Multicenter Case-Control Study of the Role of Lens Materials and Care Products on the Development of Corneal Infiltrates

Purpose. To evaluate the association of symptomatic soft contact lens (SCL)-related corneal infiltrative events (CIEs) with SCL material, lens care products (LCPs), and other risk factors. Methods. Cases with symptomatic CIEs were identified in a retrospective, multicenter case-control study at five academic eye care centers. Each case was matched to three controls each who had received eye care near the time of the case's last full examination at that center but were not matched for demographic or other factors. Infiltrate status was established by an expert panel who were masked to sponsor, SCL, and LCP brand. Stratified analyses were conducted removing all daily disposable (DD) and all extended wear (EW) cases. Results. Clinical records from 166 patients with symptomatic CIEs and known EW status were included. Cases used >50 SCL brands and >10 LCP brands. Increased risk in univariate analysis for LCP was not significant after adjustment for other factors. In the multivariate analysis of all cases, use of reusable SCLs (4.03X; 95% C.I. 1.12 to 14.67) and EW (3.98X; 2.32 to 6.84) increased risk and patient age (per year older) was protective (0.96X; 0.94 to 0.98). Among daily wear cases (n = 102 cases), use of reusable SCLs (12.46X; 1.54 to 100.62) and silicone hydrogel (SiHy) (1.99X; 1.06 to 3.75) and age (0.95X: 0.92 to 0.97) were associated. Without DD cases (n = 162), EW (4.42X; 2.53 to 7.70), SiHy use (1.84X; 1.03 to 3.29), and patient age (0.96X 0.94 to 0.98) were significant factors. No specific SCL or LCP brands were associated with increased risk. Conclusions. In this community-based trial, younger patients were at increased risk of infiltrative events. DD lenses were protective relative to reusable lenses. Overnight use increased risk in all analyses and silicone hydrogels increased risk in daily wearers, regardless of LCP brand. Improvements in lens storage case hygiene and environment may be a mechanism for reducing risk of CIEs related to SCL use. (Optom Vis Sci 2012;89:316-325)