Risk factors and causative organisms in microbial keratitis in daily disposable contact lens wear

• Published in: PloS one Vol. 12; no. 8; p. e0181343
• Main Authors: Stapleton, Fiona, Naduvilath, Thomas, Keay, Lisa, Radford, Cherry, Dart, John, Edwards, Katie, Carnt, Nicole, Minassian, Darwin, Holden, Brien
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.08.2017; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Australia - epidemiology; Biology and Life Sciences; Contact lenses; Contact Lenses - adverse effects; Cornea; Demographic aspects; Demographics; Demography; Environmental effects; Eye; Eye lens; Factor analysis; Female; Health aspects; Health risks; Humans; Hydrogels; Hygiene; Keratitis; Keratitis - diagnosis; Keratitis - epidemiology; Keratitis - microbiology; Lenses; Male; Medicine and Health Sciences; Microorganisms; Middle Aged; New Zealand - epidemiology; Odds Ratio; Optometry; Organisms; People and Places; Personal hygiene; Population Surveillance; Regression analysis; Risk analysis; Risk Factors; Risk management; Science; Severity of Illness Index; Smoking; Statistical tests; Studies; Surveys; United Kingdom - epidemiology; Wear; Young Adult; Australia; United Kingdom; United Kingdom > UK; Sydney New South Wales Australia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0181343

This study investigated independent risk factors and causative organisms in microbial keratitis in daily disposable contact lens (CL)-wearers. A multisite prospective case-control study was undertaken. Cases were daily disposable CL-wearers attending Moorfields Eye Hospital with microbial keratitis and those reported through a one-year surveillance study in Australia and in New Zealand. A population-based telephone survey identified daily disposable CL-wearing controls. Subjects completed a questionnaire describing CL-wear history, hygiene and demographics. The sample used for risk factor analysis was weighted in proportion to the CL-wearing population at each location. Corneal scrape results were accessed. Independent risk factors were determined using multiple binary logistic regression. Causative organisms in different CL-wear modalities were compared using a chi-squared test. 963 daily disposable CL-wearers were identified, from which 67 cases and 374 controls were sampled. Independent risk factors were; wearing CLs every day compared with less frequent use (OR 10.4x; 95% CI 2.9-56.4), any overnight wear (OR 1.8x; 95% CI 1.6-2.1), less frequent hand washing (OR 1.8x; 95% CI 1.6-2.0), and smoking (OR 1.3x; 95% CI 1.1-1.6). Certain daily disposable CLs (OR 0.2x; 95% CI 0.1-0.2) had protective effects. Environmental organisms were less frequently recovered with daily disposable CLs (20%), compared with other modalities (36%; p<0.02). Overnight wear, increased exposure in daily wear, smoking and poor hand hygiene are significant risk factors for microbial keratitis with daily disposable CLs. Risk varied with daily disposable CL type. The profile of causative organisms is consistent with less severe disease.