Trends in Australian contact lens prescribing during the first decade of the 21st Century (2000–2009)

Profile of contact lens prescribing in GCC countries

PURPOSE

This study aimed to report the pattern of contact lens prescribing from the Gulf Cooperation Council (GCC) countries.

METHODS

Optometrists in the GCC region were contacted to participate in a web-based survey hosted on Qualtrics XM (Provo, Utah, USA). The survey methodology was adapted from the International Contact Lens Prescribing Consortium, and participants were asked to report their last five lens fits. It collected information on practitioner demographics (age, gender, nationality, qualification, country of practice, and number of years of experience), CL user demographics (age and gender) and on lens specific details such as lens type, lens design, lens material, replacement plan, and modality of lens wear. Descriptive statistics were used to analyse and report the data.

RESULTS

This study reports 739 contact lens fits by 174 practitioners from six GCC countries. The average age of the patients was 29.72 ± 9.07 (Mean ± SD) years and 64 % of them were females. The majority (80.2 %) were fitted with soft contact lenses, with 59 % preferring silicone hydrogels, 20 % wearing them for cosmetic purposes and nearly half of them disposed of their lenses daily (55 %). Among the RGP lenses, 41 % were scleral lenses. This survey demonstrated a greater proportion of new lens fits (55 % vs. 37 %), disposable hydrogel lens use (21 % vs. 13 %), and a preference for cosmetic contact lenses (20 % vs. 4 %) compared to the international data.

CONCLUSION

The pattern of CL prescriptions in the GCC region closely resembled the global trend. The survey observed a higher preference towards frequent replacement soft lenses, a greater proportion of silicone hydrogel lenses, a higher percentage of rigid lens fits, a greater affinity for cosmetic contact lenses, and a higher percentage of new fits. These trends suggest that contact lens prescription habits in the region are likely to continue evolving in the future.

Contact Lens Prescribing Patterns in a University Clinic in Trinidad and Tobago

The study assessed the contact lens prescribing patterns and associated factors in a university optometry clinic in Trinidad and Tobago. The data relating to habitual or new contact lens (CL) prescribing patterns among wearers over a two-year period were reviewed. Pearson’s chi-squared test and logistic regression models were used to analyze the findings. The Hosmer–Lemeshow goodness-of-fit test was used to examine the model calibration. A total of 243 CL fits were analyzed, and the Homeshow–Lemeshow goodness-of-fit test indicated a good fit (χ² (7) = 7.296, p = 0.399). The mean age of lens wearers was 29.6 ± 12.4 (mean ± SD); the majority, 155 (63.8 %) of whom, were 21 to 40 years old. Most lenses were fitted on females (64.2% of fits overall) and about half of the wearers (n = 122, 50.2%) were prescribed lenses for cosmetic purposes. Conventional soft CL were the most prescribed modality of wear, accounting for 129 (53.1%) of the fits. Age from 21 to 40 years was the predictor of lens type prescribed, and those in that age range were four times more likely to be prescribed soft lenses compared to other ages. The patterns of CL prescribing in a university optometry clinic in Trinidad and Tobago are similar to the global market trends with slight variations.

Results From the German Fungal Keratitis Registry: Significant Differences Between Cases With and Without a History of Contact Lens Use

PURPOSE

Fungal keratitis (FK) is a serious ophthalmic disease with a potentially devastating outcome that seems to be increasing in recent years. The use of contact lenses (CLs) was evaluated as a risk factor for FK to determine possible differences in course and outcome.

METHODS

Data from 173 cases reported in the German FK registry until August 2019 were evaluated regarding CL behavior, other ophthalmological and general risk factors, age, sex, identified pathogens, conservative and surgical therapy, visual acuity, and findings at admission and follow-up.

RESULTS

One hundred seventy-four eyes from 173 patients between 2000 and 2019 were included [64.4% women, median age 54 (39; 72) years]; 49.7% wore CL, of which 81.3% were soft CL, and 50.3% had no history of contact lens use (NCL). CL users were significantly more often women and otherwise healthy (CL: 80.2% vs. NCL: 48.9%; P < 0.0001). The spectrum of pathogens among CL users showed a significantly higher proportion of infections with filamentous pathogens, in particular Fusarium sp. (total filament: CL 69.8% vs. NCL 27.3%; P = 0.0001; Fusarium sp.: CL 50.0% vs. NCL 14.8%; P < 0.0001). Overall, 54.6% required keratoplasty and 8.6% enucleation.

CONCLUSIONS

CLS are the most important risk factor for FK in Germany. With CLs, typically, the infection is caused by molds, and patients are comparably younger and otherwise healthy. Often, extensive surgery is needed. To evaluate changes in the pathogen and resistance spectrum and to further monitor possible CL-related risk factors, a consistent collection of data remains paramount.

Trends in contact lens microbial keratitis 1999 to 2015: a retrospective clinical review

IMPORTANCE

Contact lens microbial keratitis (CLMK) is the most common cause of microbial keratitis in our community.

BACKGROUND

Define the trend in rate of CLMK and define patient demographics/culture results that may have a predictive value in patients with CLMK.

DESIGN

Retrospective review of clinical records of patients with MK.

PARTICIPANTS

All patients with positive corneal scraping between 1999 and 2015 at the Princess Alexandra Hospital, Brisbane, Queensland identified through local microbiology database.

METHODS

Trend in CLMK tested with chi-squared test of peak 3 years vs other years and Poisson regression of interrupted time series. Patient characteristics predictive of CLMK were defined by creating a polynomial regression model by stepwise variable selection.

MAIN OUTCOME MEASURES

Yearly rate of CLMK.

RESULTS

Records of 895 episodes of MK were included. The most common: risk factor was contact lens wear (324, 36.2%), isolated organism was Pseudomonas aeruginosa (P. aeruginosa 181, 55.9%) and treatment was monotherapy with a fluoroquinolone 172, 53%). CLMK was most common between 2009 and 2011 (49.5% vs other years 32%, P < 0.001). Poisson regression of the interrupted time series showed there was a significant decrease in the rate over time after 2010 (P < 0.001). Independent factors predictive of CLMK in multivariate regression were young age (15-49 years) and corneal culture positive for P. aeruginosa CONCLUSIONS AND RELEVANCE: The rate of CLMK in our community ranged between 32% and 50% and the rate of disease appears to have peaked during 2009 to 2011 and subsequently declined.

Does Occupation Influence Selection of Contact Lens Material?

OBJECTIVE

Long-term follow-up of contact lens (CL) wearers leads to better understanding of the factors leading to changes in CL trends. This study is an attempt to ascertain these factors in an emerging market like India. Factors like occupation were analyzed to determine if these contributed to changes in selection of CL materials in this article.

METHODS

Occupations were categorized as per the norms of International Standard Classification of Occupations-2008 (International Labor Organization, United Nations organization).

RESULTS

A majority of lens wearers were professionals and hydrogel lens materials were the lenses of choice among most of the lens wearers. There was a significant variation in CL material with different occupations (χ=19.29, P=0.037).

CONCLUSION

To conclude, employment and affordability influenced the selection of lens materials.

A Survey of Presbyopic Contact Lens Wearers in a University Setting

PURPOSE

To determine why presbyopic patients discontinue contact lens wear and describe their opinions of comfort and visual quality with contact lenses.

METHODS

A survey assessing current age, gender, contact lens material/design, and opinions of contact lens comfort and visual quality was mailed to 2400 presbyopic patients (age 40 years and older) that have had eye exams in the Ohio State University College of Optometry's Contact Lens Services over the last 4 years.

RESULTS

A total of 496 surveys were analyzed. The mean age of survey respondents was 57 ± 9 years, and 68% of the sample was female. Permanent discontinuation of contact lens wear was reported by 15%. No association was found between contact lens discontinuation and age (p = 0.7), gender (p = 0.2), age of beginning contact lens wear (p = 0.1), or contact lens material (p = 0.1). Poor vision (38%), discomfort (34%), convenience (20%), and cost (6%) were the primary reported reasons for discontinuation. There was no difference between the proportion of subjects reporting "poor vision" as their primary discontinuation reason and those reporting "discomfort" (p = 0.7). Discontinued wearers had a worse overall opinion of their distance (p = 0.03), intermediate (p = 0.01), and near vision (p = 0.002) compared to subjects who were still wearing their contact lenses.

CONCLUSIONS

Discomfort has been reported as the primary reason for contact lens discontinuation. In this presbyopic population, dissatisfaction with vision and discomfort were reported equally as often as primary reasons for discontinuation. As well, subjects who ceased contact lens wear had worse overall opinions of their vision at all distances than current contact lens wearers. The results of this survey suggest that presbyopes have unique demands and opinions related to contact lens wear.

Presbyopic and non-presbyopic contact lens opinions and vision correction preferences

PURPOSE

To compare vision correction preferences, refractive error, and gender of non-presbyopes and presbyopes.

METHODS

Adults who wear spectacles or contact lenses completed a survey about refractive correction opinions and refractive error was measured.

RESULTS

Of the 304 subjects, 38.2% were presbyopic (≥40 years) and 59.2% were female. Spectacles were the primary vision correction for 78.0% of subjects. Compared to contact lens wearers, the proportion of presbyopes was higher (p=0.006) in spectacle wearers. There was no difference in the proportion of presbyopes and non-presbyopes who have tried contact lenses (p=0.2) or who would prefer to wear contact lenses (p=0.2). In contact lens wearers, there was no difference in the proportion of presbyopes and non-presbyopes with a history of temporary discontinuation (p=0.9). Within the contact lens wearing group, there was no refractive error difference between presbyopes and non-presbyopes (spherical equivalent p=0.6; power vector J0 p=0.5; power vector J45 p=0.4; anisometropia p=0.2). Overall, contact lens wearers were more likely to be female (p=0.004). There was no difference in gender in presbyopic and non-presbyopic contact lens wearers (p=0.5).

CONCLUSIONS

Presbyopes and non-presbyopes have similar opinions about spectacles and contact lenses. Presbyopes of all refractive errors prefer contact lens correction when good vision and comfort can be achieved. Eye care providers should not assume that presbyopia, refractive error, or gender are factors that preclude a patient from being interested in contact lens wear.

Cytotoxic and Inflammatory Effects of Contact Lens Multipurpose Solutions on Human Corneal Epithelial Cells

Multipurpose solutions (MPSs) are the leading method for cleaning and disinfecting soft contact lenses (CLs). During recent years, numerous clinical studies have evaluated the MPS damage to the ocular surface. This study examined the cytotoxic and the inflammatory effects of MPSs and hydrogen peroxide disinfection system (H202) compared to appropriate controls on human corneal epithelial (HCE) cells. Primary cultured HCE cells were exposed to eight different commercially available MPS products (MPS A, ReNu MultiPlus®; MPS B, Opti Free® EverMoist; MPS C, Solo-care Aqua®; MPS-D, Complete®; MPS-E, Unica Sensitive®; MPS-F, Options Multi®; MPS-G, Biotrue®; MPS-H, COMPLETE® RevitaLens). Morphological changes and cytotoxic effects were examined with FITC-Annexin V/PI and MTT assays. The protein contents of the inflammatory cytokines interleukin (IL)-1β, TNF-α, IL-6 and IL-8 were examined by multiplex fluorescent bead immunoassay (FBI), and the mRNA expression was examined by real time PCR. Lipopolysaccharide (LPS) with 500 ng/ml CD14 and 500 ng/ml LBP (LPS complex), polyinosinic: polycytidylic acid (Poly I:C) and un-neutralized H202 served as positive controls, respectively. Phosphate-buffered saline (PBS) was added as a negative control. The study demonstrated that most of the MPSs induced varying degrees of cytotoxicity to HCE cells, and increased production of pro-inflammatory cytokines compared to the negative control. In addition, several MPS increased the mRNA level of inhibitory factor-κBα (1-κBα). Among the various MPSs, MPS-H induced the highest protein contents of the pro-inflammatory cytokines (14.37±2.2-fold for TNF-α, 41.39±2.5-fold for IL-1β and 5.24±0.6-fold for IL-6) compared to the negative control (p<0.05). In contrast, no significant differences were noted between the neutralized H202 and the negative control. We conclude that most of the currently used MPSs induce significant damage and inflammatory response in corneal epithelial cells. MPS-induced inflammation was mediated through NF-κB signal transduction. This study demonstrates for the first time inflammatory responses at the molecular level in primary HCE cells following exposure to a large series of commercially available and commonly used MPSs. These findings strongly suggest that certain MPSs may be partially involved in the pathogenesis of contact lens intolerance. Therefore, we recommend that practitioners advise patients as to the preferable disinfecting contact lens solutions, and to consider using the hydrogen peroxide disinfection systems instead.

A 'cost-per-wear' model based on contact lens replacement frequency

PURPOSE

The aim was to construct and advise on the use of a cost-per-wear model based on contact lens replacement frequency, to form an equitable basis for cost comparison.

METHODS

The annual cost of professional fees, contact lenses and solutions when wearing daily, two-weekly and monthly replacement contact lenses is determined in the context of the Australian market for spherical, toric and multifocal prescription types. This annual cost is divided by the number of times lenses are worn per year, resulting in a 'cost-per-wear'. The model is presented graphically as the cost-per-wear versus the number of times lenses are worn each week for daily replacement and reusable (two-weekly and monthly replacement) lenses.

RESULTS

The cost-per-wear for two-weekly and monthly replacement spherical lenses is almost identical but decreases with increasing frequency of wear. The cost-per-wear of daily replacement spherical lenses is lower than for reusable spherical lenses, when worn from one to four days per week but higher when worn six or seven days per week. The point at which the cost-per-wear is virtually the same for all three spherical lens replacement frequencies (approximately AUD$3.00) is five days of lens wear per week. A similar but upwardly displaced (higher cost) pattern is observed for toric lenses, with the cross-over point occurring between three and four days of wear per week (AUD$4.80). Multifocal lenses have the highest price, with cross-over points for daily versus two-weekly replacement lenses at between four and five days of wear per week (AUD$5.00) and for daily versus monthly replacement lenses at three days per week (AUD$5.50).

CONCLUSIONS

This cost-per-wear model can be used to assist practitioners and patients in making an informed decision in relation to the cost of contact lens wear as one of many considerations that must be taken into account when deciding on the most suitable lens replacement modality.