Contact lens user profile, attitudes and level of compliance to lens care
Introduction
Contact lenses provide a convenient way of correcting refractive error, and they offer great advantages over spectacles in many regards. Even though contact lens related complications are rare, and most can be managed without any lasting side-effects, vision loss does occur. Microbial keratitis is the most severe sight threatening condition associated with lens wear. In addition to vision loss, the disease burden such as loss of income due to days off work, and treatment costs may also be significant to the individual [1]. Studies have identified several risk factors associated with lens wear complications in an attempt to encourage successful lens wear and to minimise the disease burden. Amongst the identified risk factors, some are non-modifiable, such as gender or age [2]. Others risk factors are modifiable, for instance, poor hand cleaning and lens case hygiene [3], and therefore can be targeted in minimising vision loss and maximising successful lens wear. Recently, the purchase of contact lenses over the internet and higher socio-economic status have been found to be associated with microbial keratitis [3]. As internet purchase has become more commonplace [4]; further research is required to establish to what degree if these factors influence lens wear behaviours and compliance.
In general health care, non-compliance is common. This is particularly true in the contact lens field, where non-compliance varies from 40% to 91% [5], [6], [7]. A potential contributing factor to this disturbingly high rate is that lens wear recommendations are predominantly preventative in nature. Contact lens wearers do not receive immediate benefit from following the recommendations nor do they perceive any direct threat as a result of failing to follow the recommendations. Factors such as the effort needed to maintain an optimal cleaning regime or inadequate knowledge and awareness about safe lens wear may contribute to non-compliance behaviours [5]. Wearers’ compliance continues to be a challenge for eye care practitioners.
With the aim of improving compliance, it is essential to identify the scope of hygiene behaviours and the demographic profile of lens wearers, and further, to assess whether attitude to lens care has an impact on the level of compliance. If lens care compliance is influenced by attitude, we should endeavour to develop strategies to change lens wears’ attitude towards contact lens hygiene. This study was undertaken to identify the demographics profile of lens wearers, and the scope of non-compliant behaviours through a self-reported questionnaire. The level of non-compliance behaviours was also compared with previous studies to examine whether the compliance level has changed over time.
Section snippets
Method
A questionnaire regarding lens wear habits and hygiene behaviours was developed by revising a questionnaire used in a previous Microbial keratitis study [3]. The revised questionnaire was tested on two focus groups, consisting of nine optometrists and twenty community lens wearers. The optometrist group consisted of experienced contact lens practitioners. The questionnaire was reviewed by these focus groups to ensure ease of comprehension and completeness.
Between May and September 2008,
Data analysis
Analysis of the categorical data was performed using non-parametric comparisons, using either Pearson's Chi-square or Fisher's Exact test. Associations between lens wearers’ demographic, hygiene behaviours and attitude to aftercare visits were examined with parametric or non-parametric correlation test. Factors that were significant at p < 0.05 were considered for multivariate testing using logistic regression. Statistical analyses were carried out using SPSS v14.0 statistical software.
Results
210 contact lens wearers were invited to participate. Response rate was 56% (60/108) for at the sites of consultation and 50% (51/102) for phone recruitment (p > 0.05).
Contact lens purchase location
Sixty-six percent (73/111) of participants usually obtained their contact lenses from optometrists, 17% (19/111) obtained lenses from optical outlets and 17% (19/111) from online sources.
Aftercare schedule awareness
Eighty-two percent (91/111) had their most recent aftercare within the last 12 months. Six participants had not had an aftercare for more than two years.
When participants were asked to specify how often they were advised to return for an aftercare visit, 51% reported that they could not remember or that no advice was given regarding their aftercare schedule. Lens wearers who purchased contact lenses from the internet were 3.8 times more likely to forget their aftercare schedule than those who
Contact lens and lens case hygiene practices
Lens wearers were questioned about what hygiene measures were carried out when contact lenses were last handled. Eight-eight percent (97/111) of participants reported having washed their hands with water prior to handling contact lenses, 11% (12/111) reported “no/sometimes”, 1% (1/111) was “unsure”.
Fig. 4 shows the summary of solution types reported used by lens wearers. Sixty-three percent (66/104) reported they rinsed their contact lenses, 37% (38/104) rubbed their contact lenses and 7%
Water activities and lens wear
Sixty percent (67/111) of participants recalled that, during the past 12 months, they had been engaged in water sport(s) (surfing/swimming) while wearing their contact lenses. Fifty-nine percent (40/67) reported engaging in water sports while wearing their contact lenses without swimming goggles or the use daily disposable lenses.
The geographic locations reported for these incidents were: ocean/river/lake (29%), public pool (30%), and private pool (26%).
To provide a comparison, the major
Discussion
This study aimed to explore the demographics of lens wearers, the scope of non-compliance behaviours and to compare the level of the non-compliance with previous studies.
The majority of the participants surveyed fell in the higher socio-economic class (education, occupation and income level) compared with the Australian census population data from 2006 (Australian Bureau of Statistics, Commonwealth Australia, http://www.abs.gov.au/) (Fig. 1, Fig. 2, Fig. 3) Owing to the site of recruitment, a
Acknowledgements
This study was undertaken at the Institute for Eye Research and School of Optometry of UNSW, Sydney. We thank clinical directors, Mr. David Pye and Dr. Vicki Evans for kindly allowing us to survey their contact lens wearers. We appreciate Thomas John's assistance with statistical analysis. This study was supported in part by Alcon Laboratories Ltd.
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