Laura Kapitanovaitė1, Simas Giedrys1, Dalia Jarušaitienė2
1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania
2Department of Opthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Abstract
Background & objectives: Dry eye disease is a multifactorial disorder which affects millions of people worldwide. The aim of the study is to investigate prevalence of dry eye disease among young contact lens (CL) wearers, compare with non-wearers and evaluate correlations between different features of contact lens usage and the manifestation of dry eye disease.
Methods: Questionnaire CLDEQ-8 was used for contact lens wearers and DEQ-5 for non-wearers. For contact lens wearers questions about the type of their contact lens was inquired to determine lens parameters. The character of the symptoms was measured with the dimensions of frequency and intensity. Water content and oxygen transmissibility values were conducted through reports of the manufacturer.
Results: The dry eye questionnaires were completed by 238 students (126 DEQ-5 and 112 CLDEQ-8). Most students use CL for more than 5 years (57,1%) and monthly CL are the most popular (76,8%). Most common wearing time of CL was between 8h. and 16h (51,8%). The most common symptom of dry eyes experienced in contact lens wearers was dryness of eyes (85,7%), while eyes discomfort (84,9%) was the most common symptom in non-contact lens wearers. Correlations between expressed dry eye symptoms and contact lenses parameters were not significant (p = 0,632, p = 0,347)
Conclusions: Dry eye disease is a common pathology in young adult population, especially for contact lens wearers. Symptoms usually increase at the end of the day, but does not depend on composition of the lens.
Keywords: contact lens, dry eye disease.
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82
Medical Sciences 2020 Vol. 8 (13), p. 82-88
Prevalence of dry eye disease related to contact lens wear in
young adults
Laura Kapitanovaitė
1
, Simas Giedrys
1
, Dalia Jarušaitienė
2
1
Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine,
Kaunas, Lithuania
2
Department of Opthalmology, Lithuanian University of Health Sciences, Kaunas,
Lithuania
Abstract
Background & objectives: Dry eye disease is a multifactorial disorder which affects millions of people
worldwide. The aim of the study is to investigate prevalence of dry eye disease among young contact lens
(CL) wearers, compare with non-wearers and evaluate correlations between different features of contact
lens usage and the manifestation of dry eye disease.
Methods: Questionnaire CLDEQ-8 was used for contact lens wearers and DEQ-5 for non-wearers. For
contact lens wearers questions about the type of their contact lens was inquired to determine lens
parameters. The character of the symptoms was measured with the dimensions of frequency and intensity.
Water content and oxygen transmissibility values were conducted through reports of the manufacturer.
Results: The dry eye questionnaires were completed by 238 students (126 DEQ-5 and 112 CLDEQ-8).
Most students use CL for more than 5 years (57,1%) and monthly CL are the most popular (76,8%). Most
common wearing time of CL was between 8h. and 16h (51,8%). The most common symptom of dry eyes
experienced in contact lens wearers was dryness of eyes (85,7%), while eyes discomfort (84,9%) was the
most common symptom in non-contact lens wearers. Correlations between expressed dry eye symptoms
and contact lenses parameters were not significant (p = 0,632, p = 0,347)
Conclusions: Dry eye disease is a common pathology in young adult population, especially for contact lens
wearers. Symptoms usually increase at the end of the day, but does not depend on composition of the lens.
Keywords: contact lens, dry eye disease.
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Journal of Medical Sciences. March 23, 2020 - Volume 8 | Issue 13. Electronic-ISSN: 2345-0592
83
Introduction
Dry eye disease (DES) is a
multifactorial disorder in which homeostasis of
ocular surface is damaged (1). DES has a
tendency to manifest itself as different
discomfort symptoms of the eye - e.g. itching,
dryness, foreign body sensation etc. (2)
Prevalence of DES varies depending on the
study, but during 2017, in Europe and Asia from
5 to 50% of the population was suffering from
this disease (3).
Schein at al. reported that 1 in 7
people aged from 65 to 84 suffer from dry eye
disease, while Moss et al. reported that 14,4%
people aged 48 to 91 are prone to dry eye disease.
(4,5) Risk factors include age, sex, autoimmune
diseases and other environmental factors (6).
One of the most significant environmental
factors are long term usage of contact lenses
(CL). (7)
More than 140 million people
worldwide wear contact lenses every day (8).
Nowadays the most popular CL are silicone
hydrogel lenses (9). These lenses include silicone
within the hydrogel material to increase the
oxygen transmissibility of the lenses (10). They
transmit up to six times more oxygen to the
cornea than regular soft lenses (11). Oxygen
permeability (Dk) is a parameter used to describe
ability of contact lens to deliver oxygen to the
surface of the eye and it differs depending on
water content of the lens. (12) Oxygen
transmissibility (Dk/t) is a derived variable that
shows the degree to which oxygen may pass
through a particular material of a given thickness
(12).
Even though CL is a popular way to correct
refractive errors, in the long term about 10 to 50
% of people go back to wearing prescription
glasses (13). When CL wearers insert a contact
on the ocular surface, the tear film becomes
separated into pre- and post-lens tear film (14).
After this, aqueous layer of the pre-lens tear film
is decreased and becomes unstable which leads
to faster tear break up time. Faster tear break up
time leads to increased tear film osmolarity
which initiates inflammation to the ocular
surface (15). Also if the tear volume is not
sufficient, the post-lens tear film becomes thin
and friction between CL and the ocular surface
increases (14).
This mechanism of action leads to
DES symptoms which can have a significant
impact on the quality of life. Different structure
of contact lenses might induce different effect on
the ocular surface. Recent study showed that
choosing right lens material that fits one’s eye
and frequent replacement of the lens can help to
improve DES symptoms (16).
In conclusion, people wearing contact
lenses are at high risk for developing dry eye
disease and it is important to address and treat
clinical symptoms in order to prevent further
damage to the ocular surface.
The aim of this study was to investigate
prevalence of dry eye disease among young adult
population wearing contact lenses, compare it to
non-contact lens wearers and to evaluate any
possible correlations between different features
of CL usage and the manifestation of dry eye
disease.
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Material and methods
This study was conducted among young
adult in Lithuania aged between 18 and 30 who
wear contact lenses. Study was conducted from
August till October of 2019. Participants who
wear contact lenses were given contact lens dry
eye questionnaire (CLDEQ-8). CLDEQ-8 is a
specific questionnaire designed to assess
prevalence of dry eyes among CL wearers (17).
Contact lens wearers were asked to report
symptoms they experienced while wearing
contact lenses. Questionnaire included
categorical scales to measure the prevalence,
frequency, severity, and occurrence of common
ocular surface symptoms. Ocular symptoms that
were assessed included discomfort, dryness,
blurring of vision. The CLDEQ-8 score of ≥ 12
points was used to identify CL wearers who
could benefit from clinical management of their
symptoms (18). Dry eye questionnaire (DEQ-5)
was given to non-contact lens wearers. They
were asked to evaluate their symptoms and their
severity. DEQ-5 score of > 6 indicate dry eyes
and > 12 might indicate further testing for
Sjogren syndrome induced dry eyes (19).
For CL wearers questionnaire also
included questions about the duration of lens
wear (by months, by days per week and by hour
per day), type of contact lens (daily, weekly,
monthly lenses) and full name of the contact
lenses brand they were using, in order to
determine their material and parameters. Water
content and oxygen transmissibility (Dk/t) values
were conducted through reports of the
manufacturer.
Statistical analysis and calculations
were done with SPSS version 26.0 (SPSS Inc.,
Chicago, IL, USA) software package.
Descriptive statistics are given as percentages
and mean ± standard deviation (M ± SD).The
Kolmogorov-Smirnov test showed the data was
not normally distributed. Spearman correlation
analysis was used to detect associations between
variables. Results of all statistical analysis were
evaluated within a 95% confidence interval and
p values less than 0.05 were accepted as
significant
Results
Questionnaire was uploaded online and total of
238 responders filled it. 47% (112) of them were
contact lens wearers and 53% (126) non-contact
lens wearers.
Contact lens wearers:
Out of 112 contact lens wearers who filled out
our questionnaire 85,7% (n = 96) were female,
14,3% (n = 16) were male and the mean age was
22,86 ± 2,34 (range, 18 - 30) years. Among 112
participants 5,4% (n = 6) wore contact lenses less
than a year overall, 18,8% (n = 21) between 1 and
2 years, 18,8% (n = 21) between 3 and 4 years
and 57,1% (n = 64) wore contact lenses more
than 5 years overall. 15,2% (n = 17) were using
daily disposable contact lenses, 0% (n = 0)
weekly contact lenses, 8% (n = 9) bi-weekly
contact lenses, 76,8% (n = 86%) monthly contact
lenses. The daily wearing time of contact lenses
varied: 7,1% (n = 8) wore contact lenses less than
4h, 17,9% (n = 20) between 4h. and 8 h., 51,8%
(n = 58) between 8h. and 16h., 23% (n = 26) wore
lenses more than 16h. a day.
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85
Between the given symptoms the most
common was feeling of eye dryness in 85,7% (n
= 96) out of whom 44,6% (n = 50) rarely felt it,
24,1% (n = 27) complained sometimes, 15,2% (n
= 17) felt it frequently and 1,8% (n = 2)
constantly suffered from it. The intensity of this
symptom varied and 17% (n = 19) complained
of a very intense feeling of dryness at the end of
wearing time. The least common symptom was
blurred vision which was present in 58,9% (n =
41) of participants out of whom 39,3% (n = 44)
rarely felt it, 8% (n = 9) frequently felt it, 5,4%(n
= 6) and 6,3%(n = 7) suffered from it constantly.
Only 6,3% (n = 7) of participants complained of
very intense blurred vision at the end of wearing
time (figure 1).
Figure 1:Frequency of dry eye symptoms in contact lens wearers
Non-contact lens wearers
Out of 126 non-contact lens wearers 77,8% (n = 98) were female and 22,2% (n = 28) were male, their mean
age was 22,89 ± 2,54 (range, 18 - 30).
Between the given symptoms the most common was feeling discomfort in 84,9% (n = 107) out of whom
37,3% (n = 47) rarely felt it, 27% (n = 34) complained sometimes, 16,7% (n = 21) felt it frequently and
4% (n = 5) constantly suffered from it. The intensity of this symptom varied and 2,4% (n = 3) complained
of a very intense feeling of discomfort at the end of the day. The least common symptom was excessively
watery eyes which was present in 61,1% (n = 77) of participants out of whom 38,1% (n = 48) rarely felt it,
18,3% (n = 23) frequently felt it, 4% (n = 4) and 0,8% (n = 1) suffered from it constantly (figure 2).
40.2
44.6
38.4
34.8
25
24.1
15.2
22.3
16.1
15.2
8
20.5
0
1.8
0.9
0
0
5
10
15
20
25
30
35
40
45
50
Eye discomfort Eye dryness Blurring of vision Wanting to close eyes
Number of responders (%)
Rarely Sometimes Frequently Constantly
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Figure 2:Frequency of dry eye symptoms in non- contact lens wearers
CL wearers vs. non- CL wearers
Prevalence of dry eye and discomfort symptoms
were the same between CL wearers and non-CL
wearers (p > 0,05). By the end of the day
symptoms increased significantly for CL wearers
comparing with non-CL wearers (p < 0,05). CL
wearers scored a median of 8 (0 - 28) points.
According to CLDEQ-8 guidelines 42% (n = 47)
of subjects scored more than 12 points which
indicates that they might be prone to dry eye
syndrome. Non-CL wearers scored a median of 6
(0 - 19) points. According to DEQ-5 evaluations
34,1% (n = 43) of non-CL wearers have dry eyes
and 20,6% (n = 26) might need further testing for
the cause of dry eyes.
Dry eyes and contact lens parameters:
No significant links between daily and overall
usage of contact lenses with manifestation of
clinical symptoms were found (p = 0,068, p =
0,24). CL wearers who scored more than 12
points used contact lenses in which water content
median was 48 (24 - 69) and Dk/t median 160
(24-175). For those who scored less than 12
points water percentage in CL was 38 (24 - 69)
and Dk/t 160 (21 - 175). Correlations between
expressed dry eye symptoms and contact lenses
parameters were not significant (p = 0,632, p =
0,347).
Discussion
We conducted a small study on a young
adult population and it supported a global
population study, which states that a lot of people
these days are prone to dry eye (3).
Contact lens
wear is a known factor for this disease, but there
is still lack of studies which would show the
prevalence of DES in adults younger than 40
years old (1). In our study a lot of young CL
wearers and non-CL wearers were feeling
symptoms related to dry eyes. In CL wearers the
feeling of dryness was the most common. In
another study the same symptom was also the
37.3
36.5
38.1
27
24.6
18.3
16.7
8.7
44
1.6
0.8
0
5
10
15
20
25
30
35
40
45
Eye discomfort Eye dryness Watery eyes
Number of responders (%)
Rarely Sometimes Frequently Constantly
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most popular among students (20).
According to
this study prevalence of DES was higher in CL
wearers, while in our study it was even between
the groups (20). Difference in the results might
have been due to a smaller sample size and
accuracy of questions, which were translated
from English language.
Our hypothesis about DES prevalence
due to contact lens composition was proven
wrong, which might be because of minor water
content and oxygen transmissibility differences
between high-end silicone contact lenses.
According to F. Stapleton et. al, most of lenses
that are available nowadays have sufficient
oxygen transmissibility to eliminate the
symptoms traditionally associated with chronic
hypoxia and have limited effect on corneal
homeostasis (11). To accurately evaluate
different clinical manifestation of DES between
contact lens users and non-contact lens wearers
more in-depth studies with a bigger sample size
and improved methods are required.
We concluded that majority of young
adults are wearing contact lenses for more than
5 years, 8-16 hours per day and monthly lenses
are the most popular. Our study showed that the
most common symptom of dry eye syndrome,
experienced in contact lens wearers, is the
subjective feeling of dry eyes and discomfort in
non-contact lens wearers. The majority of
participants were rarely bothered so much that
they needed to cope by closing their eyes and
needed to take out contact lenses due to
discomfort less than once a week. Prevalence of
dry eye symptoms were the same during the day
amongst contact lens wearers and non-wearers,
but increased for contact lens wearers
significantly by the end of the day. Contact lenses
parameters did not correlate with clinical
manifestation of dry eye disease.
Financial support & Sponsorship: none
Conflicts of interest: none
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