Contact Lens Practice Pauline Cho, PhD FAAO This presentation. Survey conducted in 2006 Microbial contamination & non- compliance among soft contact lens wearers School of Optometry The Hong Kong Polytechnic University 1 2 2 Aim of the survey To appraise contact lens practice & cleaning systems used by practitioners in HK in 2005 practitioners prediction on changes in the contact lens market in HK Method Questionnaires sent out to 1490 Hong Kong registered optometrists in February 2006 3 3 4 4 Results Response rate 41% Part I Part II 45% 1 (604 questionnaires returned) Part IV 46% 你工作的機構屬於以下哪一種類型 7 6 5 4 Types of practice Non-CL practitioners 1 3 CL-practitioners 9 1 Chain Store Optometric Clinic HA / Health Clinic Others (private) 5 5 6 6 School of Optometry, The Hong Kong Polytechnic University 1
在 2005 年, 你的客人當中需要不同視力矯正方法的百分比是多少? 他們當中當中有多少有多少人以隱形眼鏡矯正視力? % of clients in each category % of each category using CL 在 2005 年的隱形眼鏡顧客裡, 初次配戴者和重配人士的比例是多少? New Fits vs Refit 8 7 6 5 Emmetropes 5% 3% 4 3 Hyperopes 19% 9% 1 Myopes 76% 83% 7 7 New Wearers Refit 8 8 在有散光的客人中 ( 散光 > -0.75D) 當中, 使用散光及非散光鏡片的百分比是多少? 有老花的客人中, 使用單視矯正, 雙光, 漸進和單光隱形眼鏡片的百分比是多少? 10 9 8 7 6 5 4 3 1 RGP Toric CL for toric patients RGP Spherical SCL Toric SCL Spherical 9 9 7 6 5 4 3 1 7 6 5 4 3 1 CL for presbyopic patients (RGP) Monovision RGP Bifocal RGP Progressive RGP RGP Overspectacles CL for presbyopic patients (SCL) Monovision SCL Bifocal SCL Progressive SCL SCL Overspectacles 10 10 配戴以下鏡種的客人的百分比分別是多少? 配戴以下軟性軟性鏡種的客人的百分比分別是多少? 0.5% 0.6% 2. Types of lenses prescribed 9% 3% 16% Types of SOFT lenses prescribed 6. 0.3% PMMA RGP EW OK DW RGP DW OK ON Soft CL 13% SH-D M CSL 3% SCL Conventional DW SCL Conventional EW SCL Disposable Daily SCL Disposable Biweekly 90. 19% BW DD 27% SCL Disposable Monthly SH DW SH EW 11 11 12 12 School of Optometry, The Hong Kong Polytechnic University 2
你建議配戴軟性鏡片客人使用以下隱形眼鏡藥水的百分比分別是多少? Care regimen used (SCL) 3 25% 10 8 你會建議使用以下隱形眼鏡藥水的客人揉搓鏡片嗎? How to clean lenses Rub with cleaner Rub only No rub 15% 1 5% 6 4 No Cleaning AO Sept Oxysept Titmus ReNu Opti-Free Complete Solo Care Others AO Sept Oxysept Timus ReNu Opti-Free Complete Solo Care 13 13 14 14 依你的經驗, 你認為揉搓鏡片和不揉搓鏡片和隱形眼鏡引發的眼睛毛病有關嗎? Association between lens rubbing and ocular 10 discomfort 86% 8 6 4 6% 9% None Some Significant 15 15 假如你的客人裡, 有人因為不揉搓鏡片眼 睛出現問題時, 你會怎樣理? Part 1 Part 2 Part 4 38% 16% 18% 12% 18% 12% 4% 7% 11% 14% 14% 9% 6% 14% 6% 2% 5% 5% 24% 18% 2% 2% 2% 2% 6% 2% 2% 6% 16 2% Rub lens Stop CL wear Re-educate cleaning Cleaner + rub Change lens type/new lens Aftercare See ophth if indicated Use cleaner Change solution Others 16 以下哪一種產品在你工作的地方有出售? 你認為 在現時的市場中, 以下哪個鏡種最有市場潛力? Lens type No 1 No 2 No 3 RGP Toric 2% 3% 3% SCL Toric 7% 13% 28% RGP Progressive 1% 3% 4% SCL Progressive 13% 13% 23% RGP Bifocal 1% 2% 1% SCL Bifocal 2% 8% 6% OK 5% 4% 12% SH DW 51% 22% 8% SH EW 17% 34% 16% 17 17 BCLA, Manchester 31 May 3 June 2007 Microbial contamination of contact lens care accessories and level of compliance in soft contact lens wearers 18 School of Optometry, The Hong Kong Polytechnic University 3
Co-investigators Dr Maureen Boost Microbiologist Non-compliance Complicated care procedures & irregular replacement Pxs confused Practitioners confused? Roy Cheng Research Assistant PT-MPhil 19 20 Complicated care procedures No-RUB formula Simultaneous enzymatic and disinfection Irregular replacement of lenses And now we have disposable, FRL etc.. SO, HAS COMPLIANCE IMPROVED? Purpose of this study To determine nature of microbial contamination of the care accessories level of compliance in a group of soft contact lens wearers attending a university clinic 21 22 Subjects 36 SCL wearers ( 6 mths) from our Clinic 27 female; 9 male Mean (SD) age: 25 (3.4) yrs Data collection visits Baseline All accessories collected New set of accessories given Questionnaire administered 30 days after V1 All accessories collected New set of accessories given 30 days after V2 All accessories collected New set of accessories given 23 24 School of Optometry, The Hong Kong Polytechnic University 4
Items collected for analysis Lens case MPS, Saline, Cleaner, Artificial Tears Tweezers RESULTS Contamination rates of cases & tweezers 5 1st visit 2nd visit 3rd visit 39% 4 32% 31% 3 23% 25% 1 8% Cases Tweezers 25 No improvements!! Pxs knew items were being examined 2 nd & 3 rd visits items replaced monthly 26 Contamination rates of solutions 5 4 3 1 39% 26% 16% 22% 19% 17% 1st visit 2nd visit 3rd visit N=5 MPS Saline Cleaner Artificial tears Improvements noted for MPS but.. More careful? Frequent replacements (2 nd and 3 rd samples) No improvements noted for saline! 27 Number of isolations of potentially pathogenic organisms from lens accessories at first/second/third visit Ps. aeruginosa Pseudomonas species Staph. aureus Serratia (Ser. marcescens & Ser. liquefacieus) Others ** No fungus found MPS: 1/1/1 4 / 2 / 1 7 / 4 / 3 5 / 4 / 0 Case: 2/2/3 2 / 6 / 2 8 / 3 / 3 11 / 2 / 2 10 / 9/ 3 T: (n=13) 3 / 1 / 3 1/0/0 28 Most commonly isolated organisms Staph. aureus from nose/skin Hands/fingers case Serratia toilet organisms (faeces) Hands/fingers case Improper storage? 29 30 School of Optometry, The Hong Kong Polytechnic University 5
Pseudomonas species Staph. aureus MPS: 4 / 2 / 1 Case: 2 / 6 / 2 8 / 3 / 3 T: 3 / 1 / 3 Determination of the levels of compliance (1 st visit): Care of Serratia (Ser. marcescens & Ser. liquefacieus) 7 / 4 / 3 11 / 2 / 2 Number of subjects (Percentage) Lens Lens case Solutions No. of potentially pathogenic organisms decreased at 2 nd and 3 rd visits regular monitoring and replacement of accessories help to keep the number of potentially pathogenic organisms down High Medium Low 24 (67%) 4 (11%) 8 (22%) 6 (17%) 2 (5%) 28 (78%) 23 (64%) 12 (33%) 1 (3%) 31 32 Low level of compliance for care of LENSES (n=8 (22%)) did not rub lens after removal did not use soap to clean hands before lens removal did not dry hands (after washing with tap water) before lens removal 7/8 3/8 3/8 Low level of compliance for care of LENS CASES (n=28 (78%)) never disinfect their lens cases stored lens cases in bathroom did not clean case daily/after each use never clean lens case 24/28 12/28 7/28 6/28 33 34 **64% (23) of subjects reported that they cleaned their lens cases everyday or after each use Actually 56% (13/23) just rinsed the case with tap water **Be aware of pxs idea of cleaning Main breaches in protocol Inadequate/irregular cleaning, disinfecting procedures for lens accessories esp. Lens case **Note where the dirt accumulates 35 36 School of Optometry, The Hong Kong Polytechnic University 6
Contamination rates of accessories in subjects with low/medium levels of compliance (1 st visit) Lens case MPS Subjects with low/medium levels of compliance 30 13 Subjects with contaminated items 13 High % of contaminated items (case and MPS) in subjects who were either not/not very 8 % 43 62 hmm? What s that again.? What s that again.? Most commonly reasons for breaching protocol Forgot (39%) Inconvenient and troublesome (23%) Did not realize the importance of the procedure (39%) compliant 37 38 Collins & Carney (1986) Most subjects (78%) said they would replace the case if one comes with a new bottle solution remaining 22%?? Only 26% fully compliant Current study, less than 17% Non-compliance highly correlated with signs & symptoms Current study: high contamination rates of MPS and cases in px with low/medium compliance 39 40 Bowden et al. (1989) 24 CL px with CLassociated microbial keratitis 88% failed to follow lens care instructions McLaughlin-Borlace et al. (1998) 20 px with microbial keratitis Contaminated lens case 85% Contaminated lenses 55% 41 42 School of Optometry, The Hong Kong Polytechnic University 7
Non-compliance Big Trouble! Possible to change Px s habits.? ESSENTIAL to ensure/maximise Summary SCL still dominates the CL market in HK Silicone hydrogel and daily disposable lenses are becoming increasingly popular Multipurpose solutions are the care regime of choice, but the majority of practitioners recommended rubbing when cleaning Toric and presbyopic CL are still not very popular in HK compliance 43 44 Non-compliance is common among SCL wearers Lens accessories are the most contaminated and most inappropriately cared for Essential Stress/review compliance particularly wrt lens cases (+ other accessories) Daily care Clean (soft brush), not just rinse Weekly disinfection 10 mins soak in hot water (just boiled) Regular replacement Avoid giving unnecessary accessories, eg. tweezers Eyedrops? Unit dose preferred 45 46 Pxs are forgetful Keep an BOTH eyes on them 4 Rs Remind Review Reeducate Regularly Remember Clear written & oral instructions important Sometimes we need to be very blunt (?) 47 48 School of Optometry, The Hong Kong Polytechnic University 8
Acknowledgements Grants from PolyU HKOA Do our best to ensure that this is achieved, in spite of. 49 50 School of Optometry, The Hong Kong Polytechnic University 9