Sudanese Journal of Ophthalmology

: 2016  |  Volume : 8  |  Issue : 1  |  Page : 14--19

Prevalence of contact lens-related complications among wearers in Saudi Arabia

Yousef Homood Aldebasi1, Muhammad Ijaz Ahmad2, Manzoor Ahmad Qureshi3, Salah Mesalhy Aly4,  
1 Department of Optometry, College of Applied Medical Sciences, Qassim University, Kingdom of Saudi Arabia
2 Department of Optometry, College of Applied Medical Sciences, Qassim University, Kingdom of Saudi Arabia; Department of Ophthalmology, Allied Hospital, Punjab Medical College, Faisalabad, Pakistan
3 Department of Optometry, College of Applied Medical Sciences, Qassim University, Kingdom of Saudi Arabia; Department of Ophthalmology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
4 Department of Pathology, College of Veterinary Medicine, Suez Canal University, Ismailia, Egypt

Correspondence Address:
Muhammad Ijaz Ahmad
Department of Optometry, College of Applied Medical Sciences, Qassim University


Purpose: To study the compliance of contact lens (CL) wearers and the prevalence of CL-related ocular complications. Materials and Methods: This was a cross-sectional study conducted from December 2012 to May 2013 which included CL wearers coming to outpatient department or emergency department where these patients underwent ophthalmic examination. An interview was performed about the use and care of CLs. Results: The study included 102 patients, where 26 (25.50%) were men and 76 (74.50%) were women. Patient's ages ranged from 13 to 55 with an average (mean ± standard deviation) 29.48 years. Results showed myopia in 41 (40.19%), hyperopia 13 (12.74%), astigmatism 37 (36.27%), keratoconus 8 (7.84%), and others 3 (2.94%). More than 2/3 of the patients had, at least, one complication in their eyes. The average complication rate of gas permeable (GP) lenses was significantly (P < 0.04) lower than soft CLs (SCLs) (0.75). The most common complications were papillae, giant papillary conjunctivitis, conjunctival injection, corneal infiltrates, and corneal abrasions in both GPs and SCLs wearers. Silicone SCLs had a lower average number of complication rates per eye (0.73) than nonsilicone SCLs (0.76), but the difference was not statistically significant (P = 0.19). Extended wear CL use was associated with higher complication rate (86.84%) as compared to daily wear CL use (67.85%) and it was statistically significant (P < 0.03). Conclusion: Use of CL is associated with ocular complications. Most of these complications are minor and easily manageable. It is advised that patients should adhere with the recommendations of both manufacturer and optometrist to avoid complications.

How to cite this article:
Aldebasi YH, Ahmad MI, Qureshi MA, Aly SM. Prevalence of contact lens-related complications among wearers in Saudi Arabia.Sudanese J Ophthalmol 2016;8:14-19

How to cite this URL:
Aldebasi YH, Ahmad MI, Qureshi MA, Aly SM. Prevalence of contact lens-related complications among wearers in Saudi Arabia. Sudanese J Ophthalmol [serial online] 2016 [cited 2023 Apr 1 ];8:14-19
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Full Text


Throughout the world, the number of contact lens (CL) wearers is estimated close to 125 million and approximately 38 million people use the CL in the United States.[1] CL complications will remain important part of ophthalmic and optometric practice as long as they are used for correction of different refractive errors. Good patient compliance with the use of CL is very important to avoid the CL-related ocular complications and can be defined as the adherence of the CL wearer to instructions recommended by the eye care practitioner and the manufacturers of the CLs for lens care.

Lack of compliance with the instructions for the use of CLs is common among the users. It is difficult to establish the true level of compliance because there is no direct quantitative measure of compliance. Many studies worldwide have been conducted to evaluate compliance using different self-reported written questionnaires, which have shown estimates of noncompliance ranging from 40% to 91%.[2],[3],[4],[5],[6],[7]

Recently, a study conducted in the United Kingdom for daily lens wearers, where only 0.3% of patients were fully compliant compared with 2.7% for extended lens wearers.[8] These studies have also reported many patients do not know that their CL wear and care practices are reflective of a noncompliant behavior.[2],[9] Despite the introduction of daily disposable lenses and one-step “no-rub” multipurpose disinfecting solutions, compliance with CL still remains a clinical issue.

Care of CLs, its material, durability, wearing schedule, and many other factors play an important part in causing ocular complications. The prevalence of CL-related ocular complications has been reported to be as high as 39%.[10],[11],[12]

Noncompliance with CL care has been associated with CL-related complications. There is a significant need to enhance compliance but the strategies to effectively enhance the compliance are limited.

The purpose of this study is to evaluate compliance of CL wearers and the prevalence of CL-related complications beside their association with type of CLs, wears schedules and other care systems.

 Materials and Methods

Ethical approval for this study was primarily obtained from Ethical and Research Committee of Deanship of Scientific Research, Qassim University, Kingdom of Saudi Arabia.

This was a cross-sectional study conducted during December 2012 to May 2013 in collaboration with King Fahd Specialist Hospital Buraidah, which is a tertiary care hospital in Qassim Province. Patients coming to outpatient department (OPD) or emergency department either directly or referred from peripheral basic health units or ophthalmologists were included in this research. One-hundred and two patients received in the emergency/OPD ranging from 13 to 55 years were included in the study. The category of lenses was defined as nonsilicone soft CLs (SCL) and silicone CLs. An informed consent was taken from every patient. Each CL wearer was interviewed to collect the detailed information about the use of CLs. Type of CL, duration of use, wearing time and schedule, duration of lens use during the day and other information related to care system were collected. Patients suffering from CL-related problems underwent ophthalmic examination. Complete interview was performed to assess the level of compliance.

The data were collected from the subject's examination and included visual acuity of each eye (with or without CLs), refractive errors, best corrected visual acuity, type of CLs worn, lens care system used, and wear schedule. Data were collected on the following complications commonly associated with CL wear: Giant papillary conjuctivitis (GPC), injection of the conjunctiva, chemosis of the conjuctiva, papillae, follicles, other conjunctival complications, corneal abrasion, corneal edema, corneal infiltrates, neovascularization of the cornea, diffused superficial punctate keratitis (SPK), localized SPK, corneal ulcer, superior epithelial arcuate lesion, and other corneal complications.

A candidate who used the CLs for a minimum of 8 h a day for a period of 6 months or more was considered as CL wearer.

Wearing schedule was either daily or extended wear. The extended wear was defined as continuous wear of CL without removal for more than 2-3 days; the extended wear classification did not include patients who occasionally napped with their lenses.

Complication rates of CLs were calculated. A P value of 0.05 or less was considered statistically significant. Means and standard deviations (SDs) were also determined. All statistical analyses were run on the computer, using the Statistical Analysis System (SAS) program (SAS 9.3) (SAS Institute, Cary, NC, USA).


This study was carried out on a total of 102 patients waring CLs for various indications during the study from December 2012 to May 2013 where 26 (25.50%) were men and 76 (74.50%) were women. Patients' ages ranged from 13 to 55 years with an average age of 29.48 (mean ± SD) years.

Of the 102 patients who visited the hospital for different reasons, among those 48 (47.05%) came for painful red eye, 33 (27.50%) with decreased visual acuity, 15 (14.70%) CL intolerance and 6 (5.88%) came for follow-up of CL progress evaluation [Figure 1].{Figure 1}

The diagnoses included myopia in 41 (40.19%), hyperopia 13 (12.74%), astigmatism 37 (36.27%), and keratoconus 8 (7.84%) while 3 (2.94%) were undiagnosed cases [Figure 2].{Figure 2}

The examined patients were using silicone and nonsilicone SCLs in 94 (92.15%) while 8 (7.85%) were using gas permeable (GP) lenses [Figure 3].{Figure 3}

Among the 94 patients who used SCLs; 56 (59.57%) were daily wear and 38 (40.43%) were found to be extended wear, but no patients were found to be extended wearer in GP CL users.

The wear schedule of CLs was recorded as, 64 (62.74%) used the CLs in daily wear mode and 38 (40.43%) used the lenses in extended wear mode.

The average number of complications for GP group was 0.50/eye. Out of the eight patients wearing GPs alone, the most common complications were papillae 2 (25%). Others include GPC 1 (12.5%), and diffused SPK 1 (12.5%) [Table 1].{Table 1}

Among the 94 patients using SCLs alone, the average number of complications was 0.75/eye and the most common complications for SCL wearers was conjunctival injection 16 (17.02%). Other complications were recorded such as conjunctival chemosis 11 (11.70%), corneal infiltrates 9 (9.57%), corneal abrasions 8 (8.51%), corneal neovascularization 7 (7.44%), SPK 6 (6.38%), GPC 6 (6.38%), follicles 3 (3.19%), bacterial keratitis 2 (2.12%), bacterial keratitis with hypopyon 2 (2.12%), and corneal ulcer 1 (1.06%) [Table 1].

The complication rate was much higher in extended wear group 37 (97.36%) as compared to daily wear group 34 (60.71%). Some complications as corneal ulcers and bacterial keratitis were exclusively found only in extended wear group.

Out of 94 SCL wearers, 42 were wearing silicone SCLs and 52 were wearing nonsilicone SCLs. Although, no statistically significant difference (P = 0.19), eyes with silicone SCLs had a slightly lower rate of complications than with nonsilicone SCLs. The frequency of specific complications was broadly similar across silicone and nonsilicone SCLs [Table 2].{Table 2}

Regarding the compliance and care of the CLs, it was found among the SCL users 38 (40.83%), sleeping with the CLs showed the highest percentage of complications. Fit thing and prescription of CLs were another important segment, and it was found in our study that 51% of the total cases got the CLs from optician or optical store and remainder almost 49% got from the professional optometrist.

Regarding the compliance with manufacturer recommended replacement frequency (MRRF), 57 (56%) wore their CLs more than the MRRF or optometrist instructions.

Regarding the CL hygiene, 51 (50%) mentioned that they cleaned their CLs cases infrequently and many times with tap water. Related to the cleanliness of lenses 63 (61.76%) told that they did not rub and rinse the lenses daily and also not replacing the solution daily.

The average complication rate for GP lenses (0.50) was lower than for SCLs (0.75) and the difference was statistically significant (P< 0.04).

Silicone SCLs had lower average complication rates (0.73) than nonsilicone SCLs (0.76), but the difference was not statistically significant (P = 0.19).

Extended wear CL use was associated with higher complication rate (86.84/eye) compared to daily wear CL use (67.85/eye) and it was statistically significant (P < 0.03).


The results from this study indicate that more than 50% of CLs wearers were not compliant with the instructions of the manufacturers. It was also detected that about 50% of the users did not consult the professional optometrists for CL usage and purchasing the CLs from optical shops and opticians without professional advice from the optometrists. In this study, different modalities of CL were included, and more than 2/3 of the patients had at least one complication in their eyes. The most common recorded complications were papillae, GPC, conjunctival injection, corneal infiltrates, and corneal abrasions. This high rate of complications is possibly explained by the fact that, large numbers of patients were using the lenses as extended wear mode and showed more complications. Furthermore, the majority of these patients who visited the emergency department for their examination were not as a routine visit, this further explains the possibility of the high rate of complications. A study conducted at the United State of America showed the complication rate in approximately 50% of the cases where the most common encountered complications were GPC, papillae, and neovascularization.[13]

Nagachandrika et al.; (in India) showed the complications in 1/4 of the CL wearers. The most common complications encountered in this study were CL-induced papillary conjunctivitis (6.39%), corneal vascularization (4%), and SPK (3.5%). Patients wearing rigid GP lenses demonstrated fewer complications as compared to SCLs.[14]

Regarding the nature of complications, the current study showed GPC as the most common complication followed by corneal infiltrates, corneal abrasions, and conjunctival papillary response. GPC was more common in GP lenses as compared to SCLs. Above mentioned studies also have shown more or less same type of complications where GPC was particularly more common in these studies.[13],[14] Furthermore, a study conducted in Nepal showed the CL induced papillary conjuctivitis as a major complication in SCL and it was detected in 36.9% of patients. The other complications were SPK in 16.2%, conjuctivitis in 18.2%, meibomian gland dysfunction in 8.6%, CL-induced peripheral ulcer in 4%, corneal vascularization in 3.5%, and microbial keratitis in 3%.[15]

In our previous experimental study conducted in 2010-2011, of the 52% cases of bacterial keratitis, corneal infiltrates were the most common complication found in 48% of the cases followed by corneal abrasions, GPC and corneal vascularization in 8%, 10%, and 6% of the cases, respectively.[16]

In this study, it was observed that the prevalence of complications was less in GP CL wearers as compared to SCL user and difference was statistically significant and the most complication was papillae formation followed by GPC and SPK. Our results are almost consistent with other studies that showing ocular complications were associated with GP CLs.[17],[18],[19]

In this study, it was shown that the prevalence rate was almost similar between silicone SCL wearers and nonsilicone SCL wearers although GPC and chemosis were slightly more prevalent in silico ne SCL wearers possibly because silicone SCL have been shown to have a high rate of lipid deposition.[20],[21]

The extended wear use of CLs was associated with high complication rate in our sample as compared to daily wear and the difference was statistically significant and most common complications detected were corneal infiltrates and bacterial keratitis. This case of bacterial keratitis was further resulted into hypopyon corneal ulcer. Our findings are consistent with many previous studies conducted worldwide and indicate that irrespective of lens type, extended wear is associated with high complication rate particularly corneal infiltrates and bacterial keratitis.[13],[22],[23],[24],[25],[26]

In this study, it was found that more than 50% of wearers purchased their CLs from opticians or optical stores. Regarding the compliance to instructions about 56% used their lens for more period as recommended. In the concern of lens hygiene 50% expressed that they were cleaning the CL case infrequently and also using tap water for this purpose and about 62% mentioned that, they did not rub and rinse their lenses daily and not replacing the solution daily. Our findings are somewhat closer to some recent studies. In a study carried by Dumbleton et al. in (Canada, 2011) also showed that 95% of the users purchased their lenses from professional optometrist but even then the noncompliance was high, it is indicating that purchase source of CLs may not affect the level of compliance, so more work is needed to improve the level of compliance.[27],[28] A study conducted in the United States of America about the compliance of CL wearers showed that compliance was better among those who had extensive discussions with the eye care practitioners about the use of CL.[29]

Another study showed that patients who are less compliant with the instructions for using CLs also had less full eye examination from eye care practitioners.[30]

Eye care practitioners should reinforce the importance of all aspects of lens wear and care with their patients, with the aim of reducing ocular complications. So, it is looking very obvious that extended wear use of CL and noncompliance with instructions always increases the risk to develop ocular complications.


The use of CL is associated with ocular complications regardless lens type or material. The majorities of complications are minor and can be easily managed while others may be severe enough to cause loss of useful vision. Although most of the recorded complications of the current study were neither severe enough nor endangering vision, it is highly advised patients to adhere with the recommendations of the manufacturer or the optometrist and always get the professional management when needed on time.


All the authors are thankful to Deanship of Scientific Research for funding this project.

Financial support and sponsorship

The Research Deanship of Qassim University, Kingdom of Saudi Arabia.

Conflicts of interest

There are no conflicts of interest.


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