Compliance with contact lens care and cleaning has always been viewed as a key factor in reducing complications; however, it has gained greater scrutiny since the microbial keratitis outbreaks nearly a decade ago. There have been a number of improvements in contact lens materials, an increase in recommended lens replacement frequency and new lens solution compositions. 

The FDA recently removed the “no-rub” indication from contact lens solution bottles, citing the need for mechanical disruption of the microorganisms and deposits on the lens surface. There is also a strong indication that lens cases should be wiped down daily to remove biofilm formation, which harbors microorganisms.1 Despite these changes, research indicates rates of infection are still significant.  

In an effort to better understand the noncompliance issue and prevent future problems, the Centers for Disease Control (CDC) published a study in its Morbidity and Mortality Weekly Report on the demographics and risk behaviors in contact lens-related eye infections.2

The CDC analyzed an online survey of 4,269 adults over 18 years old from the United States, approximately 1,000 of whom were contact lens wearers. The survey was statistically weighted to make the panel representative of the US population. Participants were asked demographic questions, if and what type of lenses they wore and contact lens hygiene-related risk behaviors. The survey estimated there are nearly 40.9 million adult contact lens wearers in the US—and nearly 99% of them exhibit at least one contact lens hygiene risk behavior.2

About half of all wearers report overnight wear, with 87% stating they nap in lenses. Fifty-five percent top off solutions, while 50% replace lenses less frequently than recommended. Most shocking, but least surprising, was the rampant exposure of contact lenses to water-borne sources of infection: 84.9% reported showering in lenses, 61% swim with lenses in and 35.5% of all contact wearers rinse lenses in water (91% of GP wearers).2

A Practitioner’s Perspective
I found the risk behaviors of daily disposable wearers particularly interesting. Daily disposable lenses are supposed to reduce complications by eliminating the lens care compliance problems associated with storing lenses overnight. Perhaps, however, in our effort to eliminate lens care products and increase compliance, we have unwittingly increased daily disposable wearer noncompliance risk. Are we putting our daily disposable patients at risk by not talking to them about lens care hygiene and lens cases?

According to the CDC report on soft lens wearers, daily lens wearers have the highest level of storing lenses in tap water (28% of daily wearers, compared with 12.4% of planned replacement wearers) and rinsing lenses in tap water (40.3% of daily wearers compared with 27.2% of planned replacement wearers). Sixty percent of daily wearers use a contact lens case, and most of those report topping off solution (72% of daily wearers compared with 51.3% of planned replacement wearers).

The lens care compliance “talk” remains difficult, tedious and never-ending. I’m sure many practices were happy to shorten the lens care discussion when daily disposables arrived on the scene. However, daily disposable wearers also have significant noncompliance habits, and in the absence of proper instruction on lens care, they increase their risk with water exposure. 

So, perhaps the conversation should go something like this: “Replacing your lenses daily decreases your risk of infection and red eyes. Always carry a replacement pair of lenses with you, so you never have to reuse a lens. And if you find yourself in a situation where you do have to reuse a lens, there are some safer practices that can be used, such as rubbing, rinsing and storing the lens in a disinfecting solution and never using tap water on the lens.” These kinds of reminders will help us increase patient compliance one step at a time.   

1. Wu YT, Willcox M, Zhu H, Stapleton F. Contact lens hygiene compliance and lens case contamination: A review. Cont Lens Anterior Eye. 2015 Oct;38(5):307-16.
2. Cope JR, Collier SA, Rao MM, 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.