Contact lenses-convenience and complications

Article Abstract:

Contact lenses are worn by 20 million American, half of whom wear soft contacts lenses. Contact lens use has increased because many people feel that they look better without eyeglasses and contact lenses offer improved sight. Although the use of hard contact lenses, which are removed and cleaned daily, was uncomplicated, they were irritating and uncomfortable for many wearers. Gas permeable lenses for extended wear became the preferred lens; 13 million people now wear the soft lenses. People wearing these lenses continuously are found to have more eye infections and irritations. Studies of the more serious effects of extended wear use indicate that one in every 300-400 patients will develop ulcerative keratitis. Ulcerative keratitis is an ulcer with associated inflammation on the cornea of the eye which can lead to permanent loss of vision. Previously uncommon in the healthy eye, a high incidence of ulcerative keratitis has been found in soft contact lens wearers, particularly extended-wear users. It is thought to be caused by a bacterial infection. Manufacturers of soft contact lenses should put warning labels on packaging and improve patient education regarding the use of contact lenses. The FDA has required that the label for extended wear lenses be amended to indicate a reduction of consecutive days of use from 30 to 7 days; this may not be effective since some patient non-compliance is expected. Practitioners, manufacturers, and regulators need to work together to improve the safety of contact lens use.

editorial

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The incidence of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses

Article Abstract:

Ulcerative keratitis is an ulcer with associated inflammation on the cornea of the eye. Previously uncommon in the healthy eye, a high incidence of ulcerative keratitis has been found in soft contact lens wearers, particularly among users of extended-wear lenses. It is thought to be caused by a bacterial infection. An estimated seven percent of the population wear contact lenses; four million wear extended-wear and nine million wear daily-wear lenses. The incidence of lens associated infections has increased. It is unclear whether this increase is the result of increased lens use or an increase in the incidence of the disease. A study to estimate the incidence of ulcerative keratitis among wearers of soft contact lenses surveyed eye doctors in the study area regarding new cases of the disease over a four-month period and surveyed 4,178 households to determine the number of wearers of each type of soft lens. It was found that the incidence of ulcerative keratitis was 20.9 per 10,000 population using extended-wear lenses and 4.1 per 10,000 using daily-wear lenses. This population survey did not have the complete cooperation of all eye doctors and households and is clearly an estimation. However, ulcerative keratitis can cause permanent loss of vision and practitioners are cautioned to be aware of the risk benefit ratio when prescribing soft contact lenses.

Complications and side effects, Risk factors

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The relative risk of ulcerative keratitis among users of daily wear and extended-wear soft contact lenses; a case - control study

Article Abstract:

Ulcerative keratitis is an ulcer with associated inflammation on the cornea of the eye which can lead to permanent loss of vision. Although previously uncommon, a high incidence of ulcerative keratitis has been found in people who wear soft contact lenses, particularly extended-wear lenses. Approximately 13 million people now wear soft contact lenses. It is thought that ulcerative keratitis develops in this population because of bacterial infection. To determine the relative risk for developing ulcerative keratitis, extended-wear soft contact users and daily-wear soft contact users were compared. It was found that the relative risk of ulcerative keratitis was 3.9 to 4.2 for extended wear users. Extended wear users wore their lenses overnight more often than daily wear users. Overnight use had a 10-15 fold increased risk for developing ulcerative keratitis in the extended wear group and 9 times the risk in the daily wear group. While overnight use was strongly indicated as the prime risk factor, the less-frequent hygiene practiced by extended-wear users is considered to be a contributing factor.

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