Myopia Profile


Is rubbing orthokeratology lenses necessary?

Posted on November 17th 2020 by Connie Gan

Sponsored by


In this article:

When cleaning orthokeratology contact lenses, is rubbing necessary? Would rubbing the lens cause warpage or deform the lens over time?

When we first fit patients with contact lenses, the standard advice is to rub the contact lens to properly clean them. What should one do when it comes to orthokeratology (orthoK) lenses? OrthoK lenses are designed to have a complex curvature profile, with each parameter playing a crucial part in effecting refractive error correction and ensuring lens stability. Would rubbing the lens cause warpage or deform the lens over time? This post debated the necessity to rub orthok lens while cleaning.

RC Can I ask you ortho k optoms whether you recommend rubbing clean the lenses? I have heard from manufacturers that they prefer no rubbing due to warpage and lens damage. They prefer just using the protein clean solution.

To rub or not to rub? The community was divided on this. Let’s see why.

“It is necessary to rub orthokeratology lenses”

HH We advise rubbing our ortho k, and we use Menicon Progent for an intensive clean that requires no rubbing somewhere between 2-4 weekly depending on the patient and the age of the lenses. On occasion we a peroxide based cleaner which doesnt need a rub. Im nervous with peroxide cleaners in kids who look after their own lenses though, hence the normal clean and rub regimeDS Definitely daily rub. Use ring or little finger to minimize pressure on the contact lens.NH Rub essential - particularly on reverse geometry lens - if lens distorts on periphery replace more frequently I would say.DS Personally I think it's nuts not to take the opportunity not to debulk debris with a daily cleaner. IMHO peroxide doesn't have a broad enough spectrum of action to be used without a rub step, particularly the one step systems.AS …I confess to not even considering no rub prior to this discussion.BD Having previously worked in a CSSD ( hospital central serilising department) physical debridement is considered absolutely essential to sterilization. Hydrogen peroxide is the only solution to use for RGPs and gentle physical cleaning a necessary step in disinfection.AS Add daily clean with pinky for back surface cos it approximates radius of back surface and gets in the reverse curves with lens attached to index finger to rub front surface in palm with lobob sofpro2 as it doesn't damage plasma coat as abrasive BOSTON cleaner does and yes H2O2 is good! Regular in office cleaning with NaOCL

Most commenters agreed with rubbing orthok lenses daily, gently with the fourth or little finger. Physically rubbing the lenses mechanically removes debris and deposits adhering to the lens surface. Multipurpose RGP cleaning solutions generally DO recommend rubbing the lenses when cleaning - for example the Menicon MeniCare Plus multipurpose solution. In addition, many mentioned regular use of Menicon Progent, which is a 30 minute, protein remover and intensive cleaner treatment, for regular use with any type of RGP contact lens.

“It is NOT necessary to rub orthokeratology lenses”

AP I would disagree! Have used peroxide without a rub for all ortho-K patients young and old with no problems for several years. Mainly in order to decrease corneal toxicity reactions that we were seeing occasionally with Menicare/Boston etc. Less handling of the lens is also a bonus to decrease contamination. Progent typically done monthly with this regime. (also no accidental lens breakages with H2O2, whereas we would get a few every year with overzealous rubbing!). Interested in everyone else's thoughts though!LH No rub. Peroxide all the way. Lenses are cleaner, less breakage, better disinfection, simplier to use, less corneal staining, more comfortable, lenses are in way better condition after 1, 2 and 3 years down the track, reverse curve is so much cleaner. Rubbing will still not clean out the reverse curve. Progent monthly to spin the hydrophobic silicone in the material.ML I agree with AP and LH.We've been putting all our adult and children patients on AOSEPT hydraglyde and no issues with eyes and instructions. Once you tell them how it works there is full compliance and patients who have had both systems prefer peroxide overwhelmingly. Progent as needed.

The minority suggested that it is unnecessary to rub the lens. This applies to those who use hydrogen peroxide as the main cleaning agent. Manufacturer instructions for commonly used peroxide systems don't mention a rubbing step. However, skipping the rub step with a peroxide system may mean stubborn deposits aren't removed - read more on this in the next section.

Interestingly, this group of practitioners report no complications associated with the lack of lens rubbing, and less lens breakage than in patients who are rubbing their lenses. They also advocated regular use of Menicon Progent.

What does the literature tells us?

  • Cho et al found that hydrogen peroxide and povidone iodine do not remove stubborn deposits (in this case, mascara) from rigid gas permeable lens (RGP) surfaces. However, these stubborn deposits were removed with rubbing.1
  • Hydrogen peroxide and povidone iodine solutions can effectively disinfect orthok lenses without rubbing. With RGP cleaners, rubbing the lens can significantly reduce the bacterial load, more so than if one did not rub.2
  • There is more to consider regarding orthok hygiene regimes outside of lens cleanliness. Cho et al found that while the awareness of orthoK lens cleanliness was high, lens accessories cleanliness (lens cases, suction holders and tweezers) is poor.Jun et al’s questionnaire into the most common areas of noncompliance include exposure to nonsterile solutions, not removing lens deposits with rubbing, and inadequate handwashing.4


RS Ok so Menicon and rub with ring or little finger and Progent 2 to 4 weekly or H2O2 solution with no rub and Progent…

Practitioners recommended using hydrogen peroxide or multipurpose solutions for daily cleaning and Menicon Progent every 2-4 weeks for removing protein deposits.

So, is it necessary to rub the lens while cleaning? Rubbing does allow for better removal of stubborn deposits, and a cleaner lens surface. Does it rubbing accelerate lens warpage? The fact is we simply don't know - it hasn't been studied - but a more frequently replaced lens is certainly a better outcome than a less clean lens. It is presumed that gentle rubbing should minimize any significant effect on warpage

Take home messages:

  1. Rubbing ortho-k lenses whilst cleaning does a better job to remove depositing, regardless of the type of cleaning solution used. Suggest to your patients to use their fourth or little finger to avoid applying too much pressure on the lens, which could potentially influence longer term lens warpage. Adding a regular, additional deep cleaning and protein removal treatment such as Menicon Progent was also advocated.
  2. Don’t forget to check how patients are maintaining the cleanliness of their lens accessories, such as cases and lens removal suction holders. Chances are that these are often neglected.
  3. It's important to take the opportunity at each follow up appointment to ask patients to describe and demonstrate their contact lens handling and care procedures, and to reinforce the importance of good hygiene.

Meet the Authors:

About Connie Gan

Connie is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.

Read Connie's work in many of the case studies published on Connie also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

About Kimberley Ngu

Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.

Read Kimberley's work in many of the case studies published on Kimberley also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

This content is brought to you thanks to unrestricted educational grant from


Back to all articles

Enormous thanks to our visionary sponsors

Myopia Profile’s growth into a world leading platform has been made possible through the support of our visionary sponsors, who share our mission to improve children’s vision care worldwide. Click on their logos to learn about how these companies are innovating and developing resources with us to support you in managing your patients with myopia.