Healthy Contact Lens Behaviors Communicated by Eye Care Providers and Recalled by Patients — United States, 2018

Nuadum M. Konne, MPH; Sarah A. Collier, MPH; Jennifer Spangler, MBA, MPH; Jennifer R. Cope, MD

Disclosures

Morbidity and Mortality Weekly Report. 2019;68(32):693-697. 

In This Article

Abstract and Introduction

Introduction

An estimated 45 million U.S. residents enjoy the benefits of contact lens wear, but many of them might be at increased risk for complications stemming from improper wear and care behaviors.[1] One of the most serious complications of contact lens wear is a corneal infection known as microbial keratitis, which can sometimes result in reduced vision or blindness.[2] In 2014, 50% of contact lens wearers reported ever sleeping in contact lenses, and 55% reported topping off* their contact lens solutions,[3] which put them at greater risk for a contact lens–related eye infection.[2,4] Data on communication between eye care providers and contact lens wearers on contact lens wear and care recommendations are limited. Two surveys were conducted to better understand and assess contact lens education about nine recommendations: the first assessed contact lens wearer experiences regarding recommendations received from eye care providers during their most recent appointment; the second evaluated provider-reported practices for communicating contact lens wear and care recommendations to their patients. One third (32.9%) of contact lens wearers aged ≥18 years recalled never hearing any lens wear and care recommendations. Fewer than half (47.9%) recalled hearing their provider recommend not sleeping in lenses at their last visit, and 19.8% recalled being told to avoid topping off their contact lens solution. A majority of providers reported sharing recommendations always or most of the time at initial visits, regular checkups, and complication-related visits. Providers reported sharing nearly all recommendations more frequently at initial and complication-related visits than at regular checkups. Of the nine recommendations for safe contact lens wear and care, eye care providers at regular checkups most often recommend complying with the recommended lens replacement schedules (85% of regular visits), not sleeping in lenses (79.0% of regular visits), and not topping off solutions (64.4% of regular visits). Eye care providers play an important role in the health of their contact lens–wearing patients and can share health communication messages with their patients to help educate them about healthy wear and care habits. These findings can assist in the creation of health communication messages to help encourage eye care providers to communicate more effectively with their patients.

The Porter Novelli 2018 summer HealthStyles survey, an online survey, was used to estimate the number of contact lens wearers who reported receiving contact lens wear and care recommendations from their eye care provider during their most recent visit. The following nine recommendations were evaluated: 1) avoid sleeping overnight or napping in lenses, 2) wash and dry hands before inserting or removing lenses, 3) replace lenses as often as recommended, 4) replace lens case at least once every 3 months, 5) avoid storing lenses in water, 6) avoid rinsing lenses in water, 7) avoid topping off solution, 8) avoid swimming in lenses, and 9) avoid showering in lenses. The Internet survey included 4,088 participants who are part of market research firm GfK's Knowledge Panel. Panel members are recruited using address-based probability sampling methods and provided with Internet access and a computer if needed. Statistical weighting was employed to make the panel representative of the U.S. population by race, ethnicity, sex, age, household income, household size, education level, census region, metropolitan status, and Internet access before joining the panel. Respondents received 5,000 cash-equivalent reward points worth approximately $5.

To describe provider health communication practices, 1,100 randomly selected (based on geographic region of current practice) licensed, practicing eye care providers were surveyed. The survey was piloted by members of the American Optometric Association's Contact Lens and Corneal section, and changes were made based on feedback from members. Invitations to participate in the survey were e-mailed by the American Optometric Association, primarily to optometrists working in private practice settings for ≥5 years. Four reminder e-mails were sent, one every other week, and the survey was officially closed after 2 months. Of the 1,100 providers who were sent the survey, 365 (33%) responded. Survey questions assessed how often providers mentioned the same nine contact lens wear and care recommendations to their patients at initial contact lens fittings, during regular checkups and annual visits, and at visits when patients are seen for contact lens–related complications.

Frequencies for both surveys were calculated using SAS (version 9.4; SAS Institute) with complex sample survey procedures when appropriate. To protect participant confidentiality, no individual identifiers were included in the data set received by investigators. As a result, analyses of data from the 2018 HealthStyles Fall survey were declared exempt by CDC's institutional review board. Because no interaction or intervention with human subjects occurred by U.S. Department of Health and Human Services researchers for the provider survey and no personally identifiable information was used, collected, or transmitted during the course of this analysis of previously collected data, this analysis was not considered human subjects research§ requiring review by CDC's institutional review board.

The majority of contact lens–wearing patients surveyed reported wearing soft contact lenses, were non-Hispanic (85.8%), white (77.7%), and female (59.2%) (Table 1). One third (32.9%) of contact lens wearers recalled never hearing any lens wear and care recommendations (Table 2). Fewer than half of patients recalled hearing each of the nine recommendations. During their most recent visit, patients most frequently recalled hearing their provider recommend not sleeping in lenses (47.9%), washing and drying hands before inserting or removing lenses (46.9%), and complying with lens replacement schedules (41.6%), and least frequently recalled being told to avoid swimming (12.4%) and showering in their lenses (8.3%). A majority (54.7%–97.4%) of providers reported sharing all nine messages always or most of the time at initial visits, regular checkups, and complication-related visits (Table 2). Providers reported sharing messages more frequently at initial visits and complication-related visits than at regular checkups. At regular visits, of the nine recommendations, eye care providers reported most often recommending complying with lens replacement schedules (85% of regular visits), washing and drying hands before inserting or removing lenses (79%), and not sleeping in lenses (79%), and least often recommended not swimming (63%) or showering in lenses (55%).

* Adding new solution to existing solution in the contact lens case instead of emptying and cleaning the case before adding new solution.
Porter Novelli Public Services. Summer HealthStyles 2018 methodology; Washington, DC.
§ As defined in 45 CFR part 46. https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html.

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