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Speaker: Contact lens keratitis cannot be eliminated
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DENVER – A risk factor needs to be present to alter the susceptibility of the ocular surface, Fiona J. Stapleton, PhD, McOptom, FAAO, DCLP, said here at Optometry’s Meeting during the Dr. Donald R. Korb Award Lecture.
Her presentation was titled, “Can we eliminate contact lens-related keratitis?”
“The short answer is, ‘no,’” Stapleton said.
She reviewed research conducted on contact lens keratitis over the past 2 decades.
“Normal corneas rarely get infected,” she said.
Risk factors include: trauma, contact lens wear, ocular surface disease, herpetic disease, systemic disease and multiple factors.
Key findings from early studies showed that the implementation of silicone hydrogel material did not change the rate, Stapleton said. Daily wear and daily disposable have similar rates, but disease is not as severe in daily disposable.
Independent modifiable risk factors include wearing contacts 6 to 7 days per week, extended wear, Internet purchasing, occasional overnight wear, poor case hygiene, smoking, showering while wearing lenses and hand washing, she said. Independent non-modifiable risk factors include extended wear of less than 6 months, socioeconomic class, age less than 49, hypermetropia and male gender.
“People who survive the first 6 months of extended wear have a lower risk thereafter,” Stapleton noted.
“How about rubbing and rinsing lenses prior to disinfection?” she said. “There’s good evidence that you can remove an enormous microbial load by rubbing a contact lens.”
However, a study showed that rub vs. no rub did not reach statistical significance.
“If we can’t reduce incidence, can we do anything to reduce severity?” Stapleton asked.
An elevated risk is associated with domestic water, but regional differences exist, she said.
“Vision loss is more likely to occur with an environmental organism and delay in treatment,” Stapleton said. “But are there any other risk factors we can identify that are associated with severe disease?”
She said she found that attention to storage case practice, both air drying cases and frequently replacing storage cases, could reduce the disease load in daily wear by 62%.
Patients wearing the daily disposable modality have a much lower risk of severe disease, she continued.
“There might also be individual differences in immune response,” Stapleton said. “Some wearers do everything wrong but never get a problem. We also see that long-term lens wearers are at less risk and we see people with multiple events.”
She concluded: “Can we eliminate disease? It’s highly unlikely. Can we modify disease severity with a better understanding of risk factors? Quite possibly, especially with daily disposable contact lens use.”
Stapleton recommended that patients seek treatment in a timely manner, improve storage case hygiene, avoid contact with water, and wash and dry hands before handling. – by Nancy Hemphill, ELS, FAAO
Reference:
Stapleton F. Can we eliminate contact lens-related keratitis? Presented at: Optometry’s Meeting; Denver; June 20-23, 2018.
Disclosure: Stapleton reported no relevant financial disclosures.