Carnt Nicole, Minassian Darwin C, Dart John K G
School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research Moorfields Biomedical Research Centre, London, United Kingdom.
EpiVision Ophthalmic Epidemiology Consultants, Penn, United Kingdom.
Ophthalmology. 2023 Jan;130(1):48-55. doi: 10.1016/j.ophtha.2022.08.002. Epub 2022 Aug 8.
This study was designed to establish risk factors for the development of Acanthamoeba keratitis (AK) for daily disposable (DD) contact lens (CL) users compared with daily wear (DW) reusable lens users and for risks unique to DD users. This is important because, in many major economies, CL use is the principal cause of microbial keratitis, of which AK accounts for approximately 50% of cases with sight loss. Determining these AK risks informs practitioner advice and consumer behavior.
Case-control study.
Cases and controls were recruited from an Accident and Emergency Department serving South-East England. Cases were new CL users with AK recruited retrospectively from January 2011 to February 2013 and prospectively thereafter until August 2014. Controls were recruited prospectively from February 2014 to June 2015.
Analysis of a self-administered questionnaire.
Independent risk factors and population attributable risk percentage (PAR%) for AK.
A total of 83 AK cases and 122 controls were recruited; DD use was reported by 20 (24%) cases and 66 (54%) controls. In multivariable analyses adjusted for potential confounders, the odds of AK was higher for DW reusable soft lenses (odds ratio [OR], 3.84; 95% confidence interval [CI], 1.75-8.43) and rigid lenses (OR, 4.56; 95% CI, 1.03-20.19) than for DD lenses. Within the DD-using subset, AK was associated with the following modifiable risk factors: less frequent professional follow-up visits (OR, 10.12; 95% CI, 5.01-20.46); showering in lenses (OR, 3.29, 95% CI, 1.17-9.23); lens reuse (OR, 5.41; 95% CI, 1.55-18.89); and overnight wear (OR, 3.93; 95% CI, 1.15-13.46). The PAR% estimated that 30% to 62% of cases could be prevented by switching from reusable soft lens to DD lens use.
Acanthamoeba keratitis risks are increased > threefold in DW reusable lens users versus DD lens use. Acanthamoeba keratitis risks for DD lens users can be minimized by adherence to safe use guidelines (no reuse, overnight wear, or contamination by water). Safe CL use can be improved by increasing the prominence of risk avoidance information from manufacturers and regulators. Because AK accounts for half of severe keratitis in CL users, these measures can be expected to have public health benefits.
本研究旨在确定日抛型（DD）隐形眼镜使用者与日戴型（DW）可重复使用隐形眼镜使用者相比发生棘阿米巴角膜炎（AK）的危险因素，以及DD使用者特有的风险因素。这一点很重要，因为在许多主要经济体中，使用隐形眼镜是微生物性角膜炎的主要原因，其中AK约占视力丧失病例的50%。确定这些AK风险可为从业者的建议和消费者行为提供依据。
病例对照研究。
病例和对照均从为英格兰东南部服务的急诊科招募。病例为2011年1月至2013年2月回顾性招募以及此后至2014年8月前瞻性招募的新诊断为AK的隐形眼镜使用者。对照于2014年2月至2015年6月前瞻性招募。
对一份自行填写的问卷进行分析。
AK的独立危险因素和人群归因风险百分比（PAR%）。
共招募了83例AK病例和122名对照；20例（24%）病例和66例（54%）对照报告使用日抛型隐形眼镜。在针对潜在混杂因素进行调整的多变量分析中，DW可重复使用的软性隐形眼镜（优势比[OR]，3.84；95%置信区间[CI]，1.75 - 8.43）和硬性隐形眼镜（OR，4.56；95%CI，1.03 - 20.19）发生AK的几率高于日抛型隐形眼镜。在使用日抛型隐形眼镜的亚组中，AK与以下可改变的危险因素相关：专业随访就诊频率较低（OR，10.12；95%CI，5.01 - 20.46）；戴着隐形眼镜淋浴（OR，3.29，95%CI，1.17 - 9.23）；重复使用隐形眼镜（OR，5.41；95%CI，1.55 - 18.89）；以及过夜佩戴（OR，3.93；95%CI，1.15 - 13.46）。PAR%估计，通过从可重复使用的软性隐形眼镜改用日抛型隐形眼镜，30%至62%的病例可得到预防。
与使用日抛型隐形眼镜相比，DW可重复使用隐形眼镜使用者发生棘阿米巴角膜炎的风险增加了三倍多。通过遵守安全使用指南（不重复使用、不过夜佩戴或不被水污染），可将日抛型隐形眼镜使用者发生棘阿米巴角膜炎的风险降至最低。通过提高制造商和监管机构提供的风险规避信息的显著程度，可改善隐形眼镜的安全使用。由于AK占隐形眼镜使用者严重角膜炎病例的一半，预计这些措施将对公众健康有益。
