Poor hygiene, improper handling primary culprits in contact lens contamination
Environmental contamination was the primary source of microbes found on contact lens surfaces, highlighting the need for better patient education regarding lens handling and hygiene, according to a study published in Heliyon.
“The ocular surface is a newly described niche with the unique characteristics of microbiota,” Lunla Udomwech, MD, an assistant professor and lecturer in ophthalmology at Walailak University School of Medicine in Thailand, and colleagues wrote. “The present study provided more insight into the nature of bacterial microbiota on contact lenses.”
Udomwech and colleagues surveyed 20 female contact lens wearers (mean age, 35.2 years), all of whom wore soft reusable contact lenses, with the majority wearing monthly disposable lenses and 80% wearing contacts daily.
Participants completed a 47-item questionnaire about personal information, lens-related behaviors and hygiene practices, and researchers collected 20 contact lenses, within 4 hours of wear, for laboratory evaluation.
According to study results, 90% of participants reported wearing their contact lenses for more than the recommended 8 hours per day, and 35% of participants had a history of eye infections, including keratitis, conjunctivitis and blepharitis. Although most participants reported good hygiene practices, survey data revealed that some skipped annual eye exams, wore their contact lenses in water and exceeded the planned replacement of lenses and storage cases. Half of participants reported using lenses that had been dropped.
Bacterial microbiota analysis of the lenses identified 19 genera and 26 strains of bacteria were obtained from all 20 contact lenses, with Enterobacter (27.51%), Staphylococcus (26.18%) and Achromobacter (17.41%) representing the most abundant. Thirteen of the strains were recognized as causative pathogens of ocular or contact lens-related infections.
One of the most predominant strains, Achromobacter agilis, was associated with cleaning the lens case with tap water (P = .04).
“An emphasis in patient education should be placed on careful handling during the [contact lens] care routine and managing the hygiene of the surroundings,” Udomwech and colleagues concluded.
Perspective
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Picture this: A new patient walks in, wearing unknown contact lenses that they purchased overseas. They don't know the brand and tell you “I didn't need a prescription,” or “I got them from a vending machine.” This patient is also surprised when you tell them to replace their contact lens case or to not sleep in their lenses, because they skipped the step of learning hygiene practices entirely.
This study surveys unknowingly unhygienic contact lens wearers and correlates poor hygiene habits with specific bacteria bad-guys. It's not news to eye care providers that risky contact lens behavior potentiates infection. The real learning point of this research is that it is crucial to have our clinical detective eyes looking to identify unmet patient education and to fill in the gaps. Preventive care starts with education and stops the bad bacteria.
I feel confident prescribing contact lenses for all patients, including children, under the following conditions:
- a clear, shared understanding of do's and don'ts of contact lenses;
- a thorough evaluation of the cornea to rule out pre-existing conditions that may contraindicate safe contact lens wear; and
- a plan for follow-up and compliance and to seek eye care immediately if there are signs of adverse effects.
If we can remind our patients with a few simple rules for safer eyes, we can all sleep a little better at night (without daily wear contacts, of course).
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