Contact lens wearers are significantly non-compliant in virtually all the active steps involved in soft contact lens wear, including handwashing, case hygiene, lens disinfection and following the recommended lens replacement schedule, according to new data on patient attitudes and behaviors regarding compliance with soft contact lenses.
Findings from two online surveys of frequent replacement contact lens wearers, along with a review of the many activities involved with good compliance with soft contact lens wear, suggest a number of missteps that occur before, during, and after contact lens wear that could lead to clinical complications. These findings will be published in Contact Lens & Anterior Eye, Journal of the British Contact Lens Association.
"How patients comply during each step of contact lens wear and care has a well documented impact on the rate of complications," says co-author Sheila Hickson-Curran, BSc (Hons), MCOptom, FAAO, director of medical affairs for VISTAKONÂ®, Division of Johnson & Johnson Vision Care, Inc. "Each step of non-compliance that results in no ill effects only reinforces poor behavior because nothing bad happens. However, by not following instructions on proper wear and care, contact lens wearers are more likely to experience discomfort and may put themselves at greater risk for infection or other serious complications, such as microbial keratitis."
Two independent, sponsor-masked surveys were distributed online. The first survey consisted of a random sample of 645 frequent replacement contact lens wearers who answered questions, including those relating to lens replacement frequency. The second survey was distributed to a random sample of 787 frequent replacement contact lens wearers who answered questions relating to lens disinfection, hygiene and replacement of the lens storage case. The respondents, aged 12 to 39 years old, represented wearers of hydrogel and silicone hydrogel lenses available in the United States that are prescribed for two-week or monthly replacement.
Compliance Before Lens Wear Nearly half of survey respondents admitted to not having washed their hands with soap prior to lens insertion in the morning (44 percent) and removal in the evening (49 percent). In addition, few patients rub their lenses with disinfecting solution (27 percentÂ in morning, 25 percentÂ in evening), but this may be in accordance with the product instructions, many of which use the words "No Rub" on the packaging. Recent developments may indicate that rubbing and/or rinsing of the lens surface before or after lens wear may add a safety margin for contact lens wearers.
Compliance During Lens Wear The results of the lens replacement survey indicate generally low compliance with practitioner recommendation on lens replacement frequency. "To maximize the likelihood of replacement compliance, strong doctor recommendation, backed up with written instruction and reinforced at every patient visit, teamed with a reminder service can be very effective," adds Hickson-Curran.
Compliance After Lens Wear Although 75 percent reported that they emptied disinfecting solution from the lens case in the morning, only 46 percent reported that they filled the lens case with fresh solution instead. Failure to empty and replace the full volume of contact lens disinfecting solution was one of the few significant behavioral factors found in the Centers for Disease Control and Prevention (CDC)Â investigation of the Fusarium outbreak of 2005, according to the authors.
The average frequency for cleaning the lens case wasÂ two to threeÂ times per week. Thirty percent of lens wearers reported cleaning them daily, while 33 percent said they cleaned their cases monthly or less often. In addition, most patients reported methods of cleaning the lens case that involved exposure to tap water, very likely without understanding that there is a risk involved with such action.
Lens wearers also slip in the frequency of replacement of their storage cases, even when they seem to know it should occur more often. The median interval for intended and actual replacement of the lens storage case wasÂ four to sixÂ months; however, 48 percent said they replace the storage case annually or less often.
The study was sponsored by VISTAKONÂ®, Division of Johnson & Johnson Vision Care, Inc.
Source: Article in Press -- Hickson-Curran, S, Chalmers, R, Riley, C. Patients attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases. Contact Lens & Anterior Eye (2011)