Protein deposits - how do you prevent them?

[Lia Williams]

I went for a check up last week and my contact lenses (corneal RGPs) were found to be covered in protein deposits.

Although I use Boston cleaning solution, and Amiclair protein remover tablets once a week, they were still covered in deposits. I've only had this problem in the last couple of years; previously I've had lenses which have lasted five years with only the occasional use of protein remover tablets.

Does anyone have any ideas how to prevent protein deposits build-up in the first place?

Thank you,

Lia

[electricheadx]

I use Menicon Progent to remove protein deposits from the lenses. It leaves them spotless.

I dont think you can really prevent the deposits though.

[Lia Williams]

Hi Denis,

Thank you for the suggestion. I'll see if I can find some.

Lia

[rosemary johnson]

I confidently expect there will be a whole team of optoms screaming at me for this post....
I've never had a problem with protein deposits in 36 or so years of wearing lenses.
I have sclerals - made of RPG material for the last nearly 20 years and PMMA before that.
I clean them in the same stuff that the manufactureres use - washing up liquid.

What could be of interest is that you've only just started having the problems recently.
Have you had any change in your life that may have resulting in a change in the composition of your tears?
- for example, change of diet, change of work hours and habits/daily routine, more or less tea/coffee? - different living or working environment? gong on/coming off the pill or nearing menopause (if you'll excuse me suggesting any of these), any other long-term medications.
Or anychange in regular CL fluids?
Rosemary

[Anna Mason]

I have problems and I use a cotton bud to get into the nooks and crannies.

[GarethB]

RGP is just a generic name for gas permeable lenses.

Your eyes can react to lenses before they feel uncomfortable, so there could be some minor eye irritation caused by the lenses changing the amount of protein that gets deposited on the lenses. When I had RGP's I got to the point that protein removal tablets were being used twice a week and I could only wear them 5 days a week for no more than 8 hours.

Since going to the soft lenses for KC, no protein problems and wear lenses all my waking hours (average is 16) and iof needs be for 20 hours with no ill effects the next day. I put much of this down to the fact the new lenses are so much more comfortable than RGP's plus the runni9ng costs are over a third less.

[Lia Williams]

Rosemary,
Thank you for your thoughts. I will admit to using washing-up liquid on my PMMA lenses in the late 70’s and early 80’s, it was the only way to get them clean. But then in those days we were only told to change our soaking solution once a week. Since I’ve had my RGP lenses I’ve never really had a problem with protein deposits. With the introduction of cleaning solutions, such as Boston, which are designed to remove deposits, I only used protein remover occasionally and never really noticed any difference in the lenses.

In 2004 I got a new pair of lenses which I wore quite happily for the next five years. Except that a couple of months before my appointment jn 2009 I got a bad cold and conjunctivitis and couldn’t really get my lenses clean after that. At my appointment a new pair were ordered and since then I have been using protein remover tablets regularly but at each subsequent appointment the optometrist comments on the state of my lenses . The only real change in my life is getting older, I don’t take any medication, I have gone through the menopause so that may be an issue.

Gareth,
It’s interesting what you say about not having a protein deposits issue with soft lenses. The optometrist has been trying different lens designs to reduce irritation to see if that helps. I did suggest soft lenses but it was thought that they might be too thick (I’ve a high –ve prescription). I was using a small diameter lens but my current ones are very slightly bigger and the vision with them is excellent and my wearing time is 15 hours; but I don’t want a repeat of the problem I had a couple of years ago when it became impossible to clean my lenses and the wearing time dropped dramatically. I have decided to up my use of protein remover tablets to twice a week and I will try to get some Menicon Progent that Denis suggested. If my lenses are still getting a build-up I’ll ask again about soft lenses.

Lia

[GarethB]

Lia

It is true that the older soft lenses for KC were thick and had a low oxygen permeability. My right eye is -8 but has some funny bits on the periphery becasue of the way my aging transpalnt has twisted and interacting with the KC that has come back in the edge of host cornea.

The new soft lenses have a much higher oxygen permeability that even when thicker than for example a standard silicone hydrogel soft lens, the oxygen permeability is approaching that of an RGP lens. The soft lenses I have been on for the past 25 months are the Kerasoft IC (there are others) which is a high water content silicone hydrogel lens.

With the RGP's I was starting to devlop oedema in the transpalnt due to oxygen starvation to the cornea and I was only wearing lenses 4 - 8 hours per day and only for 5 days. We tried large and smaller RGP lenses of different material but it was eventually concluded that I had become sensitised (allergic even) to the RGP lenses. It is unusual for this to happen but the fact is, it does happen to some of us. I was lucky in that there was the opertunity to go back to Ultravisin and continue with their soft lens trials under the watchful eye of my NHS hospital. As in my earlier post, I now average a 16 hour wear time 7 days per week.

Bottom line is, fitting our eyes is as much an art form as it is a science, so you are unable to say a lens offers no benefit to you until you try it. I think Andrew came up with the phrase that KC is a bespoke condition.

[Lia Williams]

Gareth, I agree that not only is Keratoconus a bespoke condition but we need bespoke lenses to deal with the problem.

I’ve followed your story with interest over the last two or three years and I’m impressed with the vision (both acuity and wearing time) you have achieved.

Although the hospital did suggest a year or so ago that soft lenses might be too thick I did volunteer for one of Lynn’s workshops last year and she assessed my eyes. As it turned out I wasn’t an ideal candidate for a workshop as my corneas, especially the right one, were found to be somewhat warped as I have worn corneal lenses since 1975 and it would therefore take some time before the eyes could adapt to the soft lenses. What I do remember is that the soft lenses were extremely comfortable; I really did not know that they were in my eyes.

Meanwhile the hospital had ordered some corneo-scleral RGP lenses and the vision from the fitting set looked promising so I didn’t pursue the soft lenses. Unfortunately the corneo-scerals didn’t work for me. So it was back to finding another pair of corneal RGPs.
The lenses I’m wearing at the moment are giving me excellent vision and reasonable wearing time, although I can’t go beyond 16hrs without having a bad-eye day a few days later. In fact the right eye has the best vision it’s had in years. Previously the only comfortable lens for my right eye was the Rose K but the vision would vary as I blinked and some ghosting remained.

My concern is that I may be approaching contact lens intolerance unless I can solve this protein deposit problem. I really can’t see enough with my back-up glasses to function properly as I can’t see well enough to drive or read easily. In the search for an alternative lens the hospital has recently taken a topography of my corneas so it may well be that soft lenses have been ruled out because they are aware that soft lenses would not be an instant fix. So if at my next check-up the optometrist comments on the state of my lenses I may suggest trying some soft lenses as ‘I’ve heard that they are less likely to accumulate protein deposits’ but pointing out that I’m aware that there could be some adaption time.

Lia

[GarethB]

There are other soft lenses that can be tried. Some people faced with the demoulding problem have done this gradually by keeping an RGP in one eye so you aren't completly without vision and concentrate on the eye that is giving the most problems with the soft. This is taking the approach used with grafts, treat the worst eye as there is nothing to loose philosphy.

Last month I met someone who had been in RGP's for far longer than I have ever worn RGP's (I can't remember how long they had been in RGP's it was a very busy event) and their eyes demoulded relatively quickly and their uncorrected vsion now far exceeds their uncorrected vision when they were in RGP's.

There are so many lens designs and lens materials out there it is hard to kn ow what to try next.