Level of compliance in contact lens wearing medical doctors in Nepal

doi:10.1016/j.clae.2015.05.010

Contact Lens and Anterior Eye

Volume 38, Issue 6, December 2015, Pages 456-460

https://doi.org/10.1016/j.clae.2015.05.010 Get rights and content

Highlights

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Compliance level of soft contact lens wearing medical doctors (MDs) in Nepal was determined.
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Compliance level was poor in 15% of the MDs.
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There was no significant difference in compliance level between MDs and others.
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Topping up solution and timely lens case replacement were the most neglected compliant behaviors in MDs.

Abstract

Purposes

To determine the level of compliance and major non-compliant behaviors in contact lens (CL) wearing medical doctors (MDs) and to compare it with age matched CL wearing normal subjects with no medical background (NS).

Methods

Thirty-nine current CL wearing MDs, who were prescribed CLs in Nepal Eye Hospital, Kathmandu, Nepal, between 2007 and 2011, were interviewed on ten modifiable compliant behaviors regarding lens care and maintenance. The level of compliance and the rate of non-compliance for each behavior were determined and compared with NS.

Results

Level of compliance was good, average and poor in 35.9%, 48.7% and 15.4% of MDs, respectively. There was no significant difference in compliance between MDs and NS (p = 0.209). Level of compliance was not associated with age, gender and duration of lens wear (p > 0.05). Compliance rate varied according to different behaviors, achieving a good compliance level of 95% for hand hygiene, avoidance of water contact and not sleeping with lenses. There was poor compliance for topping up solution (53.8%) and lens case replacement (15.4%).

Conclusion

About one third of MDs had a good level of compliance. Level of compliance and compliance rate of different behaviors were similar in MDs and NS. Periodic lens case replacement was the most neglected behavior in CL wearers for this region.

Introduction

About 140 million people around the world wear contact lenses (CLs) for the purpose of refractive error correction [1]. Complications including sight threatening microbial keratitis are found in some lens wearers. These complications are found in greater proportion in those wearers who do not follow the clinician's guidelines about contact lens care and maintenance [2].

Non-compliance in following the guidelines of CL care and maintenance is one of the major risk factors of CL related inflammation [1] and microbial keratitis [3] including acanthamoeba keratitis [4]. Cho et al. found that some of the non-compliant behaviors could be improved by training [5]. Therefore, to improve compliance, the rate of specific non-compliant behavior must be determined in order to train the subjects in that particular behavior.

Unfortunately, there is no single direct quantitative method to determine the non-compliance rate in CL wear. Many researchers use self-reported written questionnaires to determine the non-compliance rate in CL wearers, which have given inconsistent results. Several studies determined the non-compliance rate in the range of 8–85% [5], [6], [7], [8]. They considered the following behaviors: hand washing before handling CL, CL cleaning and storage with proper solution in the correct way, sleeping with CL, water contact with CL, lens replacement, lens case replacement, recommended wearing hour, lens cleaning and follow-up visit [5], [6], [7], [8]. However, a recent multinational survey determined an unexpectedly high non-compliance rate of 99.8% in conventional CL wearers [9]. They also reported that the rate of non-compliant behavior varied between the countries and the type of lenses.

Medical doctors (MDs) work with communities in hospitals, labs, clinics, with sick, infected people where there is a higher risk of transmission of microorganisms. Therefore, they might have a higher risk of ocular complications with higher severity if they do not follow the guidelines of CL practitioners about their care and maintenance. Tajunisah et al. found a compliance rate of 84% for CL wearing medical students [10]. However, until now there has been no study about the non-compliant behaviors of MDs on CL care and maintenance.

The purposes of this study were to investigate the level of compliance and rate of non-compliance of different behaviors of MDs on CL care and maintenance in Nepal, using direct interviews by a trained optometrist. We hypothesized that MDs strongly follow the guidelines of CL practitioners, as they have better knowledge of the consequences of improper CL wear. Non-compliant behaviors of MDs were compared to the age-matched CL wearing normal subjects with no medical background (NS) as controls.

Section snippets

Methods

A cross-sectional, comparative study was designed for soft CL wearers. All the current soft CL wearers who were prescribed CL after January 2007 until December 2011 in Nepal Eye Hospital (NEH) were invited to participate in the study. Thirty-nine MDs other than ophthalmologists were included in the interview by a trained optometrist. In this study, an MD was considered as a person who had completed a Bachelor of Medicine and Bachelor of Surgery (MBBS) during the time of interview. Thirty-nine

Results

Thirty-nine MDs and 39 age-matched NS were included in this study. All the subjects were wearing soft CL. There was not significant difference in age between the two groups (p = 0.386). Almost all of the subjects (94.9%) were wearing conventional hydrogel lenses. Table 3 shows the demographic information of the subjects.

As shown in Table 4, good compliant behavior was higher in the group of MDs (35.9%) than the control subjects (20.5%). However, this finding was not statistically significant (p =

Discussion

This study determined the compliance rate in MDs and compared it with the age matched control subjects. Average age of the subjects in this study was higher in comparison to the average age of Nepalese lens wearers [9], [13]. This was due to the inclusion of medical doctors who had completed their medical course, which is the longest duration undergraduate course in Nepal requiring at least seventeen school years.

It was found that 36% of the MDs had good compliance, 49% had average compliance

Conflict of interest

None.

Financial support

None.

Acknowledgement

The author would like to thank Ms Bijaya Pandit, Dr Karthikeyan Baskaran, Ph.D. Dr Luigina Sorbara, OD, MSc and Mr Michael Rosenkrantz for their help in preparation of this manuscript.

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View full text

Level of compliance in contact lens wearing medical doctors in Nepal

Highlights

Abstract

Purposes

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conflict of interest

Financial support

Acknowledgement

Contact Lens Anter. Eye

Contact Lens Anter. Eye

Contact Lens Anter. Eye

Contact Lens Anter. Eye

Contact Lens Anter. Eye

Contact Lens Anter. Eye

Contact Lens Anter. Eye

Contact Lens Anter. Eye

The epidemiology of contact lens related infiltrates

Optom. Vis. Sci.

Best practice contact lens care: a review of the Asia Pacific Contact Lens Care Summit

Clin. Exp. Optom.