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Introduction
Contact lenses (CL) are utilized by hundreds of thousands of individuals globally with an elevated pattern. The latest survey from US Facilities for Illness Management and Prevention (CDC) estimated that the prevalence of CL wearers in US has risen from 40.9 million in 2015 to 45 million in 2019.1 Fundamental goal of carrying CL is imaginative and prescient correction.2,3 CL present a number of benefits to wearers in comparison with spectacles by way of comfort, wider visible area and improved character.4 Nevertheless, poor compliance of CL put on and care can result in critical ocular issues which trigger everlasting visible loss.5 A evaluation discovered that noncompliance fee in CL wearers was excessive, starting from 50% to 91%.6 Corneal ulcer is without doubt one of the most extreme issues in CL wearers.7 Plenty of proof demonstrated a powerful affiliation between poor CL compliance and the elevated threat of corneal ulcers.5,8–11 Frequent threat behaviors in CL wearers are recognized as in a single day use, sharing lens, swimming with lens, and insufficient CL care.5,11,12
Youngsters and younger adults are discovered to have much less contact lens compliance.13,14 Earlier research revealed that folks on this age group had greater corneal infiltrative occasions (CIE)13–15 in addition to microbial keratitis in comparison with older adults.5 College college students are thought of the foremost inhabitants on this age group. We expertise a pattern of accelerating CL-related issues in Thai younger adults. This phenomenon has additionally been noticed in Singapore and Australia.16,17 To this point, little is understood about CL put on and care standing in Thailand, particularly amongst college college students. This survey goals to analyze the sample, data and behaviors of CL put on and care in Thai college college students. We additionally consider threat components that are probably related to poor CL behaviors and CL-related corneal ulcers. The outcomes from this research would assist increase consciousness of getting good CL compliance in younger folks neighborhood and act as a primer for bettering CL training coverage sooner or later.
Strategies
This research was a cross-sectional survey performed throughout July 2019 to February 2020 in two Rajabhat universities consisting of Sunandha Rajabhat and Suan Dusit College, Bangkok, Thailand. Rajabhat Universities are part of the college system in Thailand which originated from a instructor faculty system and resembles a polytechnic institute format to serve the remainder of Thailand’s instructional wants with over 38 totally different campuses throughout the nation. For the reason that improve to school standing, each universities within the system have a scholar inhabitants of over 5000 college students from six most important colleges together with College of Schooling, College of Science and Expertise, College of Humanities and Social Sciences, College of Industrial Expertise, College of Tremendous Arts, and College of Administration Science. This research protocol was authorised by the Analysis Ethics Committee of Navamindradhiraj College and Ramathibodi Hospital, Mahidol College in accordance with the tenets of Declaration of Helsinki.
An internet survey on data and conduct of CL utilizing self-administered questionnaire was launched to all college college students by college staffs and by way of faculty promoting media. College students who wore CL and have been keen to take part within the survey may entry the digital survey by way of the QR code scanning on the designated cellular Google Kind. Digital knowledgeable consent was obtained from each participant earlier than beginning survey. We excluded members who weren’t a present CL person inside one 12 months and didn’t full all key questions within the survey.
The questionnaire was in Thai language tailored from a earlier research.18 It was composed of three sections; the primary part was demographic knowledge (ie, gender, age, learning college, and sort of refractive error) and CL data (ie, kind of CL, causes for utilizing CL, locations of buying lenses, common carrying time and length of carrying contact lens). The second part requested about CL behaviors. There have been 9 objects together with hand washing, sleeping in a single day with lens, swimming with lens, sharing lens, comply with lens changing schedule, cleansing lens and lens case, and historical past of CL-related ocular issues. Within the final merchandise, the members have been additionally requested about how they managed themselves when issues occurred and the way ceaselessly they went for eye check-up. The third part contained eight objects to inquire concerning the data of CL put on and care, and CL-related ocular issues, just like the second part (the second and third sections of the questionnaire in English can be found in Appendix). Responses of seven sure/no questions in second and third sections have been scored (one rating per every right response) and summarized to find out whole conduct and data scores. Contributors who accurately answered a minimum of six from seven objects (>80%) within the second and third part have been categorised as having good conduct and good data, respectively.
Statistical Evaluation
Descriptive evaluation was carried out to explain traits of members. Steady variables have been reported in means (normal deviation, SD) or median (vary), the place acceptable. Categorical variables have been reported in frequency and share.
The correlation between data and conduct was analyzed utilizing Spearman’s rank correlation for particular person merchandise and Pearson’s correlation for whole rating. Univariate logistic regression evaluation was used to establish the danger components related to poor CL behaviors and historical past of CL-related corneal ulcers. Then components which have been vital at p stage of lower than Zero.1 within the univariate evaluation, have been subsequently included within the multivariate evaluation. Odd ratios (OR) from univariate evaluation and adjusted OR from multivariate evaluation together with 95% confidence intervals (CI) have been calculated for every issue. All analyses have been calculated utilizing STATA model 16 (StataCorp, Faculty Station, TX, USA). P worth of lower than Zero.05 was thought of statistically vital.
Outcomes
Contributors Traits
Of 503 college students who scanned QR code, 493 college students (98.01%) obtained digital knowledgeable consent to take part within the survey. Three-hundred and thirty-six college students (66.78%) have been present CL customers and accomplished the survey questionnaires. Imply age was 19.2 (SD 1.four) years with feminine predominance. Of 336 college students, 272 college students (80.95%) studied at Suan Sunandha Rajabhat College and 64 college students (19.05%) studied at Suan Dusit College as proven in Table 1. Most members have been from College of Administration Science, College of Humanities and Social Science and College of Innovation and Administration. 2 hundred and ninety college students (83.31%) wore CL on account of refractive error correction, whereas 46 college students (13.69%) used CL for beauty functions. Median refractive error was −2.75 D (ranged from −eight.00 to Zero.00 D). All college students used delicate CL. The alternative schedules have been month-to-month (90.18%). Main causes for selecting specific CL have been eye consolation (82.44%), CL model (14.58%), and value (2.98%). Duna (Prime Charoen; Nonthaburi, Thailand), was the most typical CL model (35.42%) adopted by Maxim (Maxim inter-corporation LTD; Bangkok, Thailand, 13.39%) and Bausch & Lomb (17.86%). Different bands reported have been Kitty Kawaii, Acuvue and different manufacturers of coloured CL (eg, Lollipop, Fairly Doll, Dreamcolor, and Olens). College students bought their lens from an optical store (66.07%), flea market (14.29%) and from the web (13.10%). The members largely wore lens on a mean of 5 days per week, eight–12 hours per day.
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Desk 1 Demographics, Refractive Errors and Contact Lens Data of Contributors (N = 336)
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Contact Lens Conduct
Most members (280 college students, 83.33%) wash arms each time earlier than inserting or eradicating CL. Different members normally washed hand (42 college students, 12.50%), generally washed arms (9 college students, 2.68%) and 5 college students (1.49%) by no means washed arms. Ninety-nine college students (29.46%) ever slept in a single day with lens. Fifteen college students (four.46%) ever shared lens with buddies. 100 and eighty-six college students (55.36%) changed lens based on the producer suggestion. Eighty-six college students (25.60%) had ever swum with lens. Fifty-one college students (15.81%) used faucet water for cleansing or rinsing lens. 2 hundred and sixty-three college students (78.27%) used recent lens resolution day by day. Most college students (90.18%) modified storage instances each one to a few months. 100 ninety college students (56.55%) had good CL put on and care behaviors.
Contact Lens Data
2 hundred and twenty-nine college students (68.15%) had consciousness of sleeping in a single day with lens. Virtually all members had consciousness of sharing lens with buddies (95.54%), swimming with lens (91.07%), and utilizing faucet water for cleansing or rinsing lens (96.13%). 2 hundred ninety-five college students (87.80%) have been conscious of lens alternative as suggestion. Having data of utilizing recent lens resolution day by day and altering lens case each one to a few months have been reported in 298 college students (88.69%) and 255 college students (75.89%), respectively. 2 hundred sixty-four college students (78.57%) had good data in CL put on and care.
Relationship Between Contact Lens Conduct and Data
Data and conduct weren’t correlated in all questions, aside from sharing lens with buddies (r = 1.00, p worth < Zero.Zero01). Spearman’s rank correlations between data and conduct ranged from −Zero.04 to 1.00, see Table 2. In accordance with the whole rating, imply conduct scores and data scores have been 5 (SD 1) and 6 (SD 1), respectively. There was no correlation between CL conduct and data (r = Zero.03, p = Zero.655).
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Desk 2 Conduct and Data of Contact Lens Put on and Care of Contributors (N = 336)
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Components Related to Poor Contact Lens Put on and Care Behaviors
In univariate evaluation, buying lenses from web considerably related to poor CL conduct with the OR (95% CI) of two.47 (1.27, four.78) in contrast buying lenses from optical store. College students who had expertise of carrying CL greater than 1 12 months have been 1.98 instances (95% CI 1.18, three.33) more likely to have poor CL conduct. Lengthy carrying time per day (> 12 hours/day) and common carrying (> 5 days/week) have been extra more likely to have poor CL conduct with the ORs (95% CI) of two.37 (1.05, 5.35) and 1.59 (1.00, 2.54), respectively, as Table 3. After multivariate adjustment, the remaining vital related components with poor CL behaviors included: buying from web, carrying expertise of greater than 1 12 months and lengthy carrying time per day with poor CL behaviors with the adjusted ORs (95% CI) of two.74 (1.39, 5.41), 1.82 (1.04, three.18), and a pair of.56 (1.07, 6.13), respectively, see Table 3.
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Desk three Affiliation Between Gender and Contact Lens (CL) Sample with Poor CL Conduct
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Contact Lens-Associated Ocular Issues and Eye Examine-Up
For CL-related issues, seventy-four college students (22.02%) had skilled ocular issues associated to CL. Thirty-four college students (10.12%) had historical past of corneal ulcers. Fifty-three college students (15.77%) had different issues together with pink eye, dry eye and different unspecified issues, proven in Table 4. All college students knew that CL put on may result in ocular issues, nevertheless solely 40.77% of scholars have been conscious of CL-related corneal ulcer. Eye irritation and dry eye have been essentially the most identified issues. Different identified issues included corneal abrasion and corneal neovascularization. If any ocular issues occurred throughout CL put on, most college students (81.25%) would take out their lens instantly and 24.49% of scholars would go see an ophthalmologist. Solely 10 members would proceed carrying the lens with out doing something.
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Desk four Contact Lens-Associated Ocular Issues and Eye Examine-Up (N = 336)
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For eye check-up, 219 college students (65.18%) by no means underwent eye check-up with ophthalmologists or optometrists. Solely 17 college students (5.06%) had eye check-up, see Table 4.
Threat Components Related to Contact Lens-Associated Corneal Ulcers
From univariate evaluation, put on and care behaviors together with wash arms, sharing lens with buddies, swimming with CL and utilizing faucet water to wash or rinse lens have been considerably related to historical past of getting CL-related corneal ulcers with the OR (95% CI) of Zero.37 (Zero.17, Zero.80), three.53 (1.06, 11.76), three.87 (1.87, eight.00), and a pair of.65 (1.18, 5.95), respectively. After multivariate evaluation, male gender and swimming with lens have been statistically vital affiliation with historical past of corneal ulcers on the adjusted ORs of two.78 (1.20, 6.42) and three.44 (1.57, 7.55), see Table 5.
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Desk 5 Affiliation Between Kind of Gender, Contact Lens, Threat Behaviors and Historical past of Having Contact Lens-Associated Corneal Ulcer in Contributors
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Dialogue
This present research comprehensively evaluated sample of CL use, behaviors and data by way of CL put on, care, and CL-related issues in college college students in Thailand. This survey identified insufficient CL put on and care behaviors in Radjabhat College system and located that solely 56.55% of scholars reported to have good CL put on and care behaviors. Though a majority of scholars (78.57%) had good data in CL put on and care, no vital correlation between behaviors and data was noticed. Prime three poor behaviors have been overused CL, sleeping with lenses and swimming with lenses. We hypothesized that overused CL is perhaps influenced from an absence of funds in unemployed college students, an absence of training by eye care suppliers, and a lack of know-how of unhealthy penalties, just like these key components talked about within the earlier research.13 Younger adults (18–25 years) have been proven to be much less more likely to wash their arms earlier than making use of their lens in comparison with older adults (26–33 years).13 We discovered that roughly one fifth of our college students occasionally or by no means wash their arms earlier than dealing with lenses.
Eight college students reported not altering lens instances inside three months. It has been demonstrated that a number of pathologic organisms, ie, free-living Acanthamoeba and Pseudomonas colonized on the floor of lenses and storage instances, thus CL can probably act as a vector for corneal an infection.19 Failure to interchange or correctly clear and retailer lens subsequently result in the formation of biofilm which will increase the danger of ocular an infection.20 The lens case ought to be cleaned each day with recent contact lens resolution and allowed to air dry to cut back the prospect of pathogen contamination, and ought to be changed each 90 days.21
Beforehand recognized components influencing on CL compliance included age, gender, training, socio-economic stage and perceived risk of illness.2,13,22 Though we didn’t observe an affiliation between gender and CL conduct, male college students have been about 3 times extra more likely to have a historical past of CL-related corneal ulcer in comparison with females. On this present research, buying lens from web, carrying expertise over one 12 months, and lengthy put on length (> 12 hours per day) have been considerably related to poor CL conduct. Unauthorized suppliers are considerably much less more likely to instruct acceptable lens hygiene, which may result in poor lens compliance and better CL-related issues.11,23 Buying CL from web was discovered to be related to insufficient CL conduct with an OR of two.47. Our discovering is consistent with the earlier research in Australia wherein bought lenses from web elevated threat of microbial keratitis which was probably defined by insufficient CL care attitudes and behaviors.11 Radford et al reported that CL carrying expertise was inversely related to CL compliance.24 Subsequently, common revision of lens hygiene at after-care visits ought to be emphasised for sustaining excessive stage of CL compliance.
It has been identified that poor preliminary instruction or lack of re-instruction can result in non-compliance in CL wearers.24 Nevertheless, an absence of correlation between conduct and data was present in our research, implying that data alone will not be enough to drive good CL compliance. Our findings corresponded with some earlier reviews in medical college students.25,26 Other than data, correct motivation, good doctor-patients relationship and robust regulation are importantly contributed to profitable well being promotion.27,28 Furthermore, earlier proof has additionally proven that threat taking personalities, ie, being conscious of well being hazards demonstrating dangerous behaviors whatever the consciousness, are strongly associated to general CL compliance rating.29 Multi-factors may have an affect on conduct in CL wearers.
When it comes to CL-related issues, corneal ulcer is taken into account as some of the devastating issues which may result in everlasting visible impairment.30 Our earlier research reported that 17.65% of extreme microbial keratitis have been related to CL makes use of throughout 2010 to 2016.31 This prevalence was reported as excessive as 43.9% within the developed international locations.30 Sleeping in a single day with lens, poor storage instances hygiene, methodology of CL buy, and swimming with lens have been the essential threat components for CL-related corneal ulcers.8,11,16,32,33 Sleeping with lenses was present in over a half of sufferers with corneal ulcers.30 We discovered a barely elevated threat of corneal ulcers in college students with a historical past of corneal ulcer, nevertheless it was not statistically vital, in contrast to findings from earlier research.11,34,35 This is perhaps defined by the variations of research design, topic traits and definition of in a single day put on amongst research.
The present research demonstrates that swimming pool was considerably related to the next fee of a historical past of CL-related corneal ulcer, just like earlier research in Singapore.33 Roughly one fourth of our college students had swum with their lenses earlier than, which was just like the report from Singapore (32.eight%),36 however lower than latest report from US, which discovered college students swimming with lenses to be 62–75% with a peak at school age.13,36 This excessive fee is perhaps a results of the unclear suggestion from totally different buy factors and lack of reinforcement from eye care professionals.37 It has been proven that swimming in a chlorinated pool permits for accumulation of gram constructive micro organism which have been the identical as these discovered from pool water, within the lens, no matter lens supplies.38 If one considers the advantages of CL put on throughout water actions outweigh the danger of complication, the usage of each day disposable lenses with tight-fitting goggles and discarding lenses instantly after swimming episode could also be a safer apply to attenuate the danger of corneal an infection.37,38Pseudomonas aeruginosa is the most typical pathogen detected in CL-related microbial keratitis.17,30 Apparently, it has been detected in 524/7904 (6.6%) waters examined in scorching tubs, faucet water, jacuzzis, swimming pool and bottled water.39
Fifty-one college students (15.81%) reported utilizing faucet water for cleansing or rinsing lenses. Home water generally is a supply of Acanthamoeba contamination.40 Practically 85% of sufferers with Acanthamoeba keratitis, some of the devastating types of corneal ulcers, had a typical threat issue of exposing lenses to water.41,42 Similar strains of free-living Acanthamoeba have been recovered from water provide, contact lens instances43 and cornea44 of sufferers with Acanthamoeba keratitis. Inappropriate water publicity throughout put on and care of CL can even result in bacterial contamination.45 Publicity to any supply of water whereas carrying CL are more likely to enhance the danger of an infection.44 Unexposed lenses and storage instances to any sorts of water for a one month-period has been confirmed to get rid of Acanthamoeba contamination.46
Beauty CL turns into enhance in pattern particularly in younger technology in a number of international locations23,47 together with in Thailand. This is perhaps resulted from business influences, angle of fine look, affordable value and ease of buy. Many beauty CL manufacturers have been authorised by Thai FDA, eg, Kitty Kawaii, Fairly Doll and Sweety Plus. We discovered 55 college students (18.84%) utilizing coloured beauty CL. Though some research have identified the danger of an infection in beauty CL wearers,23,47,48 we didn’t observe vital affiliation between beauty coloured CL and poor contact lens behaviors or CL-related corneal ulcers. The discrepancy in comparison with different research could also be because of the monitoring and approval of beauty CL from the Thai FDA. Most of scholars in our research put on Thai FDA authorised coloured CL with refractive error corrections (imply refractive errors of −2.21 D) and solely three college students used purely beauty lens with zero energy, whereas in different research, beauty CL with zero energy was used.47,49
The attention of CL-related issues is low amongst younger technology and 87% of them nonetheless desire to put on CL regardless of of getting CL-related issues.50,51 The attention of CL issues in our research remains to be inadequate. Though all college students knew a minimum of one in all CL-related issues, solely 40.77% of them acknowledged extreme complication of CL-related corneal ulcers. Solely 17 college students (5.06%) reported having eye check-up each earlier than and after carrying CL. A number of research confirmed that good portion of scholars wouldn’t go to eye docs and proceed carrying their lens.25 Significance of standard eye check-up ought to be emphasised in younger CL wearers.
The limitation of this research was a nature of on-line survey, which could lead to bias knowledge on account of no random sampling and low response fee. This survey was taken from the 2 chosen Rajabhat universities, subsequently our findings may not be an correct consultant of basic inhabitants of college college students elsewhere. Some essential components related to poor CL behaviors together with age group, research fields (medical vs non-medical), socioeconomics and CL kind can’t be assessed because of the homogenous profile of inhabitants within the present research. We didn’t use frequency scale and no query assessed rub and rinse strategies in our survey questionnaires. Standardized questionnaire protecting all points of CL conduct and data ought to be developed as a consensus. Our research used self-report of hygiene and issues which have been vulnerable to be underreported. Nevertheless, extreme complication of corneal ulcer is unlikely to be uncared for, subsequently our estimates on this merchandise ought to be legitimate.
In abstract, this research indicated that Thai Rajabhat College college students had insufficient CL put on and care conduct. Buying lenses from the web, skilled CL wearers and lengthy carrying time per day have been related to poor CL behaviors. Whereas, male gender, utilizing faucet water for cleansing or rinsing lenses and swimming with lenses have been related to greater threat of getting historical past of CL-related corneal ulcer. We’ve supplied the general public well being organizations with the knowledge which could result in improvement of safer well being care coverage for CL customers. Good CL practices, consciousness of CL-related issues and place of buy ought to be rigorously defined to all inexperienced persons and frequently confused in skilled CL wearers to attenuate preventable visible damages in younger inhabitants.
Acknowledgments
We thank administrative staffs and lecturers from Sunandha Rajabhat and Suan Dusit College for his or her help with knowledge assortment. We additionally thank Ms. Sranya Phaisawang for language modifying and proofreading.
Disclosures
The authors declare that they don’t have any conflicts of curiosity for this work.
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