Keratitis From Poor Contact Lens Care a Huge Burden in US

Megan Brooks

November 13, 2014

Eye infections, often resulting from improper contact lens use, send almost 1 million Americans to the doctor each year, federal health officials said today when releasing results of the first study to estimate the burden of keratitis.

"Contact lenses can provide many benefits, but they are not risk-free — especially if contact lens wearers take shortcuts and don't take care of their contact lenses and supplies," Jennifer Cope, MD, MPH, medical epidemiologist at the Centers for Disease Control and Prevention (CDC), said in a statement.

Microbial keratitis is an infection of the cornea caused by bacteria, fungi, amebae, or viruses. It causes pain and inflammation and can lead to vision loss or blindness in severe cases. Improper contact lens storage and wear are the top risk factors for developing the infection.

"Here at CDC, we have long suspected that keratitis poses a significant burden on Americans' health and on our healthcare system, both in individual cases and in periodic multistate outbreaks associated with contact lens wear. But until now, we didn't have any estimates of how large that burden might be," Dr Cope said during a media briefing.

Dr Cope and colleagues analyzed three large national databases of outpatient care centers and emergency departments from 2010 to develop the first national estimates of keratitis cases in the United States.

The results show that an estimated 930,000 doctor's office and outpatient clinic visits and 58,000 emergency department visits for keratitis or contact lens disorders occur annually.

Common and Costly

"Keratitis affects all age groups, from teens up to seniors," Dr Cope said. Women are slightly more likely to be affected than men, accounting for 63% of office visits and about 55% of ED visits.

Roughly three quarters (76.5%) of keratitis visits result in antimicrobial prescriptions.

Annually, keratitis and contact lens disorders result in about $175 million in direct healthcare costs, including $58 million for Medicare patients and $12 million for Medicaid patients, according to the CDC.

Office and outpatient clinic visits occupy more than 250,000 hours of clinician time annually.

The results were published in the November 14 issue of the Morbidity and Mortality Weekly Report, ahead of the first annual Contact Lens Health Week, which runs from November 17 to 21.

The CDC campaign will promote eye health in collaboration with physicians, public health, the eye care industry, and regulatory partners, in the hope of reducing keratitis, Dr Cope said.

"Among the estimated 38 million contact lens wearers in the United States, poor storage case hygiene, infrequent storage case replacement, and overnight lens wear are established preventable risk factors for microbial keratitis, contact lens–related inflammation, and other eye complications," Dr Cope and colleagues write.

"Keratitis associated with poor contact lens hygiene is preventable. Prevention efforts should include surveillance, improved estimates of the burden of disease, and vigorous health promotion activities focused on contact lens users and eye care professionals (ophthalmologists, optometrists, and opticians). Increased surveillance capacity is needed for microbial keratitis, in particular data from optometrist visits," they conclude.

To prevent eye infections, the CDC advises contact lens wearers to:

  • wash hands with soap and water, and dry well before touching contact lenses;

  • take contacts out before bed, showering, or swimming;

  • rub and rinse contacts in disinfecting solution each time they remove them;

  • rub and rinse the case with contact lens solution, dry with a clean tissue, and store upside down with the caps off after each use;

  • replace contact lens cases at least once every 3 months;

  • do not "top off" solution in lens case; and

  • carry a backup pair of glasses in case contact lenses have to be taken out.

Morb Mortal Wkly Rep. 2014;63:1027-1030. Full text

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