA criteria for the disinfection of bacteria and fungi.19 Additionally, OPTI-FREE® RepleniSH® MPDS contains a TearGlyde® reconditioning system, incorporating Tetronic 1304 and C9-ED3A (nonanoyl ethylenediaminetriacetic acid). The components are attracted to the surface and matrix of silicone hydrogel and traditional hydrogel lenses and form a network to maintain a thin layer of moisture on the lens surface throughout the day. OPTI-FREE® RepleniSH® MPDS has been shown to increase contact lens comfort in the most common hydrogel material among those who experience discomfort20 and maintain a low wetting angle after 14 hours of lens wear as demonstrated in ex vivo clinical studies.21 OPTI-FREE® RepleniSH® MPDS is a new generation contact lens solution formulated to provide benefits in the key areas of lens wettability,22–25 lens cleaning,19,26 and biocompatible disinfection.27 In addition, it has demonstrated clinical biocompatibility with both traditional hydrogel and silicone hydrogel lens materials.25,26 The current study investigates the patient benefit of transitioning successful full-time, daily wear, soft contact lens wearers currently using competitive older-generation multipurpose solutions to OPTI-FREE® RepleniSH® MPDS.
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