Purpose: To evaluate predisposing factors in subjects susceptible to solution-induced corneal staining (SICS).
Methods: Four hundred forty-six existing soft contact lens wearers were randomly fitted with one of two study lenses (lotrafilcon B, CIBA Vision, or omafilcon A, CooperVision) and used a hydrogen peroxide care system (Clear Care, CIBAVision) for a 1-month period. Each subject was then challenged with the same lenses presoaked in a multipurpose solution (ReNu MultiPlus, Bausch & Lomb) and assessed after approximately 2 h to be categorized as either “stainers” or “non-stainers” based on whether they showed a classic SICS pattern (diffuse punctate corneal staining in three or more peripheral quadrants).
Results: Overall, 36% (155 of 425) of eligible subjects were classified as stainers and included a higher proportion of omafilcon wearers: 44% (91 of 205) vs. 29% (64 of 220). After using the peroxide system, the stainers were more likely to show poorer wetting (odds ratio [OR] = 1.76, p = 0.02) compared with the non-stainers. Lens wetting showed a significant negative correlation with film deposits (r = −0.63, p < 0.0001, n = 425). Furthermore, on slit lamp examination, the stainers were more likely to show higher levels of upper- and lower-palpebral hyperemia (OR = 2.18, p = 0.02; OR = 1.93, p = 0.04), tarsal roughness (OR = 1.71, p = 0.01), corneal staining (OR = 17.1, p < 0.0001), and conjunctival staining (OR = 1.94, p = 0.004). Although not exposed to preservatives, twice as many eyes in the stainers group had some level of corneal staining: 51% vs. 25%. There were no significant differences between the stainers and non-stainers with respect to age, sex, refraction, or keratometry (p > 0.05).
Conclusions: This study highlighted some notable trends in patients susceptible to SICS. The findings point toward poor tear quality as a predisposing factor for SICS.