Incidence of contact-lens-associated microbial keratitis and its related morbidity

Background The incidence of contact-lens-associated microbial keratitis is uncertain and its related morbidity in the general population of contact-le ns wearers is not known. We examined these issues in a prospective epidemio logical study. Methods We surveyed all practising ophthalmologists in the Netherlands to i dentify all new cases of microbial keratitis reported during a 3-month peri od 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-permeab le 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 al l groups), Five of the 92 patients achieved a final visual acuity of 20/70 or less. Pseudomonas and Serratia sop were the organisms most commonly isol ated, Pseudomonas keratitis accounted for the largest mean diameter of corn eal ulcers, the highest mean number of days in hospital, the greatest numbe r 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 shou ld be strongly discouraged.