Adolescent, Adult Contact Lens Wearers Have Risky Habits

Diana Phillips

August 17, 2017

More than 85% of adolescents who wear contact lenses do not follow recommendations for proper contact lens hygiene, a nationally representative online survey found. That poor compliance increases their risk for severe and potentially sight-threatening eye infections, the US Centers for Disease Control and Prevention warns in an article published online August 17 in the Morbidity and Mortality Weekly Report.

The study also confirmed the findings of previous research, reported by Medscape Medical News, that adult lens wearers are just as likely to engage in risky contact lens practices.

Using data from the Porter Novelli 2016 summer HealthStyles and YouthStyles online survey of 4548 US adults (aged 18 years and older) and 1618 US adolescents (aged 12 - 17 years), investigators estimate that 14.5% of adolescents, 24.4% of young adults (aged 18 - 24 years), and 15.5% of adults aged 25 years and older in the United States wore contact lenses in 2016.

Of the adolescent lens wearers, 85.3% reported at least one risk behavior, most frequently not visiting an eye physician annually (43.9%; 95% confidence interval [CI], 33.1% - 54.6%), sleeping with contact lenses in (29.8%; 95% CI, 19.7% - 40.0%), and swimming with their lenses in (27.2%; 95% CI, 18.4% - 36.0%). Other risk behaviors included adding new contact solution to existing solution in the case, replacing lenses at longer-than-recommended intervals, replacing the lens case at longer-than-recommended intervals, and storing or rinsing lenses in tap water.

Of the young adult and older adult contact lens wearers, 80.9% and 87.5%, respectively, reported at least one lens hygiene risk behavior. Among young adults, the top three most frequent risk practices were longer-than-recommended intervals for lens replacement (52.4%; 95% CI, 38.8% - 66.1%) and case replacement (40.5%; 95% CI, 27.2% - 53.7%), and sleeping in lenses (33.3%; 95% CI, 20.9% - 45.7%). For older adults, longer-than-recommended lens replacement (44.5%; 95% CI, 39.7% - 49.4%) and case replacement (41.7%; 95% CI, 36.9% - 46.5%) intervals and swimming with lenses in (33.2%; 95% CI, 28.7% - 37.7%) topped the list.

Young adults were more likely to report having ever experienced a red or painful eye that required a visit with an eye care provider. Specifically, 14.6% of the young adult lens wearers reported such an outcome compared with 11.4% of older adults and 4.2% of adolescents, the authors write.

"[Y]oung adults might have recently left home and are no longer subject to parental reminders," the authors hypothesize. "Young adults also might have fewer resources (e.g., money and transportation) to regularly visit eye care providers and obtain hygiene education or regularly replace contact lenses, lens storage cases, and solution." Further, they add, "[Y]oung adults have been reported to have poor planning and a more impulsive lifestyle in relation to contact lens hygiene, possibly related to crowded living conditions (e.g., dormitories, living with roommates, and sharing bathrooms), alcohol consumption, and attitudes conducive to taking greater risks."

Adolescents, in contrast, appear to engage in some healthier lens practices, particularly with respect to lens replacement, than their older peers. "These findings might reflect the fact that most adolescents are still living with their parents who might help to reinforce good contact lens hygiene," the authors suggest. Even so, "there is still room for improvement to prevent potentially serious outcomes, including blindness."

The various behaviors identified are associated with increased infection risk through various mechanisms, the authors write. "Infrequent contact lens storage case replacement has been associated with microbial keratitis, and lens wearers who do not replace their lenses as often as recommended report more complications and eye discomfort." In addition, this practice increases infection risk through the introduction of microorganisms associated with frequent handling of the case and the lenses and microbial growth linked to the moist surfaces, they explain.

Using tap water to rinse or store lenses and exposing lenses to pool or other water increases the possibility of transmitting microorganisms that live in the water to the lens and to the eye, the authors write. And sleeping in lenses of any type "increases the risk for eye infections," they state.

Infection prevention efforts should include targeted education regarding optimal lens hygiene and recommended lens and case replacement intervals, the authors write. For adolescents in particular, they recommend communication strategies that have been effective in adolescent populations, such as appeals to vanity and marketing based on social norms.

"Additionally, encouraging adolescents to adopt healthy contact lens wear and care habits early might help them maintain these habits into young adulthood, when the frequency of reported risk behaviors increases," the authors state. "Prevention messages targeting young adults can be shaped around the lifestyle changes known to occur in this population."

The Centers for Disease Control and Prevention receives a yearly contribution from the Contact Lens Institute to support the Centers for Disease Control and Prevention's Healthy Contact Lens Program. The Contact Lens Institute was not involved with the survey questions, analysis, drafting, or review of the report.

Morb Mortal Wkly Rep. 2017;66:841-845. Full text

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