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      Personal hygiene risk factors for contact lens-related microbial keratitis

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          Abstract

          Objective

          Microbial keratitis is a sight-threatening complication of contact lens wear, which affects thousands of patients and causes a significant burden on healthcare services. This study aims to identify compliance with contact lens care recommendations and identify personal hygiene risk factors in patients who develop contact lens-related microbial keratitis.

          Methods and analysis

          A case–control study was conducted at the University Hospital Southampton Eye Casualty from October to December 2015. Two participant groups were recruited: cases were contact lens wearers presenting with microbial keratitis and controls were contact lens wearers without infection. Participants underwent face-to-face interviews to identify lens wear practices, including lens type, hours of wear, personal hygiene and sleeping and showering in lenses. Univariate and multivariate regression models were used to compare groups.

          Results

          37 cases and 41 controls were identified. Showering in contact lenses was identified as the greatest risk factor (OR, 3.1; 95% CI, 1.2 to 8.5; p=0.03), with showering daily in lenses compared with never, increasing the risk of microbial keratitis by over seven times (OR, 7.1; 95% CI, 2.1 to 24.6; p=0.002). Other risks included sleeping in lenses (OR, 3.1; 95% CI, 1.1 to 8.6; p=0.026), and being aged 25–39 (OR, 6.38; 95% CI, 1.56 to 26.10; p=0.010) and 40–54 (OR, 4.00; 95% CI 0.96 to 16.61; p=0.056).

          Conclusion

          The greatest personal hygiene risk factor for contact lens-related microbial keratitis was showering while wearing lenses, with an OR of 3.1, which increased to 7.1 if patients showered daily in lenses. The OR for sleeping in lenses was 3.1, and the most at-risk age group was 25–54.

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          Most cited references16

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          Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases.

          L. Laroche, T Bourcier, C. Chaumeil … (2003)
          To identify predisposing factors and to define clinical and microbiological characteristics of bacterial keratitis in current practice. A retrospective analysis of the hospital records of patients presenting with bacterial keratitis and treated at the Quinze-Vingts National Center of Ophthalmology, Paris, France, was performed during a 20 month period. A bacterial keratitis was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping and/or that was cured with antibiotic therapy. Risk factors, clinical and microbiological data were collected. 300 cases (291 patients) of presumed bacterial keratitis were included. Potential predisposing factors, usually multiple, were identified in 90.6% of cases. Contact lens wear was the main risk factor (50.3%). Trauma or a history of keratopathy was found in 15% and 21% of cases, respectively. An organism was identified in 201 eyes (68%). 83% of the infections involved Gram positive bacteria, 17% involved Gram negative bacteria, and 2% were polymicrobial. Gram negative bacteria were associated with severe anterior chamber inflammation (p=0.004), as well as greater surface of infiltrates (p=0.01). 99% of ulcers resolved with treatment, but only 60% of patients had visual acuity better than the level at admission, and 5% had very poor visual outcome. Contact lens wear is the most important risk factor. Most community acquired bacterial ulcers resolve with appropriate treatment.
          Article 0 comments Cited 145 times – based on 0 reviews     Review now
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            The incidence of contact lens-related microbial keratitis in Australia.

            Fiona Stapleton, Lisa Keay, Katie Edwards … (2008)
            To establish the absolute risk of contact lens (CL)-related microbial keratitis, the incidence of vision loss and risk factors for disease. A prospective, 12-month, population-based surveillance study. New cases of CL-related microbial keratitis presenting in Australia over a 12-month period were identified through surveillance of all ophthalmic practitioners (numerator). Case detection was augmented by records' audits at major ophthalmic centers. The denominator (number of wearers of different CL types in the community) was established using a national telephone survey of 35,914 individuals. Cases and controls were interviewed by telephone to determine subject demographics and CL wear history. Visual outcomes were determined 6 months after the initial event. Annualized incidence and confidence intervals (CI) were estimated for different severities of disease and multivariable analysis was used in risk factor analysis. Annualized incidence (with CI) of disease and vision loss by CL type and wear modality and identification of independent risk factors. We identified 285 eligible cases of CL-related microbial keratitis and 1798 controls. In daily wear rigid gas-permeable CL wearers, the annualized incidence per 10,000 wearers was 1.2 (CI, 1.1-1.5); in daily wear soft CL wearers 1.9 (CI, 1.8-2.0); soft CL wearers (occasional overnight use) 2.2 (CI, 2.0-2.5); daily disposable CL wearers 2.0 (CI, 1.7-2.4); daily disposable CL wearers (occasional overnight use) 4.2 (CI, 3.1-6.6); daily wear silicone hydrogel CL wearers 11.9 (CI, 10.0-14.6); silicone hydrogel CL wearers (occasional overnight use) 5.5 (CI, 4.5-7.2); overnight wear soft CL wearers 19.5 (CI, 14.6-29.5) and in overnight wear of silicone hydrogel 25.4 (CI, 21.2-31.5). Loss of vision occurred in 0.6 per 10,000 wearers. Risk factors included overnight use, poor storage case hygiene, smoking, Internet purchase of CLs, <6 months wear experience, and higher socioeconomic class. Incidence estimates for soft CL use were similar to those previously reported. New lens types have not reduced the incidence of disease. Overnight use of any CL is associated with a higher risk than daily use.
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              Risk factors for microbial keratitis with contemporary contact lenses: a case-control study.

              D Minassian, Shefali Verma, John K G Dart … (2008)
              To assess the relative risks (RR) of microbial keratitis (MK) for contemporary contact lens (CL) types and wearing schedules. A 2-year prospective case-control study begun in December 2003. Cases were 367 CL wearers attending Moorfields Eye Hospital with proven or presumed MK. Controls were 1069 hospital controls, who were CL wearers with a disorder unrelated to CL wear, and 639 population-based controls who were CL wearers randomly selected from the Moorfields catchment area. Hospital patients completed a self-administered questionnaire; population-based controls were interviewed by telephone. Multivariate analysis was done both for all cases of MK, and for the moderate and severe MK subgroups alone. The RR for developing MK, and vision loss, for all lens types compared with planned replacement soft lenses (the referent). Compared with planned replacement soft lenses (the referent), the RR of MK was significantly increased with daily disposable (DD) CLs (RR, 1.56x [95% confidence interval (CI), 1.1-2.1]; P = 0.009) and differed between different brands of DD lens, was reduced for rigid lenses (RR, 0.16x [95% CI, 0.06-0.4]; P or=20/40. The RR for overnight wear, for any lens type, was 5.4 times higher (95% CI, 3.3-10.9; P<0.001). Comparison of the DD soft CL types with planned replacement soft lenses (the referent), showed significant differences between brands for the risk of MK. The risk of MK has not been reduced in users of DD and silicone hydrogel CLs. However, vision loss is less likely to occur in DD than in reusable soft CL users. Different brands of CL may be associated with significantly different risks of keratitis; understanding these differences should lead to the development of safer soft lenses. These findings suggest that lens/ocular surface interactions may be more important in the development of corneal infection than oxygen levels and CL case contamination.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open Ophthalmol
                Journal ID (iso-abbrev): BMJ Open Ophthalmol
                Journal ID (hwp): bmjophth
                Journal ID (publisher-id): bmjophth
                Title: BMJ Open Ophthalmology
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2397-3269
                Publication date Collection: 2020
                Publication date (Electronic): 8 September 2020
                Volume: 5
                Issue: 1
                Electronic Location Identifier: e000476
                Affiliations
                [1 ]departmentEye Unit , University Hospital Southampton NHS Foundation Trust , Southampton, UK
                [2 ]departmentEye Unit , Clinical and Experimental Sciences, University of Southampton , Southampton, UK
                Author notes
                [Correspondence to ] Professor Parwez Hossain; P.N.Hossain@ 123456soton.ac.uk
                Author information
                http://orcid.org/0000-0001-6246-6680
                http://orcid.org/0000-0002-3131-2395
                Article
                Publisher ID: bmjophth-2020-000476
                DOI: 10.1136/bmjophth-2020-000476
                PMC ID: 7481083
                PubMed ID: 32953996
                SO-VID: f3347cf3-b4b8-4efe-87ea-69dc1a4fec90
                Copyright © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 02 April 2020
                Date revision received : 04 August 2020
                Date accepted : 15 August 2020
                Categories
                Subject: Original Research
                Subject: 1506
                Custom metadata
                special-feature unlocked

                Keywords: cornea,contact lens,infection,pathology,microbiology
                Data availability:
                Keywords: cornea, contact lens, infection, pathology, microbiology

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