Data from a new study has found stickers on contact lens cases that carry a ‘no water’ message could be beneficial to improve compliance among wearers.
The research, which was published in the Royal College of Ophthalmologists’ Eye journal, found that stickers improved water-contact behaviours and reduced storage case endotoxin.
A total of 200 daily lens wearers (188 completed the study) were randomly selected to receive either a storage case with or without a no-water sticker and both received written compliance information.
Patients completed hygiene questionnaires at the start of the trial and then again after six weeks. Microbial analysis of used storage cases that were collected at both study visits was conducted to assess microbial contamination and endotoxin levels.
After six weeks, the overall water exposure score and endotoxin levels reduced significantly in the test group compared with the control group. There were no significant changes in individual water-contact behaviours or overall storage case contamination.
Study authors concluded that a no water infographic on the contact lens case improved overall water-contact behaviours and reduced storage case endotoxin.
An effective reminder
Wider use of the no water stickers is needed across the profession, according to Irenie Ekkeshis, who started a campaign in 2011 to raise awareness around the risks of water exposure while wearing contact lenses.
‘I would love to see practitioners all over the world using the stickers as an effective reminder of the importance of avoiding water when wearing, storing or rinsing contact lenses. I’d also like to see manufacturers reviewing their own packaging designs to see if the no water logo could be incorporated onto the packaging itself.
‘If both of these things happen, then we’ll see a reduction in the numbers of people exposing their lenses to water in the reported ways, which will hopefully see a reduction in the number of reported corneal infections,’ Ekkeshis told Optician.
Ekkeshis explained that the profession needs to make a collaborative effort to make contact lens wear safer for patients. ‘Everyone in the profession carries that responsibility jointly,’ she said.
Ekkeshis’ campaign started after she contracted acanthamoeba keratitis (AK) in 2011. She explained the accepted narrative was that incidence of AK was mostly related to wearers ignoring safe wear messages. ‘I discovered that awareness of water exposure as a risk factor was low among wearers, so this narrative of blame was wholly inappropriate. I started campaigning to change that narrative and to encourage a broader and more enduring conversation with wearers about the importance of avoiding water when wearing lenses,’ Ekkeshis said.
She designed a no water graphic to be used as a reminder for people to avoid water when wearing contact lenses and shared it with the British Contact Lens Association (BCLA), who adopted it on its left and right stickers. It has since been adopted by contact lens associations and organisations across the world with the help of Dr Nicole Carnt, research optometrist and lecturer at the University of New South Wales, Australia.
Ekkeshis explained that information around safe contact lens wear needs to be reinforced regularly by practitioners and that no water stickers provide an opportunity for this to happen each time they use their contact lens case or box. ‘It’s not enough to give patients information about safe wear and specifically avoiding water only at their first consultation or fitting,’ she said.
Collective responsibility
Luke Stevens-Burt, chief executive of the BCLA, told Optician the profession needs to show collective responsibility, with no exceptions, in order for patients to understand the no water message.
‘This is only part of the education process and other measures need to be considered and acted on. We have recently updated our popular dos and don’ts guide to reflect the latest advice and we would urge all eye care professionals to download this from our website and share this information with their patients,’ Stevens-Burt said.
He added that the BCLA could consider developing stickers like this as well as a patient campaign to highlight the importance of the message. ‘We have long been at the forefront of the no water message and it’s something that remains a priority for us and our members. Ideally, the message should be reinforced at every visit and in any communication, including remote consultation, from industry-approved templates.’
When asked what impact the report could have on water-contact behaviours, Stevens-Burt said: ‘This study shows close to a 15% reduction in endotoxin levels from a very simple message. While this does not directly correlate to a reduction in contact lens related microbial keratitis, this is a very strong indicator of effect from a simple intervention. This study could have its results improved with a clearer message relating to no water at all.’
The research can be read online at www.nature.com/articles/s41433-020-1015-9
