Your contact lens questions answered

For our contact lens campaign this September we asked you to send in your contact lens care questions. Here's what you sent in, with responses from our contact lens team.

Question 1: I wear contact lenses for sport in my good eye. I have a shell on the other side. I use the daily disposable ones with no problems. I wear glasses the rest of the time. In your opinion is this a good idea? Some monoculars are completely against contact lenses.

Answer: The only sight threatening complication of contact lens wear is microbial keratitis (or infection of the clear layer at the front of the eye where the contact lens rests, the cornea). This is because microbial keratitis (MK) has the potential to scar the surface and cause distortion of vision. In some rare cases, the cornea becomes so damaged it needs to be replaced by human tissue donated for transplant, and even more rare, the whole eye becomes infected or damaged so that it needs to be removed. This is the very worst case scenario.

The contact lenses that have the lowest risk of  MK are rigid gas permeable lenses, but these are not always practical for sport and can be difficult to wear on a part time basis and they eye needs to adapt to the feel of them. While daily disposable soft lenses do not have a lower risk of MK, the cases are less severe than in reusable contact lenses. We think this is because contact lens cases can contain more harmful bacteria than we find on the body and replacing lenses daily has less chance of those harmful bacteria.

We know that many people who wear daily disposable lenses do not always wash their hands before they wear them and sometimes wear them overnight or store them and re-use them later. All these behaviours increase the risk of infection. Wearing daily disposable lenses for your purposes seems like a sensible option, providing you follow good hygiene. This includes washing hands with soap using the proper technique (link to NHS hand hygiene technique) including the tips of fingers, which touch lenses and drying hands with a lint free clean towel. Although we drink water from the tap, it can contain harmful organisms such as Acanthamoeba, which can cause a serious eye infection and should not come into contact with contact lenses.

Thank you for your question and we hope you find this information helpful.

Question 2: Any tips in putting contact lenses into my two year old granddaughter's eyes? 

For babies we often advise to insert contact lenses just before they wake up from their morning sleep i.e. whilst they are asleep. The best thing would be to contact your granddaughter's contact lens practitioner and ask them to review your insertion technique.

Question 3: My son is 25 and has been wearing contact lenses since he was 16 years of age. I nag him to wash his hands before he touches his lenses but he hardly ever does. He says to me, "Nothing has happened to me yet Mum, why would it now?"

This is a common problem, in that eye infections with contact lenses are rare (affecting around 4 per 10,000 wearers per year with vision loss affecting only around 15% of those cases), so contact lens wearers often fall into bad habits which get reinforced with time. If he has not seen it already, encourage him to watch the video of Saira talking about her experiences.  Although she had a very rare infection from contact lens wear, it has lasted more than two years and dramatically affected her life.

We think the most important time to have clean hands is before you put lenses in the eyes, so maybe he could put his lenses in directly after a shower (he should not wear them in the shower as there are bugs in the water like the type that affected Saira) and ideally if he had daily disposables he would just throw them out after he removed them. 

Question 4: Can I wear my soft monthly contact lenses when I swim? I am very shortsighted and can’t see otherwise.

Water borne bacteria and other bugs such as the free living protozoa Acanthamoeba can attach to contact lenses when swimming and cause infection. This is particularly a problem in public pools where there can often be traces of urine and faecal matter. The safest option is to use goggles made with your prescription. These can be obtained from your optician. Tight fitting goggles over contact lenses can be problematic in that water often seeps in.

If contact lenses cannot be avoided while swimming, we recommend air tight swimming goggles with daily disposable lenses which are removed shortly after swimming (wait a few minutes as the lenses can sometimes tighten up and be difficult to remove straight away) and disposed of. It is common for contact lens wearers who reuse lenses to have a small supply of daily disposable lenses that can be used when swimming with air tight goggles or for general use on holiday.  

Ask your optician as they will need to see if it is possible to fit you with daily disposable lenses that suit your eyes. 

Question 5: How much tear film do you think passes through from the vitreous, such as using bandage contact lenses? Have you seen infections from using autologous serum or PRP with scleral lenses? For example if patient has had to go overseas to access blood products which may be less screened.

Generally the way that tear film components or drugs/ additives that are added to the tear film when wearing a contact lens gets to the ocular surface is by tear exchange behind the contact lens. As you blink, tears are forced across the surface of the lens and also behind the back surface of the lens. 

One of the action of blinking is to remove debris and foreign matter from the ocular surface. This is less efficient when wearing a contact lens. Some researchers think that this disruption of the tear film contributes to the increased risk of ocular surface infection when wearing contact lenses. One of the conundrums is that bandage lenses which are usually used to stabilise a damaged ocular surface which would be at increased risk of infection as the protective barrier is no longer present, have a very low rate of infections. 

The ocular surface is likely to produce tear film components that help heal the surface and the bandage lens, like when we put a plaster on our skin, stops bugs in the environment from getting to the surface. Autologous serum and platelet rich plasma are derived from the patients own blood and helps the healing process by adding nutrients. 

Contamination could come from the blood product or just that the eye is more prone to infection because of the condition. However, a low number of infections using these products have been reported andA large scleral lens would have the same effect as a soft bandage lens and we would again expect the benefits of surface protection to outweigh the minimal risk of infection. 

For non healing ocular surface damage, the use of autologous serum usually with a bandage lens is widely used practice, especially when the patient is symptomatic.