Compliance is the key to long-term success for all contact lens wearers. It is even more important for keratoconus patients, since they are almost totally dependent upon contact lenses for all their visual tasks. After patients have been successfully fit with contact lenses, a high percentage of complications and adverse reactions are related to skipping or shortcutting the recommended procedure for cleaning, disinfecting, and storing their lenses. A study revealed that 27% of patients admitted that they don’t clean their lenses daily, and it is likely that an even higher percentage of lens wearers are non-compliant in some way. Some patients have used dishwashing liquid, baby shampoo, or even toothpaste instead of the recommended cleaners; stored their lenses dry, rather than in an FDA-approved disinfecting solution; and used saliva (which contains a host of sight-threatening microorganisms) instead of the sterile solutions that are readily available, to wet their lenses before inserting them in their eyes.
Eye infections, while infrequent, can be devastating, preventing patients from wearing their contact lenses for days or weeks and sometimes resulting in permanent corneal scarring and loss of vision. A thorough understanding of the role played by each of the rigid lens care products will help to keep lenses clean and eyes healthy.

Most rigid lens care systems today use either a combination of a cleaning/soaking,  a wetting/soaking, or cleaning/wetting/soaking/disinfecting solution. The most common systems are Bausch & Lomb’s Boston (Original Formula), Boston Advance Comfort Formula, Alcon’s Unique-PH, Allergan’s Comfort Care GP and Wet-N-Soak Plus. 

They consist of :

• A daily cleaner, to remove tear film oils, mucus, cosmetics, and other debris from lens surfaces. Cleaning solution containers have a red tip to warn patients that the solution should not be put in the eyes. If cleaner is accidentally instilled in the eyes, it should be flushed out immediately, preferably by dunking the entire face into a sink filled with water.

• A combination wetting/soaking solution for lens storage and reinsertion in the eye, which kills bacteria and other microorganisms, keeps lenses from warping, and acts as a “cushioning agent” when the lenses are placed in the eyes. 

• An optional enzymatic cleaner (in either liquid or tablet form), for patients who build up a lot of protein on their lenses. Not all rigid lens wearers need an enzymatic cleaner.

• A lubricating and rewetting drop, to instill in the eye while you are wearing lenses. This will help to flush debris from under the lenses and help the lenses to glide more smoothly and comfortably in the eyes.

•  Each night, before removing your lenses, wash your hands with a non-oily soap. Bar soaps, like  Dial, , or clear or antibacterial pump soaps are recommended. Creamy soaps like Dove and Caress transfer from hands to lens surfaces and may leave a film on the lenses.

•  Dump out the old wetting/soaking solution from the lens case, rinse the case with hot water or a rinsing solution recommended by your eye care practitioner, and refill it  with fresh wetting/soaking or conditioning solution. The lens case must be rinsed nightly and refilled with fresh solution in order to maintain maximum strength for disinfecting the lenses. Old solution that is merely “topped-off” will fail to kill microorganisms effectively and, if the tip from the solution container is immersed in the old solution while the bottle is squeezed, the dirty solution will be suctioned up and the entire bottle of solution contaminated. 

• Always refill the case before placing your lenses in it, as they may become scratched if they are placed in a dry case. 

• Set the lens case in front of you with the right compartment in front of your right hand. Remove right lens from eye. 

• Place 2-3 drops of cleaner in the palm of your hand and rub the lens with it for 20 seconds. Do not rub the lens between your fingers! It may warp or crack! If the lens curvature is too steep for your index finger to clean the inner lens surface, try using your pinkie or a cotton swab.

• Rinse the lens with cool or lukewarm water. Hot water will warp the lens. Do not rinse your lenses over an open drain!

• Replace the right lens in the case and repeat the steps for your left lens.

• Soak lenses overnight or for at least 4 hours.

• In the morning, wash your hands and insert your lenses directly from the wetting/soaking or conditioning solution. Do not rinse first! The solution will help to cushion the lenses as you insert them. In addition, if the lenses are rinsed with water after they have been disinfected, there is a chance that they may become contaminated from impurities in the water supply.

•  Most rigid lens wearers use systems with a cleaner and wetting/soaking or conditioning solutions, some may be using the Optimum by Lobob or Claris (an Allergan product). These systems contain a different group of products. They include:

• A combination cleaning/soaking/disinfecting solution, to remove tear film oils, mucus, and lens debris chemically by breaking the bonds between the deposits and the lens surfaces rather than physically by friction-rubbing with a separate cleaner. The solution also prevents lens warpage and contains benzyl alcohol to kill bacteria and other microorganisms on the lenses. These solution containers have red tips and lenses disinfected with these two systems should never be reinserted in the eyes without rinsing!

• A wetting/rewetting solution to keep the lenses from falling off the fingertip during insertion, and provide a “cushioning agent” when the lenses are placed in the eyes.

• An “Extra Strength” cleaner to be used as needed to remove stubborn deposits.

Follow steps 1-3 of “The Nightly Care Routine” above. Place the lens in the palm of your hand, cover with 10 drops of cleaning/soaking/disinfecting solution, and rub for 30 seconds until the solution becomes sudsy.

If the lenses have stubborn deposits, apply a few drops of Extra Strength cleaner and massage into the lenses for 30 seconds.

Rinse lenses thoroughly with cool or lukewarm water and store them in solution for at least 6 hours.

In the morning, wash your hands, remove the right lens from the cleaning/soaking/disinfecting solution, and rinse well. Inadequate rinsing will cause the lenses to sting when they are reinserted in the eyes.

Before reinserting your lenses, apply 2 drops of wetting/rewetting solution to the lens surfaces. Do not rub it into the lens! Insert right lens and repeat for the left eye.

Multipurpose solutions that contain ingredients to clean, soak, disinfect, and wet rigid lenses are the most recent products to become available for RGP lens wearers. At present, the only products on the market are Bausch & Lomb’s Simplicity, and Alcon's Unique-PH. Allergan plans to introduce, a one-bottle care system in the near future. The lenses are rubbed, flushed to remove loosened debris, soaked for at least 4 hours, and reinserted in the eyes with the same product. While these products may provide adequate cleaning for patients with good tear quality, many patients will find that they really need a separate cleaner in order to keep their lenses from becoming filmy. The convenience of one-bottle solutions may provide a good alternative for occasional use when patients travel and may prove to be the best option for patients who tend to skip the cleaning step most of the time or for those who live in or travel to places where water for rinsing off a separate cleaner may be contaminated or possibly not available at all.

It is important to call your contact lens fitter immediately if you should experience any of the following symptoms:

• Pain: when placing lenses on the eyes, while wearing the lenses, or after removing them

• Burning, a sensation of heat, redness, excessive tearing, or discharge

• Inability to keep the eyes open

• Extreme sensitivity to light

• Severe or persistent haze, fog, or rainbows around lights

• Severe irritation

• White spots on the cornea

Phyllis Rakow is Director of Contact Lens Services for the Princeton Eye Group in Somerset , NJ.  She is a JCAHPO and NCLE certified ophthalmic medical technologist and an Honored Fellow of the Contact lens Society of America. 

DO’S AND DON’TS FOR RIGID LENS WEARERS

• If your lenses ever dry out, soak them for at least 4 hours before you wear them again, since they may have warped or flattened in curvature when the liquid evaporated.

• Do not mix and match solutions made by different manufacturers. Doing so may cloud your lenses, cause them to become gummy, or irritate your eyes. Make sure that the cleaning, soaking, disinfecting, and wetting/rewetting products you buy are all part of the same care system.

• Always store your lenses in a case with ridges on the bottom. Lenses tend to suction onto smooth-bottomed cases and may chip if you try to pry them up at the edges.

• Replace your case each time you buy a new bottle of wetting/soaking or cleaning/soaking solution. Cases tend to become contaminated. You can clean case with your contact lens cleaner using a brand new inexpensive toothbrush. Be sure to rinse the case well before using it again.

• If the skin on your hands is rough, ask your contact lens fitter if you can use a manually-agitated device such as the Allergan Hydramat or a mechanical device such as the Clensatron. These devices work like miniature washing machines and may protect the lenses from becoming scratched from your rough skin.

• If you remove your lenses with a suction cup make sure you know exactly where the lens is before placing the suction cup on the eye. Suction cups should be cleaned with contact lens cleaner and rinsed after each use. They can also be soaked in wetting/soaking or cleaning/soaking solution.

• If you drop a lens, do not drag it along a surface. Wet your finger with wetting/soaking or rewetting solution and touch it gently to the lens to lift it.

Insurance Reimbursement Request Letter (Download)

If you cannot open this PDF file, click the "Acrobat" link above to install a free copy of acrobat reader on your computer, or if you would like a copy mailed to you, send  a "SASE"  (self-addressed stamped envelope )  to:

National Keratoconus Foundation
8733 Beverly Blvd. #201
Los Angeles, CA 90048
 

 A new diagnostic instrument for contact lens fitting is rapidly gaining popularity: the corneal topographer.  This is the machine where you are asked to place your chin in a chinrest, forehead against a headrest, and calmly stare at a red light while a whorl of illuminated concentric rings is brought so close to your eye that you feel as if you are falling into a vortex that will drop you into a Twilight Zone rerun.  As bleeping and whirring noises build to a climax, you nervously anticipate a blast of gamma rays or photon particles that will knock you out of your seat.  Suddenly, silence.  The tech says, “OK, you can relax now.”  As you sit back and decide if you’ve been accosted or not, a computer printer comes alive.  Seconds later, the printer pops out a colorful and informative map of your cornea.

 What this map reveals is the topography, or shape of the corneal surface.  A familiar analogy is a topographical land map, which uses a series of wavy lines to show the surface characteristics of a tract of land – the hills, valleys, and plains.  The closer the lines are to each other, the more abrupt the change in elevation.  Weather maps also use lines, called isobars, to show areas of different barometric pressure.  The lines used in corneal topography are the illuminated concentric circles you see in the machine.

 When the illuminated rings are brought close to the eye, a reflection is formed in the cornea as if it were a mirror.  If the corneal surface is smooth and regular, the reflected lines are circular and equally spaced.  When the corneal surface has abrupt changes in elevation and curvature, as in keratoconus, the lines become irregular and distorted.  The keratometer, which for years has been used to measure the central corneal curvature, uses the same reflecting principle but has only one illuminated ring.  Corneal topographers use numerous rings, supplying information about the corneal surface from center to edge.  This expanded information is especially useful in keratoconus, because the cone is often displaced from the center of the eye.

 The accuracy of the information from the corneal topographer is heightened as well.  Whereas the keratometer estimates corneal curvature by measuring only four points on the cornea, the topographer is linked to a computer that evaluates tens of thousands of points along the reflected lines.  The computer then illustrates the information in a color-coded map, similar to the colorful Doppler radar pictures used on weather maps to show differences in rainfall or temperature.

If your contact lens fitter uses corneal maps, ask for a copy of yours.  “Hot” colors like red and orange depict the steepest areas, with “cool” colors like blue showing the flattest.  Most maps have all the colors from red to blue explained somewhere off to the side, in terms of their corresponding dioptric values (the diopter is the unit of measurement used to express the refractive power of lenses, and eyes).  Also represented are simulated K’s, the readings at the center of the cornea that the keratometer might give; rings and/or blocks used to measure out from the center in millimeters; and numbers around the outside to mark the meridians of the circular cornea through 360o.  If you have keratoconus, the hottest spot on the map marks your cone.  Once located by the color, the dioptric power, distance from center, and meridian are easily determined.

Another handy feature of the corneal topographer allows the operator to view simulated fluorescein patterns.  The fit of rigid gas permeable contact lenses is finalized by staining the tears with sodium fluorescein dye (the orange stuff the doctor or contact lens technician puts in your eye, which later comes out your nose).  Under a black light, the dye fluoresces a beautiful lime green.  Fitters can see how much space is between the contact lens and the eye in a given area by the amount of green that collects in that area. Where the cone is lightly resting against the back of the contact, hardly any green is evident because there is not much space for the tears.  Well, the computer software of the corneal topographer can superimpose hypothetical contact lenses over your map, and show the probable fluorescein patterns on the monitor.  This feature may save time by reducing the number of lenses that actually need to be tried on the eye and evaluated.

Notice I said may save time.  When personal computers were first gaining popularity, I remember hearing how much time they would save.  Now I find myself anchored to a keyboard for several hours every day.  Despite all their fancy features, there is one thing that corneal topographers cannot replace: the skill of the contact lens fitter.  Corneal maps need to be captured properly, interpreted correctly, and filed carefully for future reference.  Otherwise, the benefits of the technology are not passed on to patients.  And even after investing the time to gather all this advanced information, lenses must still be evaluated on the eye.

Computers can simulate how the back surface of the contact lens might follow the front surface of the cornea, but many more variables affect how a lens actually fits.  Patients have different blink rates, lid tension, tear composition, and lens powers.  Skilled contact lens technicians know lenses must position properly between blinks, move just the right amount during blinks, provide crisp vision and be comfortable to boot.  To achieve success in all these categories, fitters must ultimately watch the lens perform in its dynamic natural environment - on the eye, not on a computer monitor.

Nevertheless, computerized corneal topographers are gaining favor with contact lens fitters across the country.  Topographers provide a clearer picture of the surface shape of the cornea, especially in cases where the cornea is diseased or injured.  Corneal maps can also detect changes in corneal shape from office visit to office visit, which is extremely helpful in keratoconus.  Maps can even be sent over the Internet to contact lens manufacturers who are customizing lenses, or to other doctors for second opinions.  So if you haven’t yet seen a map of your cornea, you probably will in the near future.  Just keep watching for those illuminated rings spiraling toward your eye.

Patrick B. Goughary, a Fellow member of the Contact Lens Society of America, teaches contact lens fitting at Camden County College in Blackwood, NJ.
 

acanthamoeba keratitis  (AY-can-tha-MEE-buh ker-a-TIGH-tiss):  A rare but serious sight-destroying inflammation of the cornea caused by a parasite found in contaminated water.  Most cases have been traced to the use of home-made saline solution, tap water rinses, and contaminated pools, lakes and hot tubs.

accommodation:  A change in the focus of the eye to allow clear vision at various distances.

apex of cornea  (Ay-pex): The peak of the cornea, normally located  directly over the pupil and visual axis.

aspheric lens  (ay-SPHER-ic):  A lens that resembles an ellipse, parabola, or other conic section rather than a sphere.  It can be designed to improve the fit and comfort of a lens by paralleling the cornea more closely or to provide a progressive bifocal effect.

astigmatism  (uh-STIG-ma-tizm):  A refractive condition in which the cornea, the lens, or both are ellipsoidal rather than spherical and light is not refracted equally in all meridians.

axis (AK-siss):  The principal meridian of a cylindrical lens (in reference to contact lenses, the flattest meridian of a toric contact lens).

bandage lens:  See therapeutic lens.

base curve:  The central posterior (inside surface) curve of a  contact lens.  The measurement of the base curve is actually that of the radius of curvature of the sphere from which the lens is made.

benzalkonium chloride  (ben-zal-CONE-ee-um KLOR-ide):  A quaternary  ammonium compound used as a preservative or disinfectant in eye medications and rigid lens solutions.

benzyl alcohol  (BEN-zil):  A disinfectant and preservative in rigid lens solutions.

blepharitis  (blef-er-EYE-tiss):  An inflammation of the margins of the eyelids, often caused by the staphylococcus organism.

conjunctiva  (kon-junk-TIVE-a):  A thin, transparent membrane that lines the eyelids (palpebral conjunctiva) and the sclera (bulbar conjunctiva).

conjunctivitis  (kon-junk-ti-VIGH-tiss):  An allergic, infectious, or chemically-induced inflammation of the conjunctiva.

cornea  (KOR-nee-uh):  The transparent, avascular structure that forms the "window of the eye."  It can be compared to the watch crystal over the face of a watch, and is composed of five layers: the epithelium (outermost layer), Bowman's membrane, the stroma (center layer), Descemet's embrane, and the endothelium (innermost layer).

corneal edema  (Kor-nee-al e-DEE-ma):  Swelling and fluid retention in the cornea, usually related to lack of sufficient oxygen in contact lens wearers.

corneal ulcer:  A sight-threatening lesion, usually bacterial in nature, and often causing permanent scarring of the cornea.

DK value:  A measure of the oxygen transmitted by a contact lens material

DMV remover:  A suction cup type of device used to remove a rigid contact lens from the eye.

enzymatic cleaner  (en-zi-MAT-ick)  A cleaner that will decompose or digest protein, muco-protein, or lipoprotein deposits on a contact lens.

equivalent oxygen percentage  (EOP):  A lens that is impermeable to oxygen is said to have an EOP of zero; a lens completely permeable to oxygen would have an  EOP of 21 (the same as the percentage of oxygen in the atmosphere).  The EOP of a contact lens falls between zero and 21, depending upon its material

fenestration  (fen-i-STRAY-shun):  The drilling of tiny holes in a contact lens to allow tears to circulate more freely and to provide more oxygen to the cornea through the tear exchange.

flare:  Light streamers seen by rigid contact lens wearers whose lenses have too small an optical zone or overall diameter or whose lenses center poorly.

fluorescein  (FLU-re-seen):  A fluorescent dye that is instilled in the eye to evaluate the fit of rigid lenses and to highlight corneal staining, abrasions, and other corneal pathology.

fluorescein pattern:  The pattern formed by fluorescein-stained tears flowing under a rigid lens and observed with a Burton lamp or through the cobalt blue filter of a slit-lamp.  This pattern shows the relationship between the lens and the cornea (where the lens makes contact and where there is clearance).

gas permeable lens:  a lens made of materials that transmit oxygen to the cornea and carry carbon dioxide and heat back to the atmosphere.

ghost image:  A shadow-like image alongside letters or objects caused by residual astigmatism, poorly-fitting lenses, or badly-coated lenses.

GPC  (giant-cell papillary conjunctivitis):  An inflammation of the lining of the eyelids, generally induced by the presence of  denatured protein on the patient's contact lenses rubbing against the lids.  Symptoms of this auto-immune or allergic condition include itching, mucus secretion, a foreign body sensation, lens clouding, and lens slippage.

hyperopia  (high-per-OH-pee-uh):  A refractive state of the eye in which parallel rays of light would come to focus behind the retina (if they were not intercepted by it).  This can result from a cornea that is too flat, an eyeball with too short an axial (front-to-back) length, a crystalline lens that is too thin, or a combination of these factors.  Hyperopia is commonly referred to as farsightedness. 

hypoxia  (high-POX-ee-a):  Insufficient oxygen reaching the cornea.

infiltrates  (IN-fil-trates):  Collections of white blood cells and lymphocytes in the cornea.  Causes include viral infection, hypoxia, and solution sensitivity.

K-readings:  The measurement of the flattest and steepest meridians  of the patient's cornea.

keratitis  (ker-uh-TIGH-tiss):  An inflammation of the cornea that can be caused by mechanical irritation, solution sensitivity, allergy, infection, or other disease process.

keratoconjunctivitis  (KER-uh-toh-kon-junk-ti-VIGH-tiss):  An inflammation involving both the cornea and the conjunctiva.

keratometer  (ker-uh-TOHM-i-ter):  An instrument used to measure  the curvature of the two principle meridians of the central  cornea.

keratoplasty  (ker-uh-toh-PLASS-tee):  Corneal transplant.

lacrimal gland  (LACK-ri-mul):  A gland that produces tears. 

lysozyme (LIGH-so-zime).  An antibacterial enzyme in tears that forms protein deposits on contact lenses.

Mixed Solution Syndrome.  A toxic red eye caused by mixing contact lens solutions with incompatible preservatives or active ingredients and wearing a lens that has been soaked in the resulting solution.

myopia (migh-OH-pee-uh).  A refractive state of the eye in which  parallel rays of light come to focus in front of the retina.  This may result from a cornea that is too steep, a crystalline lens that is too thick, an eyeball whose axial (front-to-back) length is too great, or a combination of these factors.  Commonly referred to as nearsightedness.

neovascularization (nee-oh-VAS-cue-lar-i-ZAY-shun).  The ingrowth of abnormal blood vessels in the normally avascular cornea, often due to hypoxia in contact lens wearers.

optical zone (OZ).  The central area of a contact lens within which the power is ground or molded.

overrefraction.  A refraction performed over a patient's contact lenses to determine what power is needed to provide optimum visual acuity.

Overwearing Syndrome.  An acute corneal reaction to hypoxia, often seen in PMMA contact lens wearers, with clinical findings that include central epithelial erosions, pronounced injection (redness), lid edema, and constricted pupils.

pachometer (pak-AH-mi-ter).  An instrument used to measure corneal thickness.

pancreatin (pan-kree-AT-in).  A substance containing enzymes obtained from the pancreas of the hog.  These enzymes are used to digest or decompose tear proteins, muco-proteins, and lipo-proteins that have accumulated on the surface and within the matrix of a contact lens.

papain (PAP-ayn).  An enzyme obtained from the papaya tree and used to decompose protein deposits on contact lenses.

photokeratoscope (foh-toh-KER-i-tuh-scope).  An instrument for the measurement of corneal curvature that photographs a concentric(bull's-eye) target reflected off the patient's cornea.  The data obtained from measuring the distance between the concentric circles is fed into a computer, which provides readouts of the central and peripheral corneal curvature in several meridians.

photophobia (foh-toh-FOH-bee-uh).  Sensitivity to light.

polymethylmethacrylate  (pah-lee-METH-il-meth-ACK-ruh-late).   (Commonly referred to as PMMA).  A material similar to Lucite®  or Plexiglas® used for the manufacture of non-gas permeable rigid contact lenses.

polymer (PAH-luh-mer).  A material formed by the joining of many small molecules (monomers).  The polymer may be formed from units of the same monomer or different monomers.

presbyopia (prez-bee-OH-pee-uh).  From the Greek term for "old sight."  A hardening of the normally flexible crystalline lens of the eye that results in the gradual loss of accommodation (the ability to focus at near) as we get older.

pseudomonas aeruginosa (soo-doh-MOH-nos uh-roo-jin-OH-suh).  A bacterium that causes sight-threatening corneal ulcers, found more commonly in extended wear patients than in patients who remove and disinfect their contact lenses on a daily wear basis or who do not wear contact lenses.

punctate staining.  An abnormal stippling of the corneal epithelium that stains when fluorescein dye is instilled in the eye.  It may be caused by desiccation, solution sensitivity, deposits on the contact lens, hypoxia, mechanical irritation, or infection.

refraction.  A change in the direction of rays of light when they pass obliquely from one transparent medium to another of a different density.

residual astigmatism (ree-ZID-you-uhl uh-STIG-muh-tizm).  The amount of astigmatism that remains after a patient has been fit with contact lenses.

sagittal depth (SA-juh-tuhl).  A measurement of the height of a lens, in millimeters, from a flat surface to the highest point of its curvature.

serratia marcescens (suh-RAY-shuh mar-SESS-ins).  A bacterial organism associated with infection in contact lens wearers.  The organism has been found on lenses, in lens cases, and in lens care solutions that have been mishandled by patients.

silicone acrylate (SIL-uh-kohn AC-ruh-late).  Silicone and oxygen are made into a siloxane which is then copolymerized with PMMA to create silicone/acrylate, an oxygen permeable material used in the manufacture of rigid lenses.

spectacle blur.  Vision that is temporarily distorted or out-of-focus when a contact lens wearer, particularly a rigid contact lens wearer, switches from contact lenses to glasses.  The blur may be caused by corneal edema, mechanical molding, or a combination of the two.

sphere (sfeer).  A curved surface that has the same radius of  curvature in all meridians.

staining.  Retention of fluorescein dye by damaged corneal tissue.

superpermeable lens.  A rigid contact lens that transmits very high amounts of oxygen.

surfactant cleaner (ser-FACK-tent).  A detergent-like cleaner that emulsifies debris and removes foreign substances from the surfaces of a contact lens.

tear exchange.  The pumping in of fresh, oxygenated tears between  the contact lens and the cornea and the pumping out of deoxygenated tears and metabolic wastes with each blink.  This is necessary to maintain normal corneal metabolism.

thimerosal (thigh-MER-uh-sall).  A mercury compound, used as a preservative in some contact lens solutions, that has been implicated as the cause of many red eyes and other adverse reactions in contact lens wearers.

toric lens.  A cylindrical contact lens used for the correction of astigmatism.

visual acuity.  Sharpness of vision.  Normal visual acuity is expressed by the fraction 20/20.  The numerator indicates the patient's distance from the Snellen eye chart.  The denominator indicates the size of the letters he is able to read.  A visual acuity of 20/200 means that from a distance of 20 feet, the patient can read letters of a size that someone with normal vision can read from 200 feet away.  Visual acuity of 20/15 means that from a distance of 20 feet, the patient can read letters that someone with normal vision would have to ome within 15 feet of the chart to read.  He is considered, in this instance, to have better-than-normal vision.

wetting agent.  A substance that enables tears to spread evenly over the surface of a rigid contact lens and helps to cushion the lens on insertion.

wetting/soaking solution.  A combination solution for rigid contact  lenses that contains both wetting agents and disinfecting chemicals.