Non-compliance is an ongoing problem among contact lens wearers, as a majority of wearers neglect to follow the manufacturer, prescriber or clinician’s recommendations for periods of time. While the development of frequent replacement contact lenses and simplified cleaning procedures was an attempt to improve compliance and reduce contact lens-related ocular problems, overwear still remains an issue.

Despite the introduction of daily disposable lenses, which may obviate the need for lens maintenance, and silicone hydrogel lenses, which minimize clinical problems by allowing unprecedented amounts of oxygen through to the ocular surface, users still overwhelmingly fail to replace their lenses in line with their actual prescription.1-3 Even though there has been significant progress made in the contact lens world—including new technologies and advancements in their medical understanding—non-compliance with contact lens wearers still remains a monumental problem in the eye care community.

Corneal Complications
Even with a careful and regular cleaning regimen, the use of contact lenses has been widely associated with a number of corneal complications, including giant papillary conjunctivitis, keratitis and lesions ranging from small peripheral sterile infiltrates to infectious corneal ulcers.4,5 The longer a lens is worn, the more protein deposits absorb on its surface—leading to loss of comfort and visual acuity, and eventually corneal complications.

For example, studies have found a higher overall incidence of keratitis in wearers who sleep in contact lenses compared with those who only use their lenses during waking hours.6-8

Defining Non-Compliant Behavior
To better understand who is actually being non-compliant and to pinpoint the culprits, certain studies have taken a closer look at those performing the misdeeds. In general, patient non-compliance with contact lenses has been shown to occur between 50% and 79% of all users, and women have proven more compliant than men.9-11 Typically, non-compliance occurs in younger users: One study found that 10- to 30-year-olds are less compliant than those older than 50 years.12

One study found that patients were non-compliant with at least one recommended procedure, and non-compliant behavior associated with contact lens safety was more common than non-compliant actions affecting contact lens comfort—57% of patients used disinfection procedures that could seriously affect safety.13

Another study reported that 24% of patients did not properly disinfect their lenses, and 5% used saline as their method of cleaning.14 The survey suggests that for habitual contact lens wearers, the level of knowledge and compliance rates decrease over time.
In a study of 50 daily wear contact lens patients, investigators found that just 26% were compliant with all aspects of their care system.15 Another study addressing reasons behind lack of compliance found that patients say forgetfulness is the primary reason behind contact lens overwear.16

Our Internal Investigation
To more closely determine the prevalence and reasoning behind non-compliance among contact lens wearers, we conducted an anonymous survey of 28 contact lens wearing eye care professionals in February and March 2011.

Of the 28 surveyed, 92.9% have worn contact lenses for more than five years. When asked about replacement schedules, 32.1% have a one-month prescription, 32.1% have a two-week replacement schedule, 32.1% have a daily replacement schedule and 3.6% do not know their schedule.

To better understand the actual compliance rates, comparisons were made between prescribed replacement schedules (one-month, two-week and daily) with the surveyed responses. Interestingly, we found that 78% of those surveyed with a one-month replacement schedule changed their lenses longer than the prescribed length, while 89% of those surveyed with a two-week replacement schedule changed their lenses longer than the prescribed length and 44% of those surveyed with a daily replacement schedule replaced their lenses longer than the prescribed length.

Generally speaking, all three groups were non-compliant with their prescribed replacement schedules, though it is worth noting that we found those with daily lenses to be most compliant. Additionally, 92.9% of those surveyed said that they never sleep with their lenses in, while 7.1% say they do so often (two to four times a week). When asked for reasons behind non-compliance, 46.4% mentioned cost and 28.6% mentioned convenience.

All in all, the compliance rate for contact lens wearers is far below a healthy standard. Eye care professionals should make a concerted effort to continuously make sure their patients are complying with all of the necessary steps, including cleaning, disinfecting, storing and adhering to their prescribed replacement and wearing schedules. Follow-up with patients is a necessity to ensure that compliance does not slip even further by the wayside. 

1. Hingorani M, Christie C, Buckley RJ. Ulcerative keratitis in a person wearing daily disposable contact lenses. Br J Ophthalmol. 1995 Dec;79(12):1138.
2. Lim L, Loughnan MS, Sullivan LJ. Microbial keratitis associated with extended wear of silicone hydrogel contact lenses. Br J Ophthalmol. 2002 Mar;86(3):355-7.
3. Whiting MA, Raynor MK, Morgan PB, et al. Continuous wear silicone hydrogel contact lenses and microbial keratitis. Eye (Lond). 2004 Sep;18(9):935-7.
4. Michaud L, Giasson CJ. Overwear of contact lenses: increased severity of clinical signs as a function of protein adsorption. Optom Vis Sci. 2002 Mar;79(3):184-92.
5. Moriyama AS, Hofling-Lima AL. Contact lens-associated microbial keratitis. Arq Bras Oftalmol. 2008 Nov-Dec;71(6 Suppl):32-6.
6. Morgan PB, Efron N, Hill EA, et al. Incidence of keratitis of varying severity among contact lens wearers. Br J Ophthalmol. 2005 Apr;89(4):430-6.
7. Poggio EC, Glynn RJ, Schein OD, et al. The incidence of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. N Engl J Med. 1989 Sep;321(12):779-83.
8. Schein OD, Buehler PO, Stamler JF, et al. The impact of overnight wear on the risk of contact lens-associated ulcerative keratitis. Arch Ophthalmol. 1994 Feb;112(2):186-90.
9. Claydon BE, Efron N. Non-compliance in contact lens wear. Ophthalmic Physiol Opt. 1994 Oct;14(4):356-64.
10. De Oliveira PR, Temporini-Nastari ER, Ruiz Alves M, Kara-Jose N. Self-evaluation of contact lens wearing and care by college students and health care workers. Eye Contact Lens. 2003 Jul;29(3):164-7.
11. DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004 Mar;42(3):200-9.
12. Chun MW, Weissman BA. Compliance in contact lens care. Am J Optom Physiol Opt. 1987 Apr;64(4):274-6.
13. Turner FD, Stein JM, Sager DP, et al. A new method to assess contact lens care compliance. CLAO J. 1993 Apr;19(2):108-13.
14. Ky W, Scherick K, Stenson S. Clinical survey of lens care in contact lens patients. CLAO J.1998 Oct;24(4):216-9.
15. Collins MJ, Carney LG. Patient compliance and its influence on contact lens wearing problems. Am J Optom Physiol Opt. 1986 Dec;63(12):952-6.
16. Dumbleton K, Woods C, Jones L, et al. Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in the United States. Eye Contact Lens. 2009 Jul;35(4):164-71.