Taking a Second Look at Disposable Contacts : Health: Once touted as convenient and safe, lenses are now linked to increased risk of infection. Misleading labels, sloppy eye care may be to blame.
When the nation’s eye-care manufacturers released disposable contact lenses four years ago, they admittedly acted with less than perfect vision.
Since then, guidelines on how to use disposable contacts have evolved amid reports that the lenses--worn by 2 million Americans--might increase the risk of serious eye infections.
So muddled is the picture now that practitioners disagree on how the lenses should be used, what labels should say and even what the lenses should be called. Although safety continues to be the primary issue, most experts say the risk of infection from the lenses is extremely low.
“There is a lot of confusion on this whole issue of disposable contact lenses,” says Dr. James Key, a clinical associate professor at Baylor University and an adviser to the contact lens industry. “Even a large number in the medical community are confused.”
In the latest of several studies examining a possible link between disposables and a rare but serious eye infection called ulcerative keratitis, researchers from the Wilmer Eye Institute at Johns Hopkins University Medical School in Baltimore reported last month that disposable-lens wearers have up to 14 times the risk of users of other types of contacts. However, the study did not specify how long users were wearing their lenses, including overnight, and whether they were cleaning them properly.
A much larger study submitted for publication by Harvard University researchers reportedly has found a very low risk of the condition.
What is perhaps most disturbing to consumers is that the lens’ mixed reputation comes after they were originally touted for their convenience and their safety. Because fresh pairs were used regularly, the risk of eye infection ostensibly would be lower than with reusable contacts.
Now, neither assumption about potential benefits is proving completely accurate, experts say.
When approved in 1988, disposable contacts were considered an extended-wear product that could be worn continuously for up to 14 days before being discarded. But because of the risk of infection, some doctors recommend that patients avoid wearing the lenses overnight.
“For labeling requirements, disposable means no lens care,” Key says. “But most practitioners recommend that they be removed and sterilized.”
Adds Dr. Jay Schlanger, who practices at the Cedars-Sinai Medical Towers, “The disposable is moving much more away from extended wear into the concept of flexible wear--wear it on a daily basis; sleep in it when you want to, but not all the time.” He advises patients to wear disposables for a week continuously or days-only for two weeks.
In 1989, the first study to suggest a connection to ulcerative keratitis reported that wearing the lenses continuously for more than a week increased the risk of the infection, which can lead to vision loss. The Food and Drug Administration, with the backing of the contact lens industry, cautioned that the lenses should be worn for no more than seven days without being removed.
Gary Mulloy, president of the Sunnyvale lens manufacturer Pilkington Barnes Hind, agrees with the idea of caution. His company is test-marketing its disposable contact lens only in Europe, having postponed entry into the U.S. market because it anticipated problems with misuse, Mulloy says.
“Manufacturers have sold the whole notion to consumers of no care for the lenses,” Mulloy says. “I think that’s one of the reasons that the lenses are open to abuse. It is still a soft lens that should be properly disinfected and cleaned.”
Mulloy says his product, which the company hopes to begin marketing here in a year or two, will discourage overnight use.
Key says he and others have recommended that the term “frequent replacement lenses” be substituted for “disposable lenses” to clarify that they are not recommended for extended wear and should be taken out, cleaned and reused.
But even with a name change, potential problems remain. “Even if you wear them on a daily wear basis, you still have more of a risk with disposable lenses,” says Dr. Anthony Nesburn of the American Eye Institute at Cedars-Sinai Medical Center. “I would assume that has to do with the care the lenses get. People might just pop them out and, thinking they are disposables, not take care of them.”
For this reason, Key says he dissuades teen-agers from using disposables. Others who shouldn’t wear them, he says: people with sloppy habits and “know-it-alls.”
“These are people who don’t follow instructions well,” Key says.
He is particularly critical of using newer one-step cleaning solutions on disposable lenses, saying, “I think there has been too much emphasis on convenience in making these lenses last longer than they should and by cleaning methods that are less than optimal.”
Instead, he recommends that wearers use hydrogen peroxide for cleaning.
But Dr. Daniel J. Sigband, a Huntington Beach ophthalmologist who was an early researcher of disposable lenses, says any handling of the lenses can increase the risk of contamination.
“The advantage of wearing the lenses (only during the day) is that it adds an element of safety,” says Sigband, who notes that he has nonetheless seen very few problems with disposables. “The disadvantage is that you’re handling a lens much more.”
Another problem is that cleaning the lenses will add to the cost. The contacts cost about $3 to $6 each, but cleaning solutions may cost up to $150 a year. With the added expense, Mulloy says, disposables can start to look less attractive.
Many doctors also criticize the purchase of disposable lenses through mail-order houses and chain stores that provide a bare minimum of service and follow-up care.
“This is not something you should go to the cheapest place to buy the lenses from,” says Schlanger. “In the hands of a good patient under the care of a good doctor, the extended wear is not as bad as it has been publicized.”
Most experts say that people who follow their doctor’s advice and receive regular eye exams will have no problems.
“The key is for patients to follow their eye-care practitioner’s instructions and to determine if an individual can tolerate overnight wear,” Sigband says. “In my experience, 85% can adapt.”
