Contact Lens Assessment in Youth - Transition from Research to Practice
Course Description:
Evidence based clinical practice improves the management of patient care, from examination
procedures to methods of patient education. The literature related to contact lens complications
has been extensive over the past 20 years as contact lens products and patients have evolved.
The Contact Lens Assessment in Youth (CLAY) study group was formed in 2008 to answer the
question: Are youth at greater risk for contact lens related complications, and if so, at what age
does the added risk abate? This course will review research related to contact lens complications
as well as summarize the results of the contact lens safely results for possible implications in
changes in the standard of care in general practice.
Course Learning Objectives:
 Review historical data on soft contact lens complications
 Summarize the outcomes of the CLAY study
 Assist practitioners in identifying those patients at a higher risk of contact lens
complication so that they may educate the patient on recommended hygiene practices,
appropriate self-management of complications and types of lenses or lens care products
to help decrease that risk.
Course Outline:
I. History
A. Microbial keratitis
1. 1989 - Schein et al
a. 1/500 in EW, 1/2500 DW
2. 1999 - Cheng et al
a. 1/500 in EW, 1/2857 DW
b. Frequent replacement, improved materials and lens care products did not
minimized complications
3. 2005 - Schein et al
a. 0.3 to 3.6 per 10,000 incidence of loss of acuity among SiHy
4. 2005 - Morgan et al
a. Higher incidence in extended wear
b. Severe keratitis versus non-severe keratitis
5. 2007 - Keay et al
a. Principal risk factor is extended wear
B. Risk factors for corneal infiltrates
1. Age
a. Under 25 years old
2. Overnight wear
3. Lens modality
II.
III.
4. Smoking
C. Age
1. Bimodal distribution of young and old SCL wearers
2. Orthokeratology
a. Limited utility to estimate rates in cosmetic SCL wear
D. Increased use of SCL wear among children and teens
1. Myopia control technology
a. Adapted optics directly on the corneal surface
2. ACHIEVE study
a. Examined the self-perception of children near-sighted children
b. Improved self-esteem with contact lens wear
c. Children can be responsible for SCL wear
E. Gaps in knowledge
1. Shape of the age-related risk profile is unknown
a. Plateau, peak or steady profile?
b. Theoretical pattern unknown thought to be peak, but unknown because of
limited data with younger population.
Microbial keratitis vs. other life risk factors
A. 1995 - Meyers and Weiss
B. 2009 - Szczotka-Flynn et al
Contact Lens Assessment in Youth
A. Research question
1. Are youth at greater risk for contact lens related complications, and if so, at
what age does the added risk abate?
B. Multicenter clinical chart review to measure the influence of age on SCL related
complications
1. Retrospective chart review of 3,549 SCL wearers aged 8-33 years old
2. Representing 4,663 years of SCL wear
C. Results
1. Corneal infiltrates and inflammatory events peak in late adolescence and
early adulthood
2. Age
3. Lens replacement schedule
4. Years of SCL wear
5. Material
6. Overnight wear
a. Indication or out-of-indication wear
D.
Identifying risk
1. Modifiable vs. non-modifiable risk factors
a. Development of a survey
IV.
1. College vs. non-college
2. Wearing habits of 18-25 to 26-33 years old
b. Survey to younger SCL wearers
2. Prospective Study
a. Case-control of inflammatory events
Driving education
A.
Age
B.
Lens replacement
C.
Lens care products
D.
Overnight wear