Do swimming goggles limit microbial contamination of contact lenses?

TFOS Lifestyle: Impact of contact lenses on the ocular surface

Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviors (e.g., when using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.

A Pilot Study of the Effects of Swimming Goggles on Meibomian Glands

OBJECTIVES

This study evaluated whether swimming goggle wear contributes to meibomian gland (MG) atrophy or functional change.

METHODS

Subjects included minimal goggle wear experience (normal subjects) and maximal goggle wear experience (competitive swimmers). Principal outcome measures were meiboscore and percent MG area remaining percent gland area remaining [PGAR]). Clinical tests included symptoms, tear meniscus height, lipid layer thickness, fluorescein tear breakup time, corneal and conjunctival staining, lower lid margin signs, gland secretion quality, Schirmer I, and meibography.

RESULTS

Forty-two age-matched, and sex-matched subjects completed the study (25 normal subjects and 17 goggle-wearing swimmers). Tear breakup time was significantly shorter in goggle wearers (P=0.016, Mann-Whitney U). Differences in meibography, symptoms, and other clinical dry eye workup parameters were not statistically significant (all P values >0.05). Regression analysis indicated that sex, tear breakup time, and meiboscore statistically impacted PGAR.

CONCLUSIONS

There was no apparent difference in MG morphology and function between goggle-wearing swimmers and nongoggle-wearing control subjects in this study sample. Although swimming goggles have been documented as having adverse effects on the periorbital tissues, mechanical forces from long-term swimming goggle wear may not impact MG morphology or function. The tarsal plate likely plays a protective role for the MGs from external mechanical friction from swimming goggles.

Influence of Contact Lens Materials and Cleaning Procedures on Bacterial Adhesion and Biofilm Formation

Purpose

The present study aimed to compare the existing soft contact lens (CL) materials regarding their influence on bacterial biofilm formation and adhesion susceptibility. Then, the study was designed to investigate the effectiveness of various disinfecting solutions and evaluate the ability of cleaning regimens in terms of anti-bacterial adhesion and biofilm removal on different soft CL materials.

Methods

Bacterial biofilm formation on CLs was evaluated by biomass assay. Adhesion assay and standard plate count were carried out at time-interval periods within 24 h. Various CL disinfecting procedures were assessed for their efficacy to remove biofilm and reduce bacterial adhesion. Scanning electron microscopy (SEM) was performed for the morphological assessment of bacterial biofilm.

Results

Printed hydroxyethyl methacrylate (HEMA) CLs significantly demonstrated more biofilm staining and bacterial attachment when compared with non-printed HEMA CLs, while the Filcon II 3 and Nesofilcon A CLs possessed less biofilm biomass and adherent cells. Staphylococcus aureus and Pseudomonas aeruginosa represented the highest biofilm producing bacteria on HEMA-based materials in this study. The disinfecting regimen with the highest efficacy was the two-step system, first using multipurpose disinfecting solution containing edetate disodium and sorbic acid (MPDS+EDSA), followed by soaking in multipurpose solution (MPS). The regimen demonstrated the greatest effect against the pre-formed biofilm and the adhesion activity of S. aureus and P. aeruginosa on the soft CLs. The SEM micrographs confirmed the morphological changes of bacterial biofilm after disinfecting and revealed that the two-step system treated CLs displayed less adherent bacteria.

Conclusion

HEMA-based soft CLs may facilitate bacterial biofilm formation and adhesion capability. The two-step system was the most effective regimen for biofilm removal, where the soaking period in the disinfecting solution of the no-rub regimen should last more than 6 h to remove pre-formed biofilm.

CLEAR - Evidence-based contact lens practice

Evidence-based contact lens -->practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as -->minimising risks of lens wear through encouraging compliance) and an aftercare routine.

Gas-Permeable Contact Lenses and Water Exposure: Practices and Perceptions

SIGNIFICANCE

This study provides insight into the current recommendations, clinical behaviors, and risk assessments of eye care professionals on the topic of rigid contact lens exposure to tap water. This knowledge may motivate professional organizations to develop initiatives to educate eye care professionals on the dangers of contact lens exposure to water.

PURPOSE

The purpose of this study was to investigate the practice patterns and risk perceptions of eye care professionals regarding gas-permeable contact lens exposure to tap water.

METHODS

A branched-logic survey was started by 320 clinicians, vision scientists, and industry personnel and was fully completed by 272 participants. The survey queried participants about their current practices, recommendations, and perceptions of risk regarding exposure of gas-permeable contact lenses to tap water.

RESULTS

Of those who prescribe gas-permeable contact lenses, 57.4% reported rinsing lenses with tap water, whereas only 32.7% reported engaging in this same behavior in front of patients. Of those who reported never rinsing lenses with tap water, 85.6% indicated that rinsing lenses with water increases infection risk, whereas 52.1% of those who rinse lenses with water reported the same perceived risk (P < .001). Of all participants, 60% indicated that wearing contact lenses while showering increases infection risk, and 50.2% of all participants advised patients to avoid this behavior.

CONCLUSIONS

A discrepancy exists between perceptions of risk concerning exposure of contact lenses to water and both clinical practices and patient education provided by professionals.

Compliance behaviour change in contact lens wearers: a randomised controlled trial

BACKGROUND

Water exposure during contact lens wear has been associated with contact lens disease including microbial keratitis and sterile corneal infiltrates. Despite the documented risks, water exposure is common amongst lens wearers. This study aimed to determine the effect of water education in the form of "no-water" lens case stickers on water-contact behaviours and storage case contamination.

METHODS

In a prospective, masked, randomised controlled trial, 200 daily lens wearers were randomised to either receive a storage case with a "no-water" sticker (test) or without a "no-water" sticker (control). Both groups received written compliance information. Participants completed a self-administered lens hygiene questionnaire at baseline and after 6 weeks. Microbial analysis of used storage cases, collected at both study visits, was conducted using ATP and limulus amebocyte lysate (LAL) assays for overall microbial contamination and endotoxin levels, respectively. A one-way ANCOVA and multiple logistic regression determined the change in water-contact behaviours and storage case contamination over time.

RESULTS

A total of 188 lens wearers completed both study visits; 128 females and 60 males; average age 29 ± 13 (range 18-78 years); 95 test and 93 control participants. After 6 weeks, the overall water exposure score and endotoxin levels reduced significantly in the test group compared with the control group (p < 0.05). There were no significant changes in individual water-contact behaviours or overall storage case contamination.

CONCLUSION

A no-water infographic on the contact lens case improved overall water-contact behaviours and reduced storage case endotoxin. Refining the messaging may be beneficial in future to improve other aspects of compliance.

Water Exposure and the Risk of Contact Lens-Related Disease

PURPOSE

To describe the association of water exposure with contact lens (CL)-related disease and explore the guidelines regarding water exposure to CL wearers, provided by CL manufacturing industry, global public health, and CL-related professional associations.

METHODS

A review of the literature was conducted by searching PubMed, MEDLINE, and Web of Science databases up to September 2017 for articles published or translated in English using keywords: contact lens* AND tap water OR swimming OR showering OR water exposure AND microbial keratitis OR Acanthamoeba keratitis OR corneal infiltrate* OR ocular adverse event*. References in all relevant publications were also reviewed.

RESULTS

Water exposure during CL wear is associated with complications ranging from sterile corneal infiltrative events to sight-threatening infections. Despite the documented risks due to water exposure, water-related habits are common among CL wearers. This suggests a lack of awareness and understanding regarding the risks among CL wearers and potentially CL practitioners. Discrepancies exist in guidelines for CL hygiene and compliance provided by the CL manufacturing industry, global public health, and CL-related professional associations. There is also widespread use of water imagery within CL marketing and packaging materials. These factors may give rise to confusion among wearers and may contribute toward risk-taking behaviors.

CONCLUSIONS

Consensus among stakeholders about water and CL care is needed. Guidelines should unequivocally advocate for the avoidance of any water exposure including handling CLs with wet hands, rinsing CLs or storage cases in tap water, showering while wearing CLs and swimming with CLs without wearing goggles.

The diagnosis and management of contact lens-related microbial keratitis

Contact lens-associated microbial keratitis poses a diagnostic dilemma for optometrists on two fronts. The distinction between sterile inflammation and microbial infection is often blurred. In addition, there is a requirement with nearly 50 per cent of the Australian and New Zealand optometric profession being therapeutically endorsed, to distinguish between cases of infection that can be managed in the community verses those that require escalation to public hospitals that have access to laboratory diagnostic tools and advanced imaging techniques, such as in vivo confocal microscopy. Pattern recognition and incorporation of knowledge of aetiology and risk factors assists optometrists to decide on optimal management strategies. Skilled optometrists will utilise emerging diagnostic and therapeutic technologies to ensure safe management strategies and better outcomes for these cases.

Knowledge, Behavior, and Free-Living Amoebae Contamination of Cosmetic Contact Lens Among University Wearers in Thailand: A Cross-Sectional Study

OBJECTIVE

To assess the general knowledge, behavior, and presence of potentially pathogenic amoebae in cosmetic contact lens (CCL) wearers.

METHODS

One hundred CCL asymptomatic wearers were randomly selected. A questionnaire regarding their lens use, and a pair of their CCL was obtained. Identification of free-living amoeba (FLA) strains was based on morphological diagnosis, enflagellation tests (for non-Acanthamoeba strains), and sequencing of the small-subunit rRNA gene fragments.

RESULTS

Most (92%) of the participants surveyed were women, and the average age of the participants was 21.5±0.2 years. The CCL wearers generally showed a moderate (47%) or good (35%) level of knowledge, and good (51%) or excellent (40%) use of CCL. Two CCL samples were positive for Acanthamoeba genotype T3 or Vahlkampfia. The Acanthamoeba-contaminated CCL was from a wearer who used saline for treating lenses, and the Vahlkampfia-contaminated CCL was from a wearer who used CCL while swimming.

CONCLUSIONS

This is the first report of the presence of potentially pathogenic FLA in used CCL from asymptomatic wearers in Thailand. Although there was satisfactory knowledge and practice of lens care use, the public should be aware of CCL contaminated with potentially pathogenic FLA that can directly or indirectly cause keratitis.

Non-compliance with contact lens wear and care practices: a comparative analysis

PURPOSE

To compare the effects of existing patient awareness of lens-related complications and underlying risk factors on actual patient behavior during contact lens wear and care practices in two different clinical study populations.

METHODS

Established contact lens wearers (n = 281) completed an anonymous written questionnaire on presenting to their habitual eye care practitioner in the Dallas-Fort Worth metroplex. Data were analyzed and compared against a second study population, which comprised established contact lens wearers (n = 152) who were sequentially evaluated after their routine contact lens examination at the University of Texas Southwestern Medical Center at Dallas, TX (UTSW). All patients were questioned regarding his or her lens care practices and knowledge of complications and risk factors associated with contact lens wear.

RESULTS

Fifty-eight percent of patients in the general community could identify by name a complication associated with lens wear compared with 91% within the medical center. The most frequent complications reported were related to comfort and handling (72%, Dallas-Fort Worth) and infection (47%, UTSW). The majority of patients could correctly identify risk factors associated with lens-related complications; awareness for topping-off solutions, tap water exposure, and hygiene varied between groups. Overall, 85% of patients perceived themselves as compliant with their lens wear and care practices. Using a standard scoring model to determine actual compliance, 2% of patients demonstrated good compliance; however, only 0.4% of patients were fully compliant with contact lens wear and care practices.

CONCLUSIONS

The data reveal some study bias in complication and risk awareness between populations; however, despite this limitation, a significant proportion of patients exhibited actual non-compliant behavior despite acknowledged awareness of risk. Although most patients consider themselves to be complying with standard practitioner guidelines for lens wear and care practices, essentially all contact lens wearing patients exhibit behavioral non-compliance with resulting increased risk for significant complications.