This article was originally published in a sponsored newsletter.

The COVID pandemic taught practitioners the importance of educating patients on what to do in an eye emergency. This is true for both contact lens wearers and non-contact lens wearers. There were too many patients with eye emergencies who went to the emergency room instead of seeing an eyecare practitioner. Since our practice was open while many were closed, we saw all sorts of eye-related emergencies during this time, including contact lens-associated emergencies.
 
Over the years, there have been a few patients who could not get their contact lenses out and went to the emergency room. The first patient was a scleral lens wearer the first year that we started fitting scleral lenses. I was informed that some instrument was used to remove the lens. I am frightened about what that instrument was exactly.
 
This experience emphasized the importance of teaching patients how to remove scleral lenses both with and without devices. It’s also important to educate patients on where to find devices and solutions when traveling.
 
The goal is to keep all patients out of the emergency room for an eye-related emergency. Inform patients to call if there is an emergency and send a message if it is non-emergent. Eyecare practitioners have sophisticated tools to evaluate contact lenses and the ocular surface. However, not all emergency departments have these same tools.
 
A retrospective longitudinal study published evaluated the epidemiology of contact lens-related visits to the emergency department nationwide in the U.S.¹ The attributes and frequency of keratitis in contact lens wearers visiting the emergency department from 2006 to 2017 were assessed. The study also categorized high-risk groups.

In totality, 149,716 emergency room visits were documented with a diagnosis of corneal disorder due to contact lens. The occurrence of emergency room visits dropped progressively from 2010 to 2016. The majority of patients were female (67%), 68.9% were adults from 19 to 44 years old, and more than half (56.3%) had a private insurance provider.
 
Those who had higher socioeconomic status, women, and young adults presented to the emergency department most often with contact lens-related corneal visits. The average charge per patient discharged from the emergency department was $1,051.40.
 
What is the frequency of scleral lens wearers presenting with adverse events to practices and/or the emergency department? The accounts of microbial keratitis and other adverse events in scleral lens wearers are largely anecdotal. Fortunately, an ongoing multicenter research study is being performed to evaluate and estimate the incidence and prevalence of adverse events in scleral lens wearers. Classification of risk factors and characteristics will hopefully aid to prevent additional adverse events in scleral lens wearers.

REFERENCES

1. Usmani B, Dayananda S, Shah S, Jhanji V. Epidemiology of Contact Lens-Related Emergency Department Visits: Data From Nationwide Emergency Department Sample. Cornea. 2023 May 1;42:572-577. 

Melissa Barnett, OD, FAAO, FSLS, is a principal optometrist at the University of California Davis Eye Center in Sacramento, specializing in anterior segment disease and specialty contact lenses. She is the past president of the Scleral Lens Education Society. She is an advisor to and/or has received honoraria or travel expenses from AccuLens, Alcon, Allergan, Bausch + Lomb, Bruder, Contamac, CooperVision, EveryDay Contacts, Johnson & Johnson Vision, Mojo Vision, Ocusoft, ScienceBased Health, Shire, SynergEyes, Tarsus, and Visus Therapeutics.