TY - JOUR
T1 - Incidence of contact-lens-associated microbial keratitis and its related morbidity
AU - Cheng, K H
AU - Leung, S L
AU - Hoekman, H W
AU - Beekhuis, W H
AU - Mulder, P G
AU - Geerards, A J
AU - Kijlstra, A
PY - 1999/7/17
Y1 - 1999/7/17
N2 - BACKGROUND: The incidence of contact-lens-associated microbial keratitis is uncertain and its related morbidity in the general population of contact-lens wearers is not known. We examined these issues in a prospective epidemiological study.METHODS: We surveyed all practising ophthalmologists in the Netherlands to identify all new cases of microbial keratitis reported during a 3-month period in 1996. Follow-up telephone calls were made to examine ocular morbidity. We undertook annual nationwide telephone surveys between 1994 and 1997 to estimate the prevalence of contact-lens wear.FINDINGS: Of 440 ophthalmologists contacted, 379 provided information. There were 92 cases of microbial keratitis; 17 used daily-wear rigid gas-permeable lenses, 63 daily-wear soft lenses, and 12 extended-wear soft lenses. The estimated annualised incidence of microbial keratitis was 1.1 per 10,000 (95% CI 0.6-1.7) users of daily-wear rigid gas-permeable lenses, 3.5 per 10,000 (2.7-4.5) users of daily-wear soft lenses, and 20.0 per 10,000 (10.3-35.0) users of extended-wear soft lenses (p<0.00001 for comparison between all groups), Five of the 92 patients achieved a final visual acuity of 20/70 or less. Pseudomonas and Serratia spp were the organisms most commonly isolated. Pseudomonas keratitis accounted for the largest mean diameter of corneal ulcers, the highest mean number of days in hospital, the greatest number of mean outpatients visits, and the poorest visual acuity outcome.INTERPRETATION: The incidence of microbial keratitis among users of extended-wear soft contact lenses in the Netherlands is similar to that reported in the USA during 1989. Awareness of risk factors and improvement in contact-lens materials have not led to a decrease in incidence. Overnight wear should be strongly discouraged.
AB - BACKGROUND: The incidence of contact-lens-associated microbial keratitis is uncertain and its related morbidity in the general population of contact-lens wearers is not known. We examined these issues in a prospective epidemiological study.METHODS: We surveyed all practising ophthalmologists in the Netherlands to identify all new cases of microbial keratitis reported during a 3-month period in 1996. Follow-up telephone calls were made to examine ocular morbidity. We undertook annual nationwide telephone surveys between 1994 and 1997 to estimate the prevalence of contact-lens wear.FINDINGS: Of 440 ophthalmologists contacted, 379 provided information. There were 92 cases of microbial keratitis; 17 used daily-wear rigid gas-permeable lenses, 63 daily-wear soft lenses, and 12 extended-wear soft lenses. The estimated annualised incidence of microbial keratitis was 1.1 per 10,000 (95% CI 0.6-1.7) users of daily-wear rigid gas-permeable lenses, 3.5 per 10,000 (2.7-4.5) users of daily-wear soft lenses, and 20.0 per 10,000 (10.3-35.0) users of extended-wear soft lenses (p<0.00001 for comparison between all groups), Five of the 92 patients achieved a final visual acuity of 20/70 or less. Pseudomonas and Serratia spp were the organisms most commonly isolated. Pseudomonas keratitis accounted for the largest mean diameter of corneal ulcers, the highest mean number of days in hospital, the greatest number of mean outpatients visits, and the poorest visual acuity outcome.INTERPRETATION: The incidence of microbial keratitis among users of extended-wear soft contact lenses in the Netherlands is similar to that reported in the USA during 1989. Awareness of risk factors and improvement in contact-lens materials have not led to a decrease in incidence. Overnight wear should be strongly discouraged.
KW - Adolescent
KW - Adult
KW - Child
KW - Contact Lenses/adverse effects
KW - Contact Lenses, Extended-Wear/adverse effects
KW - Corneal Ulcer/epidemiology
KW - Epidemiologic Methods
KW - Female
KW - Hospitalization
KW - Humans
KW - Incidence
KW - Length of Stay
KW - Male
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Prevalence
KW - Prospective Studies
KW - Pseudomonas/isolation & purification
KW - Serratia/isolation & purification
KW - Treatment Outcome
U2 - 10.1016/S0140-6736(98)09385-4
DO - 10.1016/S0140-6736(98)09385-4
M3 - Article
C2 - 10421298
SN - 0140-6736
VL - 354
SP - 181
EP - 185
JO - Lancet (London, England)
JF - Lancet (London, England)
IS - 9174
ER -