An analysis from the Centers for Disease Control and Prevention (CDC) has linked contact lens use to permanent eye damage. According to the report, one out of five contact lens related eye infections result in permanent eye damage. The report appeared in the August 19 Morbid and Mortality Weekly Report.
Is it time for contact lens wearers to panic? Optometry Times Chief Optometric Editor Ernie Bowling, OD, FAAO, doesn’t think so.
“Contact lenses remain a safe and viable means of vision correction for our patients, when appropriate wear and care schedules are followed,” says Dr. Bowling. “Severe problems arise when these safe practices aren’t adhered to, and that is the take home message to our patients. We can use this report to shock those non-compliant patients into modifying their behaviors.”
Taking a closer look at the report’s numbers verifies Dr. Bowling’s thinking.
What the numbers really tell us
CDC researchers studied 1,075 cases of contact lens-related corneal infections containing the terms “ulcer” or “keratitis” reported to the Food and Drug Administration (FDA) from 2005 to 2015. Of these reported cases 925 (86 percent) were reported by a contact lens manufacturer, while the remaining 150 (14 percent) were reported by an eyecare provider or patient.
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Of these 1,075 incidents, 213 (19.8 percent) described cases of central corneal scar, a decrease in visual acuity, or required a corneal transplant following the adverse contact lens incident. Also, 130 (12.1 percent) reports cited emergency or urgent care visits were required, along with 25 (2.3 percent) reports citing need for hospitalization.
“This report is the type of information that often makes headlines and produces videos on the nightly news. Patients then come screaming into our offices, concerned that their contact lenses are going to make them blind,” says Dr. Bowling. “Yet the information contained in this report, by the MMWR’s own admission, is skewed. In a passive reporting system, only the most severe infections may be reported.”
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According to the CDC’s report, due to the passive nature of the surveillance system the actual proportion of contact lens related eye damage can’t be determined. This may make it difficult to rely on this research as complete fact.
The CDC reports there are approximately 41 million contact lens wearers in the United States. If worn and cared for correctly, contact lenses are still regarded as a safe and effective form of vision correction.
Optometry Times Editorial Advisory Board member Milton M. Hom OD, FAAO, FACAAI(Sc), agrees.
“They say about 1,000 cases reported in this study-this is vs. tens of millions without any problems,” Dr. Hom says. “For me, contact lenses are still extremely safe despite the fears this report may raise.”
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Some 25.1 percent of the FDA’s Medical Device Report (MDR) submissions included the terms “keratitis” or “ulcer” and mentioned modifiable risk factors as a culprit in developing an eye infection. These risk factors included such practices as sleeping in contact lenses or extended wear. Few reported problems with the contact lenses themselves.
Taking the time to educate contact lens wearers may be the top line of defense against permanent eye damage from contact lens wear.
“There is information in this report we can use to educate our patients,” says Dr. Bowling, “mostly the modifiable risk factors. A full 25 percent reported risk factors including extended wear or napping in contact lenses, wearing them longer than recommended, using expired products, storing them in tap water, and wearing them while swimming.”
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Modifiable risk factors are just that-modifiable. With proper education from eyecare practitioners, wearers can assure themselves that they are following proper protocol when wearing their contact lenses.
“An in-person, face-to-face eye examination with the patient is the only way to change contact lens habits and affect these adverse outcomes,” says Jeffrey Sonsino, OD, FAAO, chair of the AOA Contact Lens and Cornea Section (CLCS). “This study highlights the importance of doctors reviewing proper handling, care, replacement, and storage techniques each year during contact lens exams.”
Wearers of decorative or cosmetic lenses may see them as only a prop, buy them from non-medical providers without a prescription, or both.
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“Interestingly, 33 (3.1 percent) of these reports were associated with decorative or cosmetic contact lenses, and 16 (1.5 percent) reports indicated purchase of contact lenses without a prescription from an unapproved source such as a flea market or costume shop,” says Optometry Times Editorial Advisory Board member Loretta Szczotka-Flynn OD, PhD.
Contact lens wearers who purchase their lenses from online outlets may be at higher risk for adverse events due to the lack of education that contact lenses are medical devices which require proper care, fitting, and follow-up care.
American Optometric Association President Andrea Thau, OD, FAAO, FCOVD, DPNAP, says that some retailers actively undermine the care that optometrists provide with abusive and illegal practices, especially those that cause harm and result in added healthcare costs.
“The U.S. Federal Trade Commission recognized some of these practices in its recent suit against 1-800 Contacts, asserting the company has misled consumers and caused higher prices,” she says. “The AOA and the Coalition for Patient Vision Care Safety are dedicated to upholding our patients’ health by holding sellers accountable and supporting the Contact Lens Consumer Health Protection Act (S. 2777), which aims to strengthen the patient health safeguards in existing federal law that have been undermined, and in certain cases, ignored.”
Report adverse effects
“Unfortunately, the vast majority of all contact lens-related complications are not reported to the FDA,” says Dr. Sonsino. “Only 14 percent of cases were reported by practitioners or patients. Knowing how important this data is, we should work with the FDA to streamline the reporting process and to better educate doctors on the importance of reporting these incidents.”
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The CDC report stresses that eyecare professionals should quickly report any adverse effects their patients experience to the FDA. This can assist them in having a better understanding and identifying the risks associated with contact lens use.
“I've voluntarily reported infections to the FDA U.S. Food and Drug Administration’s (FDA) Medical Device Report Database, and I urge everyone else to do the same,” says Dr. Szczotka-Flynn. “Only then can we get a better picture of the risks and behaviors that contribute to contact lens infections and permanent eye damage.”