Factors Associated With Contact Lens-Related Dry Eye
The overall compliance rates among contact lens wearers were found to be low for several factors including those related to contact lens, care solution, contact lens case, and even basic hygiene practices. Compliance rates for several factors including recommended replacement of contact lenses, rub and rinse practices, care solution topping off, and washing hands before handling lenses are comparable with the estimates from previous studies. Recent reports from the United States and elsewhere highlight a disturbing continued trend of widespread noncompliance. In fact, noncompliance rates in contact lens wearers are well above those for other medical regimens such as adherence to physician-prescribed treatments for systemic disorders such as HIV disease and diabetes, which range from 25% to 44%. The reasons for such high rates of noncompliance are unclear with some studies citing lack of patient awareness of potential risks; however, several recent surveys indicate contact lens wearer apathy to potential consequences of noncompliant behavior despite awareness of risk. The current noncompliance findings indicate a need for more effective methods of patient education and reinforcement of contact lens care and compliance.
Difficulty or ease of contact lens care was rated as significantly lower (more difficult) in the CLDE group, possibly indicating a difference in patient attitude toward contact lens care. This finding may reflect that subjects with CLDE feel burdened by their lens care regimen, which may possibly include the need for additional efforts (e.g., removing and reinserting lenses if dry) or the need for specialized products (e.g., use of rewetting drops and hydrogen peroxide-based care systems) to help alleviate their CLDE problems. Alternatively, the perceived difficulty in lens care of the CLDE group may also reflect that subjects with CLDE have a poor attitude or negativity toward the lens care regimen, which may be prompted by their CLDE status. It seems unlikely that the perceived difficulty toward lens care would lead to the development of CLDE, particularly as subjects in this study had to exhibit both symptoms and signs to be classified as having CLDE. In other studies on patient characteristics such as mood, personality, and compliance, mood was not associated with CLDE. However, Carnt et al. reported that patients with personality traits of greater risk-taking propensity were associated with poor compliance practices.
Compliance with recommended contact lens replacement was surprisingly not found to be associated with CLDE. A previous report by Dumbleton et al. suggested poor patient-reported comfort and vision in patients wearing lenses that needed replacement. To our knowledge, there are no other reports on compliance and dry eye-related problems in contact lens wearers.
One other possibility to explain the lack of association between noncompliance and CLDE status in this report is that cross-sectional study designs may not be ideal for capturing some clinical problems from noncompliant behavior. To expand on this idea, the ocular defense and protection mechanisms are known to be highly redundant to maximize protection from microbial and other causes. As a result, the eye and ocular surface appear to be very resilient to harm from noncompliant practices, despite increased ocular bioburden resulting from poor lens care and case hygiene. However, such practices continued over a prolonged period might increase the chance for clinical problems. Longitudinal study designs may be better suited to capture such effects from noncompliant behavior.
Similar to dry eye in general, a multifactorial pathophysiology cannot be overlooked in CLDE. The role of other major causative factors ranging from ocular issues, such as tear film, lacrimal, ocular surface abnormalities, and eyelid pathological findings including meibomian gland dysfunction, to systemic disorders or medications known to cause ocular disturbances probably play a bigger role in the pathophysiology of CLDE.
Compliance factors were not associated with age or gender in this study, consistent with some prior reports. Few other reports have identified young male contact lens users as being more noncompliant. Age-related compliance analyses also showed very little relation between age and compliance, except that subjects who topped off care solutions were half or most of the time slightly younger compared with those who never or occasionally topped off. These findings are also consistent with previous reports that identified younger subjects as being more noncompliant.
Discussion
Overall Compliance
The overall compliance rates among contact lens wearers were found to be low for several factors including those related to contact lens, care solution, contact lens case, and even basic hygiene practices. Compliance rates for several factors including recommended replacement of contact lenses, rub and rinse practices, care solution topping off, and washing hands before handling lenses are comparable with the estimates from previous studies. Recent reports from the United States and elsewhere highlight a disturbing continued trend of widespread noncompliance. In fact, noncompliance rates in contact lens wearers are well above those for other medical regimens such as adherence to physician-prescribed treatments for systemic disorders such as HIV disease and diabetes, which range from 25% to 44%. The reasons for such high rates of noncompliance are unclear with some studies citing lack of patient awareness of potential risks; however, several recent surveys indicate contact lens wearer apathy to potential consequences of noncompliant behavior despite awareness of risk. The current noncompliance findings indicate a need for more effective methods of patient education and reinforcement of contact lens care and compliance.
Compliance and Contact Lens-related Dry Eye
Difficulty or ease of contact lens care was rated as significantly lower (more difficult) in the CLDE group, possibly indicating a difference in patient attitude toward contact lens care. This finding may reflect that subjects with CLDE feel burdened by their lens care regimen, which may possibly include the need for additional efforts (e.g., removing and reinserting lenses if dry) or the need for specialized products (e.g., use of rewetting drops and hydrogen peroxide-based care systems) to help alleviate their CLDE problems. Alternatively, the perceived difficulty in lens care of the CLDE group may also reflect that subjects with CLDE have a poor attitude or negativity toward the lens care regimen, which may be prompted by their CLDE status. It seems unlikely that the perceived difficulty toward lens care would lead to the development of CLDE, particularly as subjects in this study had to exhibit both symptoms and signs to be classified as having CLDE. In other studies on patient characteristics such as mood, personality, and compliance, mood was not associated with CLDE. However, Carnt et al. reported that patients with personality traits of greater risk-taking propensity were associated with poor compliance practices.
Compliance with recommended contact lens replacement was surprisingly not found to be associated with CLDE. A previous report by Dumbleton et al. suggested poor patient-reported comfort and vision in patients wearing lenses that needed replacement. To our knowledge, there are no other reports on compliance and dry eye-related problems in contact lens wearers.
One other possibility to explain the lack of association between noncompliance and CLDE status in this report is that cross-sectional study designs may not be ideal for capturing some clinical problems from noncompliant behavior. To expand on this idea, the ocular defense and protection mechanisms are known to be highly redundant to maximize protection from microbial and other causes. As a result, the eye and ocular surface appear to be very resilient to harm from noncompliant practices, despite increased ocular bioburden resulting from poor lens care and case hygiene. However, such practices continued over a prolonged period might increase the chance for clinical problems. Longitudinal study designs may be better suited to capture such effects from noncompliant behavior.
Similar to dry eye in general, a multifactorial pathophysiology cannot be overlooked in CLDE. The role of other major causative factors ranging from ocular issues, such as tear film, lacrimal, ocular surface abnormalities, and eyelid pathological findings including meibomian gland dysfunction, to systemic disorders or medications known to cause ocular disturbances probably play a bigger role in the pathophysiology of CLDE.
Compliance and Age and Gender
Compliance factors were not associated with age or gender in this study, consistent with some prior reports. Few other reports have identified young male contact lens users as being more noncompliant. Age-related compliance analyses also showed very little relation between age and compliance, except that subjects who topped off care solutions were half or most of the time slightly younger compared with those who never or occasionally topped off. These findings are also consistent with previous reports that identified younger subjects as being more noncompliant.
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