Contact Lens Complications Tied to Permanent Eye Damage

Diana Swift

August 23, 2016

Nearly one in five contact lens–related eye infections reported to the US Food and Drug Administration (FDA) results in damage to the eye, according to a new analysis.

Healthcare professionals should promptly report adverse events arising from their patients' use of contact lenses, according to recommendations published in the August 19 Morbidity and Mortality Weekly Report.

Researchers at the Centers for Disease Control and Prevention (CDC) analyzed 1075 cases of contact lens-related keratitis reported to the FDA between 2005 and 2105.

Overall, 213 (19.8%) reports described eye damage such as central corneal scarring or reduced visual acuity, and in 47 cases (4.4%), the outcome was corneal transplant. Emergency/urgent care was required for 130 patients (12.1%), and hospitalization for 25 (2.3%).

Although these instances are not a large proportion of the 41 million users, the potential for keratitis and serious eye damage is a concern, write Jennifer R. Cope, MD, MPH, a medical epidemiologist at the CDC's Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, and colleagues.

They note that the majority of the 1075 reports (86.0%) came from manufacturers, and 14.0% came from eye care providers or patients. Dr Cope and colleagues write that prompt reporting to MedWatch, the FDA's Safety Information and Adverse Event Reporting program, can help the agency identify risks related to contact lens use.

The reviewed case reports described frequent visits to eye care providers, frequent admin¬istration of prescribed treatments, and missed work or school, and provide "a more patient-focused view of the impact of microbial keratitis, qualitatively corroborating previous findings using large databases and demonstrating substantial morbidity even among patients who ultimately recover," Dr Cope and colleagues write.

The authors report that 270 cases (25.1%) involved potentially modifiable behaviors that could raise the risk for lens-related corneal infections, such as sleeping with lenses in or wearing them longer than recommended. Previous research has shown that sleeping with contact lenses in place confers a six- to eightfold risk for infection.

Among these alterable risk factors, extended wear accounted for 121 cases (11.3%), longer-than- recommended wear for 85 cases (7.9%), and occasional sleeping in lenses for 75 cases (7.0%). Wearing lenses while swimming was the cause of 10 reports (0.9%), and storing lenses in tap water was linked to 9 cases (0.8%).

"Health promotion activities should focus on informing contact lens wearers of common behaviors that might put them at risk for eye infections, such as sleeping in contact lenses and exposing lenses to tap water, distilled water, or recreational water," Dr Cope and coauthors write.

In 2015 Dr Cope and associates reported that more than 99% of contact lens wearers surveyed in 2014 described at least one behavior that put them at risk for a lens-related eye infection.

"While people who get serious eye infections represent a small percentage of those who wear contacts, they serve as a reminder for all contact lens wearers to take simple steps to prevent infections," said Dr Cope in a CDC news release.

In 2014, an FDA panel debated new guidelines for the safe use of these ocular devices.

"Contact lenses are a safe and effective form of vision correction when worn and cared for as recommended," said Michael Beach, PhD, director of the CDC's Healthy Water Program, in the CDC news release. "However, improper wear and care of contact lenses can cause eye infections that sometimes lead to serious, long-term damage."

Morb Mortal Wkly Rep. 2016;65;817-820. Full text

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