Wash your hands before eating. Floss. Look both ways before crossing the street. Don't run with scissors. Don't pet stray dogs. And, don't share your contact lenses with anyone. These warnings seem obvious, don't they?

Maybe not. Especially not to a 12-year-old, or even a 16-year-old. Even the late Supreme Court Justice Oliver Wendell Holmes, when he was in his 70s, said, "We [judges] too need education in the obvious." And while they may have that stray dog rule nailed, many tweens and teens should be reminded about the hazards of sharing, as well as some of the other hygiene concerns of contact lenses.

Stories about contact lens swapping have been around for years, and although many in the industry agree it's not a widespread problem, it is something to watch. Eyecare practitioners should educate all contact lens wearers--regardless of age--about the concerns of sharing contacts, says Rick Weisbarth, O.D., executive director, professional services for CIBA Vision.

"My favorite story on this topic goes back to an ad that someone sent me in the mid-1980s," says Weisbarth. "The ad read: 'One pair of tinted contact lenses available, only worn once, $40 or best offer.'"

Weisbarth says he uses the ad when emphasizing to eyecare professionals that they need to remind contact lens patients to vigilantly take care of their lenses.

"Practitioners need to say to all of their contact lens patients, 'These are for your eyes only.' You have to specifically tell that to patients, and not just to children," he says.

MEDICAL, NOT COSMETIC
There's the tendency for those who wear the colored contact lenses--especially if they are wearing them only for cosmetic purposes--to falsely believe they can share the lenses. "What happens is that the public assumes that if there's no prescription, it's not really a prescription device, which is false. A contact lens is a medical device and it must be taken care of properly. It's not something that you share," Weisbarth insists.

Joseph T. Barr, O.D., editor of Contact Lens Spectrum, says the possibility of kids swapping contact lenses may be due to the prevalence of contact lenses today. "The concern is that contact lenses are being trivialized. You can buy them all at once, or even in color, or even if you don't need them...but something that goes on your body shouldn't be shared with someone," he says.

Dwight Akerman, O.D., director of professional services for Wesley Jessen, says the company has proactively tried to tip eyecare professionals off about the potential hazards of contact lens sharing. Wesley Jessen has several lines of colored lenses, including WildEyes.

"We don't believe it's a major issue, but sporadically we get calls from practitioners saying they've had a patient who has shared lenses. Fortunately, there's never been any sight-threatening infection," he says.

Wesley Jessen developed a poster that reads,: "Don't Share your Contacts with Strangers," which the company encourages eyecare professionals to hang in their offices.

One reason not to share contacts is that the bacterial flora in everyone's eyes is different, Akerman explains. "When you share lenses, you could transfer [bacterial flora] from one eye to another, which could lead to conjunctivitis or corneal ulceration. We've gotten a few reports of conjunctivitis, which is treatable...but even one case is too much."

Akerman says he knows of no cases where the sharing of Wesley Jessen lenses may have caused corneal ulcers. "To the best of our knowledge, that has never happened," he says.

Barr also hasn't heard of any cases of corneal ulcers from the sharing of contact lenses. "But, I think it's good to be vigilant," he says. "We should tell our teen-age patients not to share their lenses."

JUST SAY NO
Freddie Bensky, O.D., the owner of Cl-Tinters Oy, a Finland-based contact lens company, says lens sharing is a potential problem with all cosmetic lenses. Cl-Tinters Oy, whose products are available in the United States only through a select number of eyecare professionals, has seven cosmetic contact lens lines.

"We noticed many years ago that there might be a risk," Bensky says. "In our patient leaflet, we say that the swapping of lenses is strictly forbidden. As a manufacturer, that's all I can do. It's up to the opticians and O.D.s to tell kids that you should not swap your lenses," he says.

Weisbarth takes it one step further. He recommends eyecare professionals warn all of their patients about contact lens swapping--even if they don't wear contacts. "Tell your contact lens patients not to share their lenses, and also tell other patients to be aware of this, in case anyone ever offers them contact lenses."

RARE, YET REAL
Mitchell Cassel, O.D., owner of Custom Color Contacts in New York City, says the lens swapping issue has been exaggerated. "I don't think it's a problem at all. I think the media has distorted it," he says. Cassel hasn't seen incidences of conjunctivitis that may have stemmed from shared lenses.

Cassel's business supplies custom-designed, handpainted soft contact lenses for prosthetic uses and special eye effects for the motion picture, TV, and video industry.

Although he gets unusual requests for special lenses every day, he sees an upswing in demand for these novelty lenses at Halloween. "When the kids do get them, we set the ground rules, and we warn their parents about sharing," he says.

'RENTS AND CONTACTS
Sharing and other hygiene issues can be quickly sidelined if parents are aware of the lens fitting and daily cleansing rituals.

"Parents need to be involved," says Sarita Soni, O.D., professor of optometry and associate dean for research and graduate programs at the Indiana University School of Optometry. Parents who are tuned in can monitor young patients at home, and inform the doctor of any non-compliance issues.

Soni notes that once tweens and teens start wearing contacts, they often don't want to return to glasses; which is why if they have problems, they won't be upfront with the doctor. "If they have symptoms, they will not complain."

Jeffrey A. Dunn, O.D., a contact lens specialist at the office of Joel Zaba, O.D., which specializes in pediatric eyecare in Virginia, agrees parents must ensure the child is properly caring for the lenses.

"I make sure to educate the parent, because many parents haven't worn contact lenses," Dunn says.

In some cases, even if the parent is a seasoned contact lens wearer, he or she may still be unaware of the precautions to take with contacts. Dunn says one time a mother brought her 10-year-old daughter in and told him the daughter was ready for contacts, and in fact, had been wearing the mother's contacts for the past 48 hours--even sleeping in them!

Dunn immediately told the woman she had put her daughter at "severe risk."

"She felt stupid, and said she had never realized it," Dunn says. "This was a concerned mother, but she just didn't know."

Dunn told the mother he would not fit her daughter with contacts, because neither one of them fully understood the responsibilities of taking care of contacts.

In addition to not sharing, these responsibilities include the following:

Cleansing. Cleanliness is a major responsibility when wearing contacts. "Stress washing your hands constantly," Soni says. David Dickson, O.D., of Professional Eye Care Associates, Columbus, Ohio, encourages using anti-bacterial soap, which won't leave a residue as some soaps will. When it comes to lens cleaners, Peter Ellis, O.D., of Point of View, Falls Church, Va., says multi-purpose solutions are good for the youngsters.

Bedtime habits. Young patients need to realize that sleeping in contacts is a major no-no. Dickson simply tells the youngsters that they should not sleep in lenses, and to reinforce the point, may say, "When I was growing up, you had to wait until you were 13 to wear contacts. You're lucky you can wear them now."

Swimming. Soni says tweens and teens must take extra precautions if they are going to swim in their lenses. "I tell patients that if they are going to swim, they should wait half an hour after getting out of the pool, because [soft] lenses may adhere to the cornea. Then, take the lenses out, and clean and disinfect them immediately." She then recommends putting on a fresh pair.

These O.D.s say the first six months is the most important time to stress overall hygiene issues to young wearers. Ellis repeats the cleansing and hygiene drill every time the young patient returns. He also has a poster with 50 photos that graphically show what could go wrong with the eye if the lenses aren't taken care of properly. "I get some good responses from that," he says.

But, the most important aspect to emphasize when fitting contact lens patients--regardless of age--is that contacts are medical devices, and must be treated as such. EB