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

Cont Lens Anterior Eye. 2025 Apr;49(2):102605. doi: 10.1016/j.clae.2026.102605. Epub 2026 Jan 10.

ABSTRACT

PURPOSE: To systematically review the antimicrobial efficacy of multipurpose solutions (MPS) and oxidative systems, hydrogen peroxide (H2O2) and povidone-iodine (PVP-I), used for contact lens disinfection.

METHODS: A systematic search of PubMed and Scopus was conducted according to PRISMA guidelines. Eligible studies compared commercial disinfecting systems using ISO 14729 reference strains or clinically relevant isolates. Extracted data included disinfectant agents, microorganisms tested, ISO compliance, test methodology, and reported outcomes.

RESULTS: Ten studies were included in this systematic review. Oxidative systems (H2O2 and PVP-I) consistently achieved strong antimicrobial effects, often maintaining efficacy in the presence of organic soil, biofilms, or clinical isolates. In contrast, MPS showed variable performance depending on their active biocides with several studies reporting reduced efficacy against fungi and Acanthamoeba cysts. Although all solutions typically met ISO 14729 criteria, several studies showed markedly reduced efficacy under clinically relevant conditions.

CONCLUSION: Oxidative systems demonstrated superior antimicrobial efficacy compared to MPS, particularly under challenging conditions and against resistant microorganisms. Given that ISO 14729 does not account for pathogens such as Acanthamoeba spp. or clinically resistant strains, reliance on this standard may overestimate real-world efficacy. Expanding testing requirements to include a broader spectrum of microorganisms would provide a more realistic evaluation of disinfecting systems and ultimately strengthen safety for contact lens wearers.

PMID:41520504 | DOI:10.1016/j.clae.2026.102605