Disposable contact lens use as a risk factor for microbial keratitis

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Abstract
AIMS A case-control study was performed to evaluate soft contact lens (SCL) wear modality as a risk factor for microbial keratitis. METHODS Contact lens wearers presenting as new patients to Moorfields Eye Hospital accident and emergency department during a 12 month period completed a self administered questionnaire detailing demographic data and contact lens use habits. Cases were patients with a clinical diagnosis of SCL related microbial keratitis. Controls were SCL users attending with disorders unrelated to contact lens wear. Odds ratios (estimates of relative risks) and 95% confidence limits (CL) were calculated through multivariable logistic regression analysis. RESULTS There were 89 cases and 566 controls. A substantially increased risk with 1–4 weekly disposable SCL compared with non-disposable SCL was identified among both daily wear (DW) (odds ratio =3.51, 95% CL 1.60–7.66, p=0.002) and extended wear (odds ratio 4.76, 95% CL 1.52–14.87, p=0.007) users after adjustment for demographic, lens use and hygiene variables. Other significant factors among DW users were “occasional” overnight use, use of chlorine based (as opposed to other chemical) systems in combination with poor storage case hygiene, and irregular disinfection. CONCLUSION Properties of some disposable SCL may be partly responsible for these excess risks. It is also possible, however, that this finding is largely a reflection of widespread complacency among patients and practitioners with respect to disposable SCL fitting and use.