CLs IN THE MILITARY
Contact Lenses at West Point Military Academy
Do the unique demands placed on cadets at the United States Military Academy affect their contact lens wear? Here's a first-time study of this special population.
Haby I. Ramirez, OD

The mission of the United States Military Academy (USMA) at West Point, New York, founded in 1802, is to develop leaders of character for our Army. It consists of a corps of 4,000 cadets, approximately 10 percent of whom are female. USMA training combines academic, military and physical development programs, which place extraordinary physical and emotional demands upon the cadets.

While there are several studies that report complications and symptoms of contact lens wear, no study makes reference to a special population like the West Point cadets.

Survey Background

The USMA sent a survey to all cadets to gather information on contact lenses and the cadets who wear them. This is the first study about contact lenses conducted at this institution. Areas of assessment included ocular health, symptoms, contact lens wearing schedule, management of complications, lens types and use in sports and in the field. Another purpose of the survey was to identify any misconceptions or problems related to contact lens use, which the USMA would correct via cadet education or USMA policy changes.

The Institutional Research Office (IRO) recommended changes to the original survey to allow cadets to answer the survey mostly by using the computer mouse. The IRO created a Universal Resource Locator (URL) to automatically connect the cadets to the survey. Each cadet received an e-mail message explaining the purpose of the survey, administered through the USMA's computer network. Included were instructions on how to use the mouse to click on the survey URL and fill out the survey form. Any medical science school or institution that wants to conduct a study can utilize this model, which saves the patient and the doctor time and money by using the Internet. One week after the survey was distributed, the IRO collected and provided me with the data for analysis. I then compared the data to current studies.

Four thousand U.S. Military Academy cadets between the ages of 17 and 26 were surveyed. All cadets go through a rigorous physical exam prior to acceptance into the institution. Some visual requirements for acceptance into the Academy are: visual acuities correctable to 20/20 in each eye, astigmatism less than 3.00D, hyperopia less than 8.00D spherical equivalent and myopia less than 6.75D. Ocular conditions that disqualify any cadet from entering the military academy include: chronic blepharitis, visual field abnormalities, exophthalmos, loss of normal pupillary reflex, night blindness and any organic disease that threatens vision or visual function.

The collected data was split into two files, free response question data and multiple choice questions. After identifying and removing a few duplicate responses, the multiple-choice data was loaded into Statistical Analysis Software Package (SPSS) for analysis. I further analyzed the information and then compared the results to current literature to identify any clinically significant findings.

Respondents' Contact Lens History

There were 807 cadets who answered the survey, 650 of whom are using contact lenses at this time. One hundred and forty-three are interested in contact lens wear, and 128 cadets discontinued lens wear, 18 percent of whom reported that they discontinued due to a complication. Three percent had problems with cleaning solutions, 11.7 percent had adaptation problems and 16.4 percent discontinued use due to lens and maintenance cost. Fifty-one percent discontinued contact lens use due to a reason not mentioned in the survey.

Complications

There were 694 complications reported by the cadets. Percentages of complications and symptoms are as follows: ripped or torn contact lenses (25.8%), dry eyes (22%), itching (12.7%), tearing (6.3%), conjunctivitis (6%), corneal ulcer (5.3%), problems with cleaning solutions (4.5%), secretions (3.9%), giant papillary conjunctivitis (3.8%), allergic reactions (2.6%) and other complications or symptoms not mentioned above (6%). Some management procedures are unknown.

When asked how their doctors managed contact lens complications, 14.4 percent reported discontinuing use for between one week and one month, 2.9 percent reported discontinuing contact lens use for one month or more, and 0.002 percent reported discontinuing contact lens use permanently. Antibiotics were prescribed for 8.4 percent of cadets with complications, 9.4 percent reported use of lubricants, 7.9 percent changed their contact lens brand, and 8.9 percent underwent other management methods which are not mentioned above.

Distribution of Contact Lens Wearers By Type

Two-week disposable lenses are the most commonly used at West Point (36%), followed by frequent replacement (25.3%). Seven percent of cadets use soft toric lenses, 1.9 percent use colored soft lenses, 15.1 percent are in soft contact lens conventional wear, 4.4 percent are in soft extended wear, three percent wear soft extended wear toric contact lenses, 6.3 percent wear rigid gas permeable contact lenses, and 1 percent use other contact lenses not mentioned above.

Contact Lens Wearing Schedule

Most of the responding cadets (55.8%) wear contact lenses on a daily basis. Some wear contact lenses for sports only (6.4%). Other cadets wear contact lenses from five to six days per week (8.8%), from three to four days per week (5.8%), from one to two days per week (3.6%), and only on special occasions (3.2%).

The survey also revealed that 18.3 percent of cadets wear contact lenses 10 hours per day or less, 81.7 percent wear them for 10 or more hours, 75.3 percent wear them for 12 or more hours, 64.9 percent for 14 or more hours, 53.1 percent for 16 or more hours, 33.9 percent for 18 or more hours, and 10.4 percent of cadets wear contact lenses in an extended wear fashion.

Field and Sporting Activities

Of the cadets who responded to the survey, 399 play basketball, 292 cadets play soccer, 211 cadets swim, 70 cadets scuba dive and 26 of the cadets sky dive while wearing contact lenses. Even though there is a policy prohibiting West Point cadets from using contact lenses in the field, 381 cadets reported doing so. A letter or memo addressing this situation will be sent through the chain of command. Three hundred, eighty-one cadets reported wearing contact lenses while doing field-training exercises, which is 58.6 percent of those who answered the survey. Forty-nine percent cleaned their lenses while in the field. Of those who wore their lenses in the field, 151 used extended wear lenses. Ten cadets reported using a different type of contact lens for field exercises.

Frequently Asked Questions

The last question of the survey invited cadets to ask any question about contact lenses. Needless to say, hundreds of questions were asked. Most of the cadets were concerned about eye health, laser surgery, swimming with contact lenses, availability of contact lens services, contact lens wearing schedules and extended wear in the field. Some cadets questioned which contact lens is best for field use.

A Comparative Analysis

Results were compared with reported data on complications. Poggio and Abelson (1993) conducted a cohort study to estimate the rates of complications and symptoms among patients using daily wear disposable contact lenses on a regular disposal regimen. They compared these results to conventional soft daily wear rates. The study reports that 1.1 percent of patients using disposable daily wear and 2.1 percent using conventional daily wear developed conjunctivitis. In the USMA study, 6 percent of the cadets reported that they developed conjunctivitis while wearing contact lenses.

The Poggio and Abelson study also reported percentages of secretions as 0.04 percent for disposable daily wear and 0.06 percent for conventional daily wear. In the USMA study, 3.9 percent of the cadets reported that they had secretions associated with contact lens use.

The results between these two studies were different, showing that the cadets may be at a higher risk for complications.

Another interesting finding of the USMA study was that 22 percent of cadets reported dry eye symptoms associated with contact lens use. Poggio and Abelson reported that 10 percent of their patients in disposable daily wear and 7.3 percent in conventional daily wear had dry eye symptoms. This difference may be due to a combination of factors. Daily sport activities like running and basketball may be an important factor in addition to the type of contact lenses used by cadets. Another survey will be designed in an attempt to isolate or determine the different factors directly associated with this symptom.

A comparison of the distribution of contact lenses by type was made between the USMA and Wesley Jessen's 1998 US Soft Contact Lens Industry Update published in Contact Lens Spectrum, April 1998. The industry update reported that 62.5 percent of soft contact lenses wearers are using disposables, 13.1 percent are on planned replacement and 24.3 percent are on conventional. The USMA survey shows that the two most commonly used contact lens types are two-week disposable (36%) and soft frequent replacement contact lenses (25.3%).

A Contact Lens Plan of Action

This study revealed that complication percentages for cadets were higher than those reported in the literature. Therefore, a plan of action, starting with cadet education, is already in place.

On the agenda is an e-mail message addressed to the entire corps of cadets, explaining the difference between various types of contact lenses and possible complications due to excessive or extended wear. The message will also emphasize current Army policies. Special contact lens handling and cleaning instructions will be provided to all cadets due to the high incidence of use for swimming, scuba diving and other aquatic activities.

The author would like to thank Mr. Douglas Gallagher for his help with this article.

To receive references via fax, call (800) 239-4684 and request document #44.

Dr. Ramirez completed SUNY's hospital-based Optometry residency at the United States Military Academy in West Point, New York and is currently optometry chief for the First Infantry Division in Vilseck, Germany.