Recently, the Centers for Disease Control’s Morbidity and Mortality Weekly Report (MMWR) highlighted the United States contact lens-wearing public’s abysmal record for contact lens compliance.1 The results of the survey were both tragic and embarrassing, and should serve as a sobering reminder that we, the contact lens prescribers responsible for our patients’ well-being, may not be doing an adequate enough job educating patients on proper lens care and hygiene. 

A population-based estimate of the number of contact lens wearers suggests there are 40.9 million lens wearers in the United States, many of whom are at risk for adverse reactions to contact lens wear.1 Demographically, the results showed that, overall, contact lens wearers were younger, female and white compared with non-lens wearers.1

A Wake-Up Call
Researchers used an adapted version of the Contact Lens Risk Survey to help describe lens behaviors. 

Approximately 99% of over 1,000 lens wearers surveyed online said they engaged in one or more behaviors identified in previous studies as a risk for infection.  Nearly one-third of those surveyed reported a previous contact lens-related red eye, a painful response requiring medical intervention, or both. Some of the reckless behaviors soft lens wearers admitted to: 1

 • Keeping daily wear lenses in overnight (50.2%).

• Napping in their lenses (87.1%).

• Topping off solution in the lens case instead of replacing it daily (55.1%).

• Extending the replacement frequency of lenses (49.9%) or lens cases (82.3%).

• Showering while wearing lenses (84.9%) and swimming while wearing lenses (61.0%).

The majority of GP wearers and about one-third of soft lens wearers also reported using tap water to rinse or store their lenses.1 This is concerning, as it violates a basic tenet of contact lens wear: exposure to non-sterile water of any type poses a potential risk for devastating microbial events.

Lens cases remain the primary reservoir of microbial contamination. Another recent study showed that over 50% of cases harbor significant amounts of microbes (bacteria and more) that can be a vector for infection in lens wearers.2 Common pathogens include coagulase-negative Staphylococcus, Bacillus sp., Pseudomonas aeruginosa and Serratia marcescens.2

Practice Implications
What’s a prescriber to do in light of these dismal results? There has to be some shared responsibility among manufacturers, practitioners and patients. For our part in the hygiene compliance redux, we must remain focused on continuing to educate patients on proper lens care—and not just early in the wearing experience, but on every single visit. Practitioners should continually emphasize the following recommendations from CDC’s Consensus Panel on Contact Lenses:1

1. Adopt good hygiene habits. Always thoroughly wash your hands. Never sleep in lenses unless instructed to by your eye care provider. Keep all water away from lenses and case and avoid swimming, using hot tubs or showering in lenses.

2. Replace contact lenses, solutions and cases. Replace lenses and cases as recommended by your eye care provider. Discard used solution from lens case and clean with fresh solution, not water.

3. Seek medical care. Visit your ECP yearly unless advised otherwise. If you experience any persistent eye pain, discomfort, redness or blurred vision, remove lenses immediately and call your ECP.

4. Be prepared. Carry a back-up pair of lenses and glasses, as well as your prescription, with you at all times.

A wise instructor once said that patients provide the highest compliment by seeking guidance through your care. They choose you because they trust you to prescribe and recommend the best care for them. But trust is a two-way street: Do you trust them to listen? Only you can know if they’re getting the message. 

1. Cope JR, Collier SA, Rao, , Chalmers R, Mitchell GL, et al. Contact lens wearer demographics and risk behaviors for contact lens-related eye infections. Morbidity and Mortality Weekly Report. 2015;64(32):865-70.
2. Tzu-Ying Wu Y, Willcox M, Zhu H, Stapleton F. Contact lens hygiene compliance and lens case contamination: A review. Contact Lens and Anterior Eye. 2015 May. [Epub ahead of print].