Contact Lens Wearers Engage in Risky Eye Care Behavior

Diana Phillips

August 21, 2015

Most adult contact lens wearers in the United States participating in a Centers for Disease Control and Prevention (CDC) online survey reported at least one lens hygiene behavior that put them at risk for an eye infection in 2014. In addition, approximately one third of them reported at least one healthcare visit for a red or painful eye while wearing contact lenses, researchers report in an article published in the August 21 issue of the Morbidity and Mortality Weekly Report.

After several CDC investigations of several multistate outbreaks of serious eye infections among contact lens wearers during the last decade, the agency conducted both a population-based survey to estimate the number of contact lens wearers 18 years or older and a separate online Contact Lens Risk Survey comprising a convenience sample of approximately 1000 contact lens wearers to determine the prevalence of hygiene-related risk behaviors.

The results indicate that approximately 40.9 million US adults (an estimated one in six adults in the United States) wear contact lenses. Nearly all (93.0%) of them wear soft contact lenses. "Overall, contact lens wearers were younger, female, more educated, and of white, non-Hispanic race/ethnicity when compared with non-contact lens wearers," write Jennifer R. Cope, MD, MPH, a medical epidemiologist in the CDC's Division of Foodborne, Waterborne, and Environmental Diseases, and colleagues.

Of the approximately 1000 respondents to the Contact Lens Risk Survey, approximately 99% reported at least one risky hygiene behavior, including ever doing any of the following: sleeping overnight in contact lenses (50.2%), napping in contact lenses (87.1%), topping off disinfecting solution (55.1%), extending the recommended replacement frequency of lenses (49.9%) or cases (82.3%), showering (84.9%) or swimming (61.0%) in contact lenses, rinsing lenses in tap water (35.5%), or storing lenses in tap water (16.8%).

Of all contact lens wearers, 30.2% reported ever having a red or painful eye while wearing lenses that required a physician's visit, the authors write.

The frequent exposure of contact lenses to water, including storing or rinsing their lenses in tap water and showering or swimming while wearing lenses, is especially concerning, the authors note. "Exposure of lenses to water raises the risk for infection because microorganisms living in water can be transferred to the eye. Even household tap water, although treated to be safe for drinking, is not sterile and contains microorganisms that can contaminate lens cases and contact lenses and cause eye infections."

And although some contact lenses have approval from the US Food and Drug Administration for overnight wear, "sleeping in any type of contact lens increases risk for eye infection," as does noncompliance with lens and case replacement schedules, the authors write. Noncompliance with lens replacement schedules is associated with more complications and eye discomfort.

"These behaviors raise the risk for eye infections because repeated handling of the lens and case provides opportunities for introduction of microorganisms, while the moist surface of the lens and case provide an environment conducive to microbial growth," they note. Further, topping off the solution in the cases compounds this risk and decreases the effectiveness of contact lens disinfection.

The risk for contamination is likely lower for individuals who wear daily contact lenses, but only if they dispose of them daily as recommended, the authors stress.

The findings suggest that many of the tens of millions of US adults who wear contact lenses "might be increasing their risk for complications because of poor wear and care behaviors," the authors write. They note that improved estimates of the extent of contact lens-associated disease and increased surveillance capacity for microbial keratitis are needed.

Health promotion activities that encourage contact lens wearers to improve their hygiene behaviors are needed to support infection prevention. The messaging should focus on keeping all water away from contact lenses, discarding used disinfecting solution from the case and cleaning with fresh solution each day, and replacing their contact lens case every 3 months, the authors conclude.

The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2015;64:865-870. Full text


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