Contact Lens Care & Compliance

Can Media Sensationalism Help Reinforce Compliance?

BY MICHAEL A. WARD, MMSC, FAAO

A recent Atlanta news story on contact lens-associated Acanthamoeba keratitis (AK) opened with, “A Centers for Disease Control and Prevention report indicated that more than one million Georgians who wear contact lenses are likely putting themselves at greater risk for infection by a parasite that feeds on eyeballs,” (www.wsbtv.com/news/news/local/are-contacts-putting-you-risk-infection-parasite/nqQPH). This is a media sensationalization of AK that referenced the CDC’s Morbidity and Mortality Weekly Report (MMWR) dated Aug. 21, 2015, in which the authors described risky behaviors related to contact lens wear from a 2014 survey (Cope et al, 2015).

A Teaching Moment

This media piece reads terrifyingly as if Acanthamoeba searches out eyeballs to eat; it actually prefers bacteria as a food source. Unfortunately, this story resulted in many fearful phone calls by worried patients to eyecare practitioners’ offices looking for assurances that their eyes are safe while wearing contact lenses. Unfortunate, but this provides an opportunity to remind our patients of proper lens care practices.

Below are selected sections of my October 2015 column regarding the referenced CDC article:

“The CDC survey was adapted from a soft contact lens risk survey by Wagner et al (2014)…. Survey respondents were mostly female (82%), more educated, and of white, non-Hispanic race/ethnicity when compared with non-contact lens wearers. GP contact lens wearers did not differ significantly in age from non-contact lens wearers, although wearers of soft, daily disposable, and overnight contact lenses were significantly younger.

“Nearly all (99%) survey participants reported at least one risky behavior relative to contact lens wear and care practices. The most commonly reported risky behaviors were napping in contact lenses (87.1%); showering in contact lenses (84.9%); and using lens storage cases longer than the recommended length of time before replacement (82.3%). Other survey results indicated that 50% of respondents extended the recommended lens replacement frequency, and 61% reported swimming while wearing contact lenses. About 91% of GP lens wearers reported using a water rinse, and one-third reported storing their lenses in water.”

Comments

This report underscores the need to provide thorough lens care instructions, including possible risks. Contact lens wear remains the number one risk factor for microbial keratitis (MK). And, the risk of lens-associated MK increases significantly with continuous wear and when wearing lenses during water activities (e.g., swimming and/or showering) (Franks et al, 1988; Stehr-Green et al, 1989; Dart et al, 1991).

AK is primarily associated with soft lens wear and water exposure. Soft contact lenses should never be exposed to water. The jury is still out regarding the relative risk of MK among GP wearers using water to rinse lenses prior to disinfection. GP lens-associated MK is relatively rare. Risks for MK can be mitigated through education and proper patient instruction. The CDC recommends: “Prevention efforts could include vigorous health promotion activities that encourage contact lens wearers to improve their hygiene behaviors, such as keeping all water away from contact lenses, discarding used disinfecting solution from the case and cleaning with fresh solution each day, and replacing their contact lens case every [three] months” (Cope et al, 2015). CLS

For references, please visit www.clspectrum.com/references and click on document #245.

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. You can reach him at mward@emory.edu.