Antimicrobial efficacy of multipurpose and oxidative contact lens disinfecting solutions: a systematic review

Area of Science:

• Ophthalmology and Vision Science
• Microbiology
• Materials Science

Background:

• Contact lens disinfection is crucial for preventing microbial keratitis.
• Multipurpose solutions (MPS) and oxidative systems are common disinfection methods.
• Evaluating the real-world efficacy of these systems is essential for contact lens wearer safety.

Purpose of the Study:

• To systematically review and compare the antimicrobial efficacy of multipurpose solutions (MPS) and oxidative disinfection systems (hydrogen peroxide and povidone-iodine) for contact lenses.

Main Methods:

• A systematic literature search was performed using PubMed and Scopus databases, adhering to PRISMA guidelines.
• Included studies compared commercial contact lens disinfecting systems against standard reference strains and clinical isolates.
• Data extraction focused on disinfectant agents, microorganisms, ISO compliance, testing methods, and outcomes.

Main Results:

• Oxidative systems (hydrogen peroxide, povidone-iodine) demonstrated robust antimicrobial activity, often effective against organic soil, biofilms, and clinical isolates.
• Multipurpose solutions exhibited variable efficacy, with some showing reduced effectiveness against fungi and Acanthamoeba cysts.
• While most solutions met ISO 14729 standards, efficacy was significantly reduced under clinically relevant conditions in several studies.

Conclusions:

• Oxidative systems offer superior antimicrobial performance over MPS, particularly against challenging microorganisms and under adverse conditions.
• Current ISO 14729 standards may overestimate the in-use efficacy of disinfectants as they do not fully account for pathogens like Acanthamoeba or resistant strains.
• Enhanced testing protocols incorporating a wider range of microorganisms are needed for a more accurate assessment of disinfectant efficacy and improved contact lens safety.