Factors Associated With Contact Lens-Related Dry Eye
Factors Associated With Contact Lens-Related Dry Eye
Objective: To determine if compliance factors are associated with contact lens-related dry eye (CLDE).
Methods: The data were derived from subject responses to a compliance survey administered in a cross-sectional study including 100 healthy, daily (nonovernight), experienced soft contact lens wearers (50 normal and 50 with CLDE). Classification into normal or CLDE groups was based on Contact Lens Dry Eye Questionnaire scores, tear breakup time, and 2 hours difference between total and comfortable daily lens wear hours. The compliance survey queried aspects of lens care, rub and rinse practices, lens and lens case replacement frequency, solution replacement, and sleeping with lenses. Statistical analysis of the data was performed using unpaired T tests, χ, and Fisher exact tests as applicable.
Results: The average age of all subjects was 24.8±4.4 years, and 60% were women. Overall compliance rates were low for several variables including recommended replacement of contact lenses (53%), rub and rinse practices (69% and 45%, respectively), care solution topping-off (80%), and washing hands before handling lenses (48%). However, almost no compliance factors were associated with CLDE status, with the exception of perceived ease or difficulty with lens care, which was rated as more difficult by the CLDE group (P=0.004).
Conclusions: Overall compliance rates with contact lens care practices are very low, highlighting the need for more effective methods of patient education regarding contact lens care and compliance. However, almost no compliance factors were found to be associated with CLDE. Factors other than compliance likely play a bigger role in CLDE.
Compliance in the context of contact lens wear is a multifaceted issue including many factors such as good hand hygiene before handling contact lenses, adherence to proper procedures for contact lens wear schedules, replacement schedules, and care of the contact lenses. In prior years, good compliance was defined as the fulfillment of three standardized criteria, namely, hand washing before lens handling, correct use of a Food and Drug Administration (FDA)-approved care system, and adherence to a daily wear schedule. Despite clear educational resources on contemporary contact lens care, high rates of noncompliance in contact lens wearers have been recognized for many years. Measures to improve compliance such as the introduction of simplified contact lens care systems, daily disposable contact lenses (which avoid lens care altogether), and additional patient education using various media (videos, pamphlets, etc.) seem to have had little or no effect on patient compliance.
Contact lens wearers are noncompliant with multiple aspects of contact lens wear despite awareness of heightened risks for potentially harmful clinical effects. For example, only 53% to 77% contact lens wearers wash their hands before handling their lenses and approximately 6% report unauthorized overnight wear of lenses, despite the increased risk for contact lens contamination, microbial keratitis and corneal infiltrates, respectively.
Violations of prescribed regimens for replacement of lens and lens care components are currently widespread. For instance, 40% to 74% contact lens wearers do not replace lenses per the manufacturer's recommended replacement schedule (MRRP), despite anecdotal and scientific reports of compromises in vision, comfort, contact lens complications, and moderate-to-severe corneal staining with use of lenses beyond their MRRP.
In addition, recommended cleaning exercises for contact lenses such as the performance of rub and rinse practices are also compromised. As many as 75% to 77% lens wearers report being noncompliant with rubbing their lenses, despite the potential risk for increased ocular bioburden. Perhaps, not surprisingly, outbreaks of infectious keratitis have occurred in recent years given that 13% to 57% contact lens wearers reported "topping off" practices and reuse of care solution.
Contact lens-related dry eye (CLDE) continues to be a major issue affecting nearly half of all contact lens wearers. Contact lens-related dry eye and alterations of the tear film in contact lens wearers are known to be associated with problems such as reduced visual performance and decreased lens wearing time, which may ultimately lead to discontinuation from contact lens wear altogether. Noncompliance with proper procedures for contact lens wear and care are likely to result in the wear of soiled and contaminated contact lenses, which may lead to compromise in the lens wearing experience. More specifically, wearing of soiled contact lenses could be associated with symptomatology and associated with CLDE in the noncompliant contact lens wearer. Given the high frequency of both noncompliance and CLDE in the contact lens wearing population, it is hypothesized that noncompliant practices may be associated with CLDE. The objective of this work was to determine the association between noncompliant practices with contact lens wear and care and CLDE.
Abstract and Introduction
Abstract
Objective: To determine if compliance factors are associated with contact lens-related dry eye (CLDE).
Methods: The data were derived from subject responses to a compliance survey administered in a cross-sectional study including 100 healthy, daily (nonovernight), experienced soft contact lens wearers (50 normal and 50 with CLDE). Classification into normal or CLDE groups was based on Contact Lens Dry Eye Questionnaire scores, tear breakup time, and 2 hours difference between total and comfortable daily lens wear hours. The compliance survey queried aspects of lens care, rub and rinse practices, lens and lens case replacement frequency, solution replacement, and sleeping with lenses. Statistical analysis of the data was performed using unpaired T tests, χ, and Fisher exact tests as applicable.
Results: The average age of all subjects was 24.8±4.4 years, and 60% were women. Overall compliance rates were low for several variables including recommended replacement of contact lenses (53%), rub and rinse practices (69% and 45%, respectively), care solution topping-off (80%), and washing hands before handling lenses (48%). However, almost no compliance factors were associated with CLDE status, with the exception of perceived ease or difficulty with lens care, which was rated as more difficult by the CLDE group (P=0.004).
Conclusions: Overall compliance rates with contact lens care practices are very low, highlighting the need for more effective methods of patient education regarding contact lens care and compliance. However, almost no compliance factors were found to be associated with CLDE. Factors other than compliance likely play a bigger role in CLDE.
Introduction
Compliance in the context of contact lens wear is a multifaceted issue including many factors such as good hand hygiene before handling contact lenses, adherence to proper procedures for contact lens wear schedules, replacement schedules, and care of the contact lenses. In prior years, good compliance was defined as the fulfillment of three standardized criteria, namely, hand washing before lens handling, correct use of a Food and Drug Administration (FDA)-approved care system, and adherence to a daily wear schedule. Despite clear educational resources on contemporary contact lens care, high rates of noncompliance in contact lens wearers have been recognized for many years. Measures to improve compliance such as the introduction of simplified contact lens care systems, daily disposable contact lenses (which avoid lens care altogether), and additional patient education using various media (videos, pamphlets, etc.) seem to have had little or no effect on patient compliance.
Contact lens wearers are noncompliant with multiple aspects of contact lens wear despite awareness of heightened risks for potentially harmful clinical effects. For example, only 53% to 77% contact lens wearers wash their hands before handling their lenses and approximately 6% report unauthorized overnight wear of lenses, despite the increased risk for contact lens contamination, microbial keratitis and corneal infiltrates, respectively.
Violations of prescribed regimens for replacement of lens and lens care components are currently widespread. For instance, 40% to 74% contact lens wearers do not replace lenses per the manufacturer's recommended replacement schedule (MRRP), despite anecdotal and scientific reports of compromises in vision, comfort, contact lens complications, and moderate-to-severe corneal staining with use of lenses beyond their MRRP.
In addition, recommended cleaning exercises for contact lenses such as the performance of rub and rinse practices are also compromised. As many as 75% to 77% lens wearers report being noncompliant with rubbing their lenses, despite the potential risk for increased ocular bioburden. Perhaps, not surprisingly, outbreaks of infectious keratitis have occurred in recent years given that 13% to 57% contact lens wearers reported "topping off" practices and reuse of care solution.
Contact lens-related dry eye (CLDE) continues to be a major issue affecting nearly half of all contact lens wearers. Contact lens-related dry eye and alterations of the tear film in contact lens wearers are known to be associated with problems such as reduced visual performance and decreased lens wearing time, which may ultimately lead to discontinuation from contact lens wear altogether. Noncompliance with proper procedures for contact lens wear and care are likely to result in the wear of soiled and contaminated contact lenses, which may lead to compromise in the lens wearing experience. More specifically, wearing of soiled contact lenses could be associated with symptomatology and associated with CLDE in the noncompliant contact lens wearer. Given the high frequency of both noncompliance and CLDE in the contact lens wearing population, it is hypothesized that noncompliant practices may be associated with CLDE. The objective of this work was to determine the association between noncompliant practices with contact lens wear and care and CLDE.
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