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Factors Affecting the Morbidity of Contact Lens–Related Microbial Keratitis: A Population Study

¹From the School of Optometry and Vision Science University of New South Wales, Sydney NSW, Australia; the ²Vision Cooperative Research Centre, Sydney NSW Australia; and the ³School of Public Health and Community Medicine, University of New South Wales, Sydney NSW, Australia.

PURPOSE. To examine factors influencing the severity of soft contact lens (SCL)–related microbial keratitis.

METHODS. Cases were detected via surveillance studies in Australia and New Zealand. Factors affecting disease severity (costs, days of symptoms, and 2 or more lines of vision loss) were examined and included age; gender; delay in SCL removal, seeking consultation, or receiving treatment; overnight wear; SCL material (hydrogel or silicone hydrogel [SiH]); and causative organism.

RESULTS. Two hundred ninety-seven cases were identified: 61% female, age: 35 ± 13 years (mean ± SD). Treatment costs were (median [interquartile range]) $760 [1859] and indirect costs were $468 [1810]. Patients were symptomatic for 7 [11] days, and vision loss occurred in 14.3% of cases. Cases with pathogenic causative organisms (66/297, 22%) were 11.4 times (95% confidence interval [CI], 4.2–30.9) more likely to result in vision loss, had longer duration of symptoms (21 [40] vs. 6 [8] days, P < 0.001) and incurred higher costs (5,512 [14,733] vs. 1,048[8,325], P < 0.001). Delays (>12 hours) before treatment increased the likelihood of vision loss (P = 0.048) disease duration (P = 0.004), and associated costs (P = 0.009). Remoteness increased the risk of vision loss (odds ratio [OR] = 5.1; 95% CI 1.6–16.6), and individuals over 28 years of age had longer disease duration (P = 0.02). In overnight wear and after adjustment for culture result and treatment delays, SiH wearers had slightly shorter disease duration (4 [4] vs. 7 [10] days, P = 0.02) but a rate of vision loss and cost similar to those of hydrogel wearers.

CONCLUSIONS. The causative organism was the major determinant of severity; however, modifiable factors such as delays in treatment had considerable influence. Duration of symptoms was shorter in SiH wearers, but other factors dominated disease outcome in this population study.

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