The effect of degree of refractive error on hydrogel contact lens-induced complications and patient self-management behaviors

Introduction. Although many aspects of hydrogel lens wear have been explore d over the last 20 years, little attention has been paid to the role of ref ractive error magnitude in determining patients' ocular responses or associ ated contact lens behaviors. Methods. A cross-sectional study was conducted in 32 optometric and ophthalmologic practices. We enrolled 2161 spherical soft contact lens-wearing patients. High ametropes were defined as those wi th at least +/-5.00 D spherical equivalent refractive error in the right ey e. Data on current contact lenses, prescribed care regimens, and slit lamp biomicroscopic signs were provided by the eye care practitioners, and infor mation on actual lens care behaviors and attitudes toward contact lens wear were gathered by survey directly from the patients. All differences betwee n high and low ametropes were compared using the chi-square test. Results. Compared with low ametropes, high ametropes were more satisfied with their vision with contact lenses (p < 0.001). More high ametropes wore their lens es on an extended-wear schedule (p = 0.015). Both groups of patients report ed a similar degree of lens awareness and lens-associated pain, but fewer h igh ametropes reported foreign body sensation (p = 0.002). In managing cont act lens discomfort, high ametropes were more likely to use an old spare le ns (p = 0.01) and more likely to continue wearing their lenses (p = 0.016)- indicators of a propensity for self-management. In response to a damaged le ns, high ametropes were less likely to remove both of their lenses (p = 0.0 02). High ametropes showed more conjunctival staining (p = 0.001) and more corneal scars (p = 0.033). High ametropes also presented with more corneal fluorescein staining (p = 0.001) and more corneal vascularization (p < 0.00 1). These relations between the degree of ametropia and slit lamp signs of contact lens wear were not significantly affected by daily- vs. extended-we ar status. Conclusions. in summary, practitioners should consider the impli cations of the patient's degree of ametropia when prescribing contact lense s. These results indicate the need for closer observation and specific advi ce concerning management of contact lens-related problems when caring for p atients with high refractive errors.