Abstract
Purpose:
To investigate independent risk factors for contact lens-related microbial keratitis in Singapore and estimate their impact on disease load.
Methods:
Cases were contact lens wearers presenting to Singapore National Eye Centre with microbial keratitis between 2008 and 2010. Community contact lens wearers were recruited as controls. All wearers completed a previously validated questionnaire describing contact lens wear history, hygiene and compliance habits, and demographics. Risk factors significant in univariate analysis (P<0.2) were evaluated in a multivariate model.
Results:
In all, 58 cases of microbial keratitis and 152 contemporaneous controls were identified. When controlling for other variables, Chinese had a 7 × lower risk compared with other races (95% CI: 2.3–21.3, P=0.001). Those aged between 25 and 44 years were at 3 × increased risk compared with younger wearers (95% CI: 1.1–9.6, P=0.04). Occasional overnight contact lens wear (less often than one night per week) was associated with a 4 × higher risk (95% CI: 1.2–15.4, P=0.03) compared with daily use. Not washing hands before handling was associated with a 13 × increased risk (95% CI: 1.9–84.8, P=0.008). Use of multipurpose solution A carried a 16 × higher risk compared with hydrogen peroxide (95% CI: 1.5–174.0, P=0.02). The combined PAR% for modifiable risk factors (occasional overnight wear, not washing of hands, and MPS A) was 82%.
Conclusions:
Consistent with previous findings, independent risk factors for contact lens-related microbial keratitis include poor hand hygiene, occasional overnight wear, and type of lens care solution. Prolonged overnight or extended contact lens use was infrequent in this population.
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References
Stapleton F, Keay L, Jalbert I, Cole N . The epidemiology of contact lens related infiltrates. Optom Vis Sci 2007; 84 (4): 257–272.
Poggio EC, Glynn RJ, Schein OD, Seddon JM, Shannon MJ, Scardino VA et al. The incidence of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. New Engl J Med 1989; 321 (12): 779–783.
Cheng KH, Leung SL, Hoekman HW, Beekhuis WH, Mulder PG, Geerards AJ et al. Incidence of contact-lens-associated microbial keratitis and its related morbidity. Lancet 1999; 354 (9174): 181–185.
Lam DS, Houang E, Fan DS, Lyon D, Seal D, Wong E . Incidence and risk factors for microbial keratitis in Hong Kong: comparison with Europe and North America. Eye 2002; 16 (5): 608–618.
Morgan PB, Efron N, Hill EA, Raynor MK, Whiting MA, Tullo AB . Incidence of keratitis of varying severity among contact lens wearers. Br J Ophthalmol 2005; 89 (4): 430–436.
Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology 2008; 115 (10): 1655–1662.
Dart JK, Stapleton F, Minassian D . Contact lenses and other risk factors in microbial keratitis. Lancet 1991; 338 (8768): 650–653.
Stapleton F, Dart JK, Minassian D . Risk factors with contact lens related suppurative keratitis. CLAO J 1993; 19 (4): 204–210.
Schein OD, Glynn RJ, Poggio EC, Seddon JM, Kenyon KR . The relative risk of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. A case-control study. Microbial Keratitis Study Group. New Engl J Med 1989; 321 (12): 773–778.
Radford CF, Minassian DC, Dart JK . Disposable contact lens use as a risk factor for microbial keratitis. Br J Ophthalmol 1998; 82 (11): 1272–1275.
Morgan PB, Efron N, Brennan NA, Hill EA, Raynor MK, Tullo AB . Risk factors for the development of corneal infiltrative events associated with contact lens wear. Invest Ophthalmol Vis Sci 2005; 46 (9): 3136–3143.
Keay L, Edwards K, Stapleton F . Signs, symptoms, and comorbidities in contact lens-related microbial keratitis. Optom Vis Sci 2009; 86 (7): 803–809.
Dart JK, Radford CF, Minassian D, Verma S, Stapleton F . Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology 2008; 115 (10): 1647–1654.
Keay L, Edwards K, Naduvilath T, Forde K, Stapleton F . Factors affecting the morbidity of contact lens-related microbial keratitis: a population study. Invest Ophthalmol Vis Sci 2006; 47 (10): 4302–4308.
Stapleton F, Keay LJ, Sanfilippo PG, Katiyar S, Edwards KP, Naduvilath T . Relationship between climate, disease severity, and causative organism for contact lens-associated microbial keratitis in Australia. Am J Ophthalmol 2007; 144 (5): 690–698.
Stapleton F, Edwards K, Keay L, Naduvilath T, Dart JK, Brian G et al. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology 2012; 119 (8): 1516–1521.
Radford CF, Minassian D, Dart JK, Stapleton F, Verma S . Risk factors for nonulcerative contact lens complications in an ophthalmic accident and emergency department: a case-control study. Ophthalmology 2009; 116 (3): 385–392.
Kim WW . Census of Population 2010: Advance Census Release. Department of Statistics, Ministry of Trade and Industry: Singapore, 2011.
Lee YC, Lim CW, Saw SM, Koh D . The prevalence and pattern of contact lens use in a Singapore community. CLAO J 2000; 26 (1): 21–25.
Saw SM, Ooi PL, Tan DT, Khor WB, Fong CW, Lim J et al. Risk factors for contact lens-related fusarium keratitis: a case-control study in Singapore. Arch Ophthalmol 2007; 125 (5): 611–617.
Teo L, Lim L, Tan DTH, Chan T-K, Jap A, Ming LH . A survey of contact lens complications in Singapore. Eye Contact Lens 2011; 37 (1): 16–19.
Thumboo J, Fong KY, Machin D, Chan SP, Soh CH, Leong KH et al. Quality of life in an urban Asian population: the impact of ethnicity and socio-economic status. Soc Sci Med 2003; 56 (8): 1761–1772.
Kim WW . Census of Population 2010 Statistical Release 2: Households and Housing. Department of Statistics, Ministry of Trade and Industry, Republic of Singapore: Singapore, 2011.
McMonnies CW . Hand hygiene prior to contact lens handling is problematical. Cont Lens Anterior Eye 2012; 35 (2): 65–70.
Joslin CE, Tu EY, Shoff ME, Booton GC, Fuerst PA, McMahon TT et al. The association of contact lens solution use and Acanthamoeba keratitis. Am J Ophthalmol 2007; 144 (2): 169–180.
Chang DC, Grant GB, O’Donnell K, Wannemuehler KA, Noble-Wang J, Rao CY et al. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA 2006; 296 (8): 953–963.
Khor WB, Aung T, Saw SM, Wong TY, Tambyah PA, Tan AL et al. An outbreak of Fusarium keratitis associated with contact lens wear in Singapore. JAMA 2006; 295 (24): 2867–2873.
Szczotka-Flynn LB, Imamura Y, Chandra J, Yu C, Mukherjee PK, Pearlman E et al. Increased resistance of contact lens-related bacterial biofilms to antimicrobial activity of soft contact lens care solutions. Cornea 2009; 28 (8): 918–926.
Dannelly HK, Waworuntu RV . Effectiveness of contact lens disinfectants after lens storage. Eye Contact Lens 2004; 30 (3): 163–165.
Bharathi MJ, Ramakrishnan R, Shivakumar C, Meenakshi R, Lionalraj D . Etiology and antibacterial susceptibility pattern of community-acquired bacterial ocular infections in a tertiary eye care hospital in south India. Indian J Ophthalmol 2010; 58 (6): 497–507.
Orlans H, Hornby S, Bowler I . In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK: a 10-year review. Eye 2011; 25 (4): 489–493.
van der Meulen IJ, van Rooij J, Nieuwendaal CP, Van Cleijnenbreugel H, Geerards AJ, Remeijer L . Age-related risk factors, culture outcomes, and prognosis in patients admitted with infectious keratitis to two Dutch tertiary referral centers. Cornea 2008; 27 (5): 539–544.
Shalchi Z, Gurbaxani A, Baker M, Nash J . Antibiotic resistance in microbial keratitis: ten-year experience of corneal scrapes in the United Kingdom. Ophthalmology 2011; 118 (11): 2161–2165.
Gray TB, Cursons R, Sherwan JF, Rose PR . Acanthamoeba, bacterial, and fungal contamination of contact lens storage cases. Br J Ophthalmol 1995; 79 (6): 601–605.
Willcox MD, Carnt N, Diec J, Naduvilath T, Evans V, Stapleton F et al. Contact lens case contamination during daily wear of silicone hydrogels. Optom Vis Sci 2010; 87 (7): 456–464.
Vijay AK, Zhu H, Ozkan J, Wu D, Masoudi S, Bandara R et al. Bacterial adhesion to unworn and worn silicone hydrogel lenses. Optom Vis Sci 2012; 89 (8): 1095–1106.
Morgan PB, Efron N, Helland M, Itoi M, Jones D, Nichols JJ et al. Demographics of international contact lens prescribing. Cont Lens Anterior Eye 2010; 33 (1): 27–29.
Stapleton F, Naduvilath T, Keay LJ, Radford CF, Dart JK, Edwards K et al. Risk factors for microbial keratitis in daily disposable contact lens wear. Invest Ophthalmol Vis Sci 2010; 51 (e-abstract 1305).
Acknowledgements
We thank Thomas Naduvilath for statistical advice. This study was supported by an unrestricted grant from Alcon. This study was presented at ARVO 2013 in Seattle, USA.
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Lim, C., Carnt, N., Farook, M. et al. Risk factors for contact lens-related microbial keratitis in Singapore. Eye 30, 447–455 (2016). https://doi.org/10.1038/eye.2015.250
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DOI: https://doi.org/10.1038/eye.2015.250
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