In the JournalsPerspective

Case series shows sleeping in contacts increases corneal infection risk

Sleeping in contact lenses increases the wearer’s risk of developing a corneal infection, according to a recent case series featured in the Morbidity and Mortality Weekly Report from the CDC.

“This case series of contact lens-related corneal infections highlights the burden these infections place on contact lens wearers and the serious outcomes associated with them,” Jennifer R. Cope, MD, MPH, medical epidemiologist in the Division of Foodborne, Waterborne and Environmental Diseases at the CDC, and colleagues wrote in MMWR.

Cope and colleagues said microbial keratitis can lead to more serious adverse outcomes that usually require frequent antibiotic eye drops, multiple follow-up appointments and permanent eye damage. According to the CDC, keratitis caused an estimated 1 million outpatient and emergency room visits in 2010, but the FDA’s MedWatch database includes only 1,075 reports of corneal infections over an 11-year period.

The CDC has collaborated with the Eye and Contact Lens Association for Contact Lens Health Week, which takes place Aug. 20 to 24. To promote healthy contact lens wear and care practices, Cope and colleagues presented six cases — from the last 2 years — of contact lens-related corneal infections. The main risk factor reported in all six cases was sleeping in contact lenses. Sleeping or napping in contact lenses is the most common risky behavior, and about one-third of contact lenses wearers report doing that, according to the report.

The patients highlighted in the cases were between 17 and 59 years old and all required antibiotic eye drop treatment, according to the report. Moreover, some of the patients required hourly administration of the drops for weeks or months. Some of the infections were caused by Pseudomonas aeruginosa and Acanthamoeba spp., which could mean the contact lenses and supplies were cleaned incorrectly and contaminated with tap water. Despite sales regulation of contact lenses, three of the six patients purchased and used contact lenses without a valid prescription, and one patient bought medically unnecessary decorative lenses.

One patient was lost to follow-up, which the researchers suggest means the infection was completely cleared up with topical moxifloxacin. However, a majority of the infections resulted in permanent eye damage, such as a stromal scar, or vision loss, and two patients required surgery.

While the researchers recognize that there are FDA-approved contact lenses for overnight wear, they stress the fact that lenses are Class 3 medical devices and still increase the risk for infection. They said that sleeping in contact lenses increases the risk for contact lens–related eye infections by six- to eightfold.

Cope and colleagues urge eye care professionals and patients to report contact lens-related infections to the FDA Safety Information and Adverse Reporting Program (www.fda.gov/MedWatch). The information can be used to improve contact lenses, care products, manufacturer guidelines and labeling.

“Health education measures directed toward contact lens wearers should emphasize raising awareness of the risks of sleeping in contact lenses as well as adherence to all recommendations for the wear and care of contact lenses,” Cope and colleagues concluded. – by Marley Ghizzone

Disclosures: CDC receives an annual contribution from the Contact Lens Institute to support CDC’s Healthy Contact Lens Program. The Contact Lens Institute was not involved in the drafting or review of this report.

Sleeping in contact lenses increases the wearer’s risk of developing a corneal infection, according to a recent case series featured in the Morbidity and Mortality Weekly Report from the CDC.

“This case series of contact lens-related corneal infections highlights the burden these infections place on contact lens wearers and the serious outcomes associated with them,” Jennifer R. Cope, MD, MPH, medical epidemiologist in the Division of Foodborne, Waterborne and Environmental Diseases at the CDC, and colleagues wrote in MMWR.

Cope and colleagues said microbial keratitis can lead to more serious adverse outcomes that usually require frequent antibiotic eye drops, multiple follow-up appointments and permanent eye damage. According to the CDC, keratitis caused an estimated 1 million outpatient and emergency room visits in 2010, but the FDA’s MedWatch database includes only 1,075 reports of corneal infections over an 11-year period.

The CDC has collaborated with the Eye and Contact Lens Association for Contact Lens Health Week, which takes place Aug. 20 to 24. To promote healthy contact lens wear and care practices, Cope and colleagues presented six cases — from the last 2 years — of contact lens-related corneal infections. The main risk factor reported in all six cases was sleeping in contact lenses. Sleeping or napping in contact lenses is the most common risky behavior, and about one-third of contact lenses wearers report doing that, according to the report.

The patients highlighted in the cases were between 17 and 59 years old and all required antibiotic eye drop treatment, according to the report. Moreover, some of the patients required hourly administration of the drops for weeks or months. Some of the infections were caused by Pseudomonas aeruginosa and Acanthamoeba spp., which could mean the contact lenses and supplies were cleaned incorrectly and contaminated with tap water. Despite sales regulation of contact lenses, three of the six patients purchased and used contact lenses without a valid prescription, and one patient bought medically unnecessary decorative lenses.

One patient was lost to follow-up, which the researchers suggest means the infection was completely cleared up with topical moxifloxacin. However, a majority of the infections resulted in permanent eye damage, such as a stromal scar, or vision loss, and two patients required surgery.

While the researchers recognize that there are FDA-approved contact lenses for overnight wear, they stress the fact that lenses are Class 3 medical devices and still increase the risk for infection. They said that sleeping in contact lenses increases the risk for contact lens–related eye infections by six- to eightfold.

Cope and colleagues urge eye care professionals and patients to report contact lens-related infections to the FDA Safety Information and Adverse Reporting Program (www.fda.gov/MedWatch). The information can be used to improve contact lenses, care products, manufacturer guidelines and labeling.

“Health education measures directed toward contact lens wearers should emphasize raising awareness of the risks of sleeping in contact lenses as well as adherence to all recommendations for the wear and care of contact lenses,” Cope and colleagues concluded. – by Marley Ghizzone

Disclosures: CDC receives an annual contribution from the Contact Lens Institute to support CDC’s Healthy Contact Lens Program. The Contact Lens Institute was not involved in the drafting or review of this report.

    Perspective
    Kerry Giedd

    Kerry Giedd

    It’s always great to see organizations such as the CDC bring attention to the conditions that we as optometrists see in our offices on a regular basis – especially when those conditions have risk factors that are modifiable behaviors. This public health message is a reminder to patients — and an educational opportunity for us — about the importance of safe lens wearing habits. The report also reminds us that we have a responsibility to report adverse events such as microbial keratitis to the FDA.

    In a world where the commoditization of contact lenses often feels like more and more the reality, the CDC’s report highlights cases where unhealthy lens habits led to life-changing consequences, including permanent vision loss and corneal transplantation. We are charged with doing all that we can to educate and protect our patients, from proper, in-office contact lens fitting and prescribing (not through a smartphone app) to education on proper lens wear and care.

    While there were early beliefs that with the advent of silicone hydrogel lenses we would greatly reduce the microbial keratitis risk associated with overnight contact lens wear, we’ve realized this is simply not the case. We know that the extended wear of contact lenses – even those cleared by the FDA for overnight wear — carries significant risks. While the article states that sleeping in contact lenses increases the risk for contact lens-related eye infections six to eight times, I believe these numbers are conservative, and the risk is actually higher.

    While I can’t force my patients to comply with daily wear and other healthy contact lens habits, including proper disinfection and adhering to recommended disposal schedules, I want to ensure that each patient at least hears the message and understands the risks.

    • Kerry Giedd, OD, MS, FAAO
    • Primary Care Optometry News Editorial Board member

      Orlando, Fla.

    Disclosures: Giedd reports she is a consultant to Bausch + Lomb and CooperVision.