Highlights
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The study is the first report in Jordan that has addressed contact lens compliance in a university student’s population.
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Generally, high to moderate levels of compliance were reported in the study.
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Low levels of compliance were found in relation to cleaning and rinsing lens case and adherence to aftercare visits.
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Smoking, longer lens experience and longer lens wear time were associated with specific non-compliant behaviours.
Abstract
Purpose
this survey aimed to assess levels of compliance with contact lens wear and care among university student’s population in Jordan.
Methods
An interviewer-administered questionnaire was used to assess the extent of compliance among contact lens wearers toward contact lens care in a university population. The questionnaire included 12 questions regarding compliance with contact lens care, lens case/solution replacement, general hygiene procedures related to contact lens and adherence to aftercare visits.
Results
210 contact lens wearers were interviewed. Of the study population 187 (89 %) were females and 23 (11 %) were males. The average age of the study group was 22.35 (± 3.77) years and all the study population were students (undergraduate or postgraduate).The average compliance rate of the study population was 75 %. High level of compliance was noticeable in the following aspects; not sharing lenses with others, not sleeping while wearing lenses, hand washing before lens use and not using water to clean lenses. Moderate level of compliance was reported in the following aspects; showering/swimming with lenses, using lenses longer than recommended replacement schedule and all behaviours related to contact lens care solution. However, low levels of compliance were reported in relation to cleaning and rinsing lens case and adherence to aftercare visits.
Conclusion
High to moderate levels of compliance were reported generally by participants. However, better strategies are recommended to further increase levels of compliance among contact lens wearers in Jordan related to adherence to aftercare visits. While this study is targeted contact lens wearers from a university student’s population, a future study is recommended to include larger sample of contact lens wearers from the general lay population.
1
Introduction
Contact lenses are clinically useful appliances used to correct ocular refractive errors as an alternative management option to spectacles correction. Despite their relative safety, contact lenses-related complications including discomfort, inflammation, dryness and microbial infection have been reported [ ]. These complications have been suggested to occur more commonly among contact lens wearers who show poor compliance with proper contact lens care guidelines [ ].
Contact lens compliance is defined as the process of fulfilling instructions related to contact lens wear that introduced by eye care practitioners (ECPs) or through written instructions given by manufacturers of contact lenses or lens care solution [ , ]. Optimum contact lens wear and care is suggested to be strongly related to high levels of compliance, where maximum compliance is suggested to be achieved by full adherence to provided contact lens care guidelines [ , , ].
Different aspects of contact lens compliance behaviours have been studied and reported extensively in the literature. Examples of these complaint behaviours include proper lens cleaning and replacement, proper use of contact lens care solution, washing hands before and after handling contact lenses, regular cleaning and replacement of lens storage cases, no sleeping with lenses, avoidance of water contact with lenses and adherence to recommended lens wearing hours and lens replacement [ , ]. Additionally, compliance can be related to adherence to aftercare visits [ ] and the way of contact lens purchase from eye care practitioner (ECP) [ , ].
Levels of non-compliance in contact lens wear were reported to be varied in the literature as ranging from 40 %–91 % [ , , , , , ]. This variability was suggested to occur depending on type of contact lenses, lens wear modality and country the studies were performed [ ]. In several studies, high levels of non-compliant behaviours were considered a modifiable risk for developing serious contact lens-related complications such as microbial infection [ , , ].
In general, few studies have been conducted in Jordan to study contact lens practice. The first report was on contact lens prescribing trend released by Morgan et al. in their international survey of contact lens prescribing in 2008 [ ]. According to their report, 370 person were fitted with contact lens, 67 % were female while 23 % are newly fit [ ]. In 2016 trends of contact lens prescribing in Jordan was re-assessed by Haddad et al., with 1730 contact lens fits were analyzed, 65 % were female and conventional hydrogel lenses were the most prescribed lenses [ ]. An increasing number of contact lens wearers have been noticed in Jordan in general and in student’s population in particular for both refractive and cosmetic purposes [ ].
To date there is no reports that assess level of compliance of contact lens care among contact lens wearers in Jordan. The current study aimed to assess compliance behaviours with contact lens wear among university student’s population in Jordan. Measuring levels of contact lens wear compliance and highlighting the non-complaint behaviours could have an important implication in controlling potential contact lens-related complications through increasing levels of awareness related to contact lens care in current and prospective contact lens wearers in Jordan. Additionally, improving levels of compliance among contact lens wearers may decrease rate of lens drop out which, in turn, could improve contact lens practice and patient eye-care in Jordan.
2
Methods
2.1
Participants
The study sample includes contact lens wearers who were invited to participate in a survey to assess their compliance with current contact lens wear. Participants were recruited through announcement on a university webpage. All participants were students at Jordan University of Science and Technology (JUST) who have used to visit the clinic for either contact lens dispensing or aftercare visits, where it was ensured that all participants had clearly been given precise instructions regarding contact lens wear and care. Participants who were prescribed contact lenses for refractive errors correction and have been wearing their lenses for at least one month were interviewed between June and December 2018.
2.2
The questionnaire
Participants were questioned using an interviewer-administered questionnaire. The questionnaire was set according to previous studies aimed to assess levels of compliance among contact lens wearers toward contact lens care [ , , , , ]. The questionnaire was further reviewed by a focus group consisted of four optometrists who are involved in contact lens fitting to ensure ease of understanding and comprehension of the questions when used in Jordanian Arabic variety. The questionnaire was initially administered to fifteen contact lens wearers students in order to check the respondent’s comprehension of the questionnaire questions and the required time to complete it. Responses from this pilot sample were not included in final data analysis of the study. The final questionnaire was administered in an interview form by a trained optometrist who is currently involved in contact lens fitting, and the time needed to answer the questionnaire ranged from 7−11 min.
General demographic information of each participant such as: age, gender, education level and smoking habit were initially obtained. The questionnaire used in this study also includes basic questions related to type of contact lenses worn, modality of contact lenses, contact lens wearing time per day, and contact lens experience in months. The questionnaire includes additional 12 questions that involve modifiable compliant behaviours related to contact lens care, lens case/solution replacement, general hygiene procedures related to contact lens wear and adherence to aftercare visits ( Table 1 ). In all these 12 questions, participants were asked to rate their compliance level in a scale ranging from one to four as illustrated in Table 1 , with lower score scales indicating better levels of compliance i.e. one being total compliance and four being total non-compliance. For statistical purposes, scores 1 and 2 were considered as complaint and three and four were considered as non-compliant according to previous studies by Yung et al. [ ] and Sapkota [ ].
| Behaviours | Score 1 | Score 2 | Score 3 | Score 4 |
|---|---|---|---|---|
| Contact lens usage | ||||
| Sharing lenses between users | Rarely | Occasionally | Frequently | Always |
| Sleeping/napping with lenses | Rarely | Occasionally | Frequently | Always |
| Showering/swimming with lenses | Rarely | Occasionally | Frequently | Always |
| Over-use of lenses (longer than recommended replacement schedule) | Rarely | Occasionally | Frequently | Always |
| Contact lens care solution | ||||
| Keeping old solution in lens case (topping up) | Rarely | Occasionally | Frequently | Always |
| Using lens solution after its expiry date | Rarely | Occasionally | Frequently | Always |
| Hand/lens Hygiene | ||||
| Hand-Washing before lens use | Always | Frequently | Occasionally | Rarely |
| Use of water/saliva to clean lenses | Rarely | Occasionally | Frequently | Always |
| Adherence to instructions of lens cleaning (rub, rinse and soak) | Always | Frequently | Occasionally | Rarely |
| Lens storage case | ||||
| Cleaning and rinsing of lens case | Always | Frequently | Occasionally | Rarely |
| Lens case replacement | Monthly | Every 3 months | Every 6 months | >6 months |
| Adherence to aftercare visit | Always | Frequently | Occasionally | Rarely |
2.3
Ethics approval
The study protocol was approved by the Institutional Review Board (IRB) at Jordan University of Science and Technology (J.U.S.T). The aim of the study and the questions in the questionnaire were explained both verbally and in a written format to all participants. Informed consent was obtained from all participants prior to their participation in the study and the study protocol complied with the guidelines of the declaration of Helsinki.
2.4
Statistical analysis
Data were analysed using the statistical Package for Social Sciences (SPSS) software version 21 (SPSS, International Business Machine Corp. IBM, Chicago, IL, USA). Simple frequencies were calculated and expressed by percentages. Mann-Whitney U test was used to determine demographic and contact lens characteristics factors (e.g. age, gender, type of contact lenses, duration of contact lens wear, wearing hours per day) that associated with non-compliant behaviours. Level of significance was set at p < 0.05 at 95 % level of confidence.
3
Results
3.1
Participants’ demographics
A total of 210 participants were interviewed in the primary eye clinic at Jordan University of Science and Technology. There was 187 (89 %) female and 23 (11 %) male. The average age of participants was 22.35 (±3.772) years with a range of 18–39 years. Of the study population 182 (86.7 %) were undergraduate students and 28 (13.3 %) were postgraduate students. Table 2 shows demographic characteristics of the study population.
| Characteristics | N (%) |
|---|---|
| Age | |
| 18-25 | 182 (86.7) |
| 26-35 | 25 (11.9) |
| 36-45 | 3 (1.4) |
| Gender | |
| Female | 187 (89) |
| Male | 23 (11) |
| Education | |
| Undergraduate | 182 (86.7) |
| Postgraduate | 28 (13.3) |
| Smoking | |
| Yes | 50 (23.8) |
| No | 160 (76.2) |
3.2
Contact lens wear profile
All participants reported contact lens wear experience with a range of 1 month to 120 months and an average lens wear history of 17.7 (± 22) months. Table 3 presents information related to contact lens wear profile of the study population.
| Information | N (%) |
|---|---|
| Contact lens wear modality | |
| Daily disposable wear | 61 (29) |
| Monthly replacement | 105 (50) |
| 3-6 months | 31(15) |
| Yearly replacement | 13 (6) |
| Type of contact lenses | |
| Soft spherical | 182 (86.7) |
| Soft toric | 17 (8.1) |
| Gas permeable | 11 (5.2) |
| Contact lens experience | |
| ≤12 months | 142 (67.6) |
| 13-24 months | 24 (11.4) |
| 25-36 months | 18 (8.6) |
| ≥37 months | 26 (12.4) |
| Contact lens wearing time per day | |
| 5-7 hours | 121 (57.6) |
| 8−12 hours | 75 (35.7) |
| More than 12 hours | 14 (6.7) |
| Contact lens care system | |
| Multipurpose contact lens solution | 199 (94.8) |
| Hydrogen peroxide | 2 (0.90) |
| Saline | 9 (4.3) |
| Contact lens purchase | |
| Eye care practitioner (ECP) | 201 (95.7) |
| Via Internet | 9 (4.3) |
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