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Rethinking contact lens associated keratitis

Efron, Nathan & Morgan, Philip B. (2006) Rethinking contact lens associated keratitis. Clinical and Experimental Optometry, 89(5), pp. 280-298.

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Abstract

This review presents a critical analysis of the literature relating to the use of binomial and polynomial classification schemes for categorising corneal infiltrative events (CIEs) associated with contact lens wear and the epidemiology of such events. The results of the Manchester Keratitis Study-a 12-month, prospective, hospital-based epidemiological study of contact lens wearer suffering from CIEs-are used as a tool to challenge and test traditional thinking in relation to contact lens associated keratitis. An innovative aspect of this study is the use of a novel clinical severity matrix to systematically score the severity of CIEs based on 10 key signs and symptoms. The ambiguities inherent in using binomial classification schemes (such as, microbial versus sterile, ulcerative versus non-ulcerative etcetera) are highlighted. The failure of a polynomial scheme-due to extensive classification overlap between proposed sub-types of CIEs-is demonstrated using a Venn diagram. A cartographic analysis reveals that infiltrates tend to occur in the superior cornea of patients wearing extended wear silicone hydrogel lenses, in the central cornea of patients wearing daily wear hydrogel daily disposable lenses and in the peripheral cornea of patients wearing daily wear hydrogel (excluding daily disposable) lenses. Infiltrates that occur more towards the limbus are less severe. The incidence of CIEs is higher when contact lenses are worn overnight. Logistic analysis reveals that the risk of developing a severe CIE is five times greater with conventional hydrogel extended wear versus silicone hydrogel extended wear. The male gender, smoking, a healthy eye and body, and the late Winter months are associated with an increased risk of developing CIEs. The rate of significant visual loss as a result of developing a CIE is low. Two key conclusions are drawn from this work, which represent a radical rethinking of this potentially sight-threatening condition. CIEs should be considered as a continuous spectrum of ocular disease. If a contact lens wearer presents with a sore eye that is becoming progressively worse and a CIE is observed in that eye, lens wear should be suspended and anti-microbial therapy initiated immediately.

Impact and interest:

24 citations in Scopus
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19 citations in Web of Science®

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ID Code: 11268
Item Type: Journal Article
Additional Information: For more information, please refer to the journal's website (see hypertext link) or contact the author.
Keywords: contact lens, corneal infiltrative events, incidence, keratitis, morbidity, risk
DOI: 10.1111/j.1444-0938.2006.00069.x
ISSN: 0816-4622
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > OPTOMETRY AND OPHTHALMOLOGY (111300)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > OPTOMETRY AND OPHTHALMOLOGY (111300) > Vision Science (111303)
Divisions: Current > Research Centres > Centre for Health Research
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2006 Blackwell Publishing
Deposited On: 04 Jan 2008
Last Modified: 29 Feb 2012 23:23

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