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Medical Forum / General / Vision / March 2006Night & Day as Bandage Lens
I have been wearing plano Ciba Night & Day lenses to protect my corneas from erosion episodes. This is my second week with bandage lens, Day 6 with Night & Days. I am finding that the lenses give me good crisp vision for a few days, but then one or both will get blurry. I suspect this is from a deposit build up of some sort. I understand that these are designed for 30-day/night continuous wear, but I want crisp vision the entire time. What can be done to prevent/eliminate deposit build-up? Should this even be happening at all? > I have been wearing plano Ciba Night & Day lenses to > protect my corneas from erosion episodes. This is my [quoted text clipped - 8 lines] > What can be done to prevent/eliminate deposit build-up? > Should this even be happening at all? Have you tried taking them out and rubbing them with an all purpose cleaner/disinfectant or something of that nature? I believe some people are more prone to protein buildup than others. Take em out, put them in your washed palm, put a few drops of whatever you use to clean or store them in, and rub gently with your washed finger. My RGPs cloud up every night. -Quick Hi, Quick, Thank you for replying to my post. I don't have anything to clean or store them with because I was told to keep them in for 30 consecutive days. What do you use? Is there something without preservatives? One other question: What are RGPs? Thanks! > Hi, Quick, > [quoted text clipped - 5 lines] > > One other question: What are RGPs? Rigid Gas Permeable And the solutions would be different for soft lenses so I can't recommend what I use. -Quick AT1, you can't clean and store these lenses in saline of any sort. They need to be sterilised and by its nature, all storing solutions are preserved. Try complete, optifree or renu, they are all pretty good and if you have problems with one, the others will probably work as the presrvatives are all different. With MDF dystrophy, the problem is on waking only, so there is really no need for a lens through the day unless you have had an erosion and are having discomfort. After that, it is a bandage to stop further tissue damage on waking. After 2 weeks, the corneal damage should be long gone and you can wear the lenses at night only. I deal with these situations frequently and have had considerable success with night only wear. You could also try PureVision, they may not deposit as much. dr grant Thank you for your reply, Dr. Grant. I will ask my doctor about night only wear. That makes sense to me. That way I could keep wearing my eyeglasses only during the day and switch to the contact lenses just before bedtime. For your patients who are on a night only wear schedule, could erosions occur from, say, an afternoon nap of a couple of hours, or dozing off during a long airplane flight? Many Thanks Yes, the problem is a combination of swelling while the eye is shut and the drying out of the tear layer, so the cells in the erosion area stick to the back of the lid, and as you open your eye, it will tear some tissue away. You can use a lubricant like lacrilube if you feel you are going to nap and are not near your lenses. dr grant You can remove and clean your lenses, that would be a good start. Deposits can happen with all lenses, N&D among them.Removal will not cause problems as the erosion is only an issue on opening your eyes first thing in the morning, so you don't need to wear them through the day, just at night. dr grant Thank you for your reply, Dr. Grant. I don't mean to be so dense, but my doctor just said to leave them in continuously. I think I would be happier with them if I did take them out during the day and clean them. Could you suggest a good preservative-free solution for this purpose? Before I had erosion episodes I used to use preservative-free Unisol solution. But I don't think that has a cleaning component. I used it as a wetting solution to insert my old lenses. Doctors have different strategies in dealing with erosions. Mine is to remove the lens as soon as the erosion is healed, and then switch the patient to a hypertonic petrolatum ointment such as Muro 128 at night for prophylaxis. Perhaps your doctor has seen similar or better results using the therapeutic lens for a longer period of time. However, if the lens is fogging, then it does need to be removed for cleaning. This should not pose any risk whatsoever, so long as the defect has closed, which usually only takes a few days to occur. Cleaning may be as basic as rubbing and rinsing the lens with non-preserved saline, or a 6 hour soak in a hydrogen peroxide-based system such as Clear Care -- which is currently difficult to find because of a temporary suspension in manufacturing. But, there are other brands out there. In some cases, a therapeutic lens can actually improve the vision in cases of map dot-fingerprint dystrophy, simply by creating a smoother refracting surface over the lakes and islands of epithelium. DrG http://www.coppellfamilyeyecare.com Thank you for your reply, Dr. Leukoma. My doctor tried putting me on Muro 128 ointment at night several months ago with a previous erosion episode. Unfortunately, the Muro only exacerbated the problem, causing my eye to swell up to the point where it could barely be opened at all. We tried the Muro several times, always with the same result. It seems I have an atypical reaction to the Muro. That is one reason my doctor went to the lenses instead. We had just been through four months of various topical treatments, none of which kept the erosions from recurring. To clarify, to restore the clarity of the lenses, is it acceptable to remove the Night & Day lenses and merely rinse them with unpreserved saline and reinsert? Or, do they need something beyond just saline? What, if anything, have you tried? The only type of cleaning I do is to rub my lens with saline, followed by a hydrogen peroxide disinfection overnight. Research has shown that most micro-organisms are removed from the lens surface by rubbing and rinsing. Disinfection takes care of the rest. Please observe that I have used the word 'rub' several times without the word 'no' in front of it. Of course, we don't really know what type of deposit is on the surface of your lens, and whether or not it can be removed so easily. Are you using an antibiotic along with the the therapeutic lens? DrG Thank you for your reply, Dr. Leukoma. The only thing I have tried thus far is to remove them, rinse with Unisol preservative-free saline, and reinsert. I have not rubbed them with anything, including the saline. I have used GenTeal drops a few times in my eyes while the lenses were in, which is something my doctor suggested. No antibiotic, and no ointments. One thing I really like about these N&D lenses is that they are so easy to handle compared to the Accuvue I used previously for normal social contact lens wear. That lens was much thinner and would always flip inside out. I used a Focus Night and Day plano lens after laser surgery. I switched to Focus Dailies with the doctors permission. The Dailies have a half diopter but to me that's no different from the plano lens. I like that I can put the Daily lens in in the morning and toss it out in the afternoon. For your situation, you could try Focus Dailies at night. I could never get used to cleaning soft lenses. Single use lenses solves the problem. I would never recommend Focus Dailies as a bandage lens. For one, they are not approved for overnight wear. Another reason is that the oxygen permeability is such that significant corneal swelling will occur. Corneal swelling would be undesirable in this situation as it can lead to further epithelial problems. DrG http://www.coppellfamilyeyecare.com >I have been wearing plano Ciba Night & Day lenses to protect my corneas > from erosion episodes. This is my second week with bandage lens, Day 6 > with Night & Days. Is there another reason to cover the corneae? Did you wear the same Ciba lenses the first week? Normally bandage lenses are not supposed to be taken out and replaced again. When bandage lenses are taken out the normal procedure is to place new ones to avoid damaging or infecting the cornea. > I am finding that the lenses give me good crisp vision for a few days, > but then one or both will get blurry. I suspect this is from a deposit > build up of some sort. Talk it over with your specialist, he might want to look at it and maybe he want to chance the replacement schedule. This problem of yours TMHO is not to be taken care off by internet. Hope this helps,  SignatureJan (normally Dutch spoken) Jan, I was recently diagnosed with Map-Dot-Fingerprint corneal dystrophy. The corneal specialist placed a bandage lens on my eye while it was healing from a recent erosion episode. The lens he used initially was an Accuvue Advantage, but it was a -0.50 power because he did not have any plano lenses in the office on that day. Since I wear progressive eyeglasses, this left me overcorrected and I could not see clearly. At my 1 week recheck, I brought CIBA N&D plano lenses with me (he had faxed in a Rx for them to an Internet contact lens provider). The exam recheck showed that my eye was healed from the erosion and he inserted the N&D lens in both eyes to be used as a pre ventative measure against further erosion episodes. He told me to put in a fresh pair after 30 days and scheduled me for a 6 month recheck. Nothing was said about these EWCLs possibly clouding or getting deposits or needing any maintenance whatsoever for 30 days. However, I am finding that they are getting something on them that is interfering with my ability to see clearly. That is why I came to this board to ask a basic question about how to handle this. I am still interested in suggestions for what type of solution to use if I do remove them for servicing in order to have clearer vision when I return them to my eyes. Note: The Unisol solution I referenced was used when I wore daily disposables---infrequently, for social wear in my pre-erosion days. At that time I found that the saline solutions with preservatives irritated my eyes so I went with a preservative-free Unisol saline. I do not have any experience with cleaning solutions and would like to know what I should consider using now that I am wearing the N&D lenses with my progressive eyeglasses over them. Many thanks. > Jan, > > I was recently diagnosed with Map-Dot-Fingerprint corneal dystrophy. > The corneal specialist placed a bandage lens on my eye while it was > healing from a recent erosion episode. The lens he used initially was > an Accuvue Advantage And just this type of lenses I had in mind. The replacement schedule of those lenses is 14 days. But as I advised before, talk it over with your specialist, especialy the use off cleaning solutions.( considering your problem a bad idea TMHO) SignatureJan (normally Dutch spoken) Jan, thank you for your reply. The reason for switching from the Accuvue Advantage is because they start at a half power and are not available in plano. Because I was told to wear them 24/7---including during the day when I wear progressive eyeglasses---my vision was overcorrected at all distances and I could not see clearly enough to read, type, etc. If I end up wearing the contacts only at night, then the half power would not be a drawback for me. I will check back with my corneal specialist to inquire about wearing them only at night. Many Thanks Doctors have different strategies in dealing with erosions. Mine i t remove the lens as soon as the erosion is healed, and then switch th patient to a hypertonic petrolatum ointment such as Muro 128 at nigh for prophylaxis. Perhaps your doctor has seen similar or bette results using the therapeutic lens for a longer period of time However, if the lens is fogging, then it does need to be removed fo cleaning. This should not pose any risk whatsoever, so long as th defect has closed, which usually only takes a few days to occur Cleaning may be as basic as rubbing and rinsing the lens wit non-preserved saline, or a 6 hour soak in a hydrogen peroxide-base system such as Clear Care -- which is currently difficult to fin because of a temporary suspension in manufacturing. But, there ar other brands out there In some cases, a therapeutic lens can actually improve the vision i cases of map dot-fingerprint dystrophy, simply by creating a smoothe refracting surface over the lakes and islands of epithelium Dr http://www.coppellfamilyeyecare.co |
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