Purpose

This study was designed to establish risk factors for the development of Acanthamoeba keratitis (AK) for daily disposable (DD) contact lens (CL) users compared with daily wear (DW) reusable lens users and for risks unique to DD users. This is important because, in many major economies, CL use is the principal cause of microbial keratitis, of which AK accounts for approximately 50% of cases with sight loss. Determining these AK risks informs practitioner advice and consumer behavior.

Design

Case–control study.

Participants

Cases and controls were recruited from an Accident and Emergency Department serving South-East England. Cases were new CL users with AK recruited retrospectively from January 2011 to February 2013 and prospectively thereafter until August 2014. Controls were recruited prospectively from February 2014 to June 2015.

Methods

Analysis of a self-administered questionnaire.

Main Outcome Measures

Independent risk factors and population attributable risk percentage (PAR%) for AK.

Results

A total of 83 AK cases and 122 controls were recruited; DD use was reported by 20 (24%) cases and 66 (54%) controls. In multivariable analyses adjusted for potential confounders, the odds of AK was higher for DW reusable soft lenses (odds ratio [OR], 3.84; 95% confidence interval [CI], 1.75–8.43) and rigid lenses (OR, 4.56; 95% CI, 1.03–20.19) than for DD lenses. Within the DD-using subset, AK was associated with the following modifiable risk factors: less frequent professional follow-up visits (OR, 10.12; 95% CI, 5.01–20.46); showering in lenses (OR, 3.29, 95% CI, 1.17–9.23); lens reuse (OR, 5.41; 95% CI, 1.55–18.89); and overnight wear (OR, 3.93; 95% CI, 1.15–13.46). The PAR% estimated that 30% to 62% of cases could be prevented by switching from reusable soft lens to DD lens use.

Conclusions

Acanthamoeba keratitis risks are increased > threefold in DW reusable lens users versus DD lens use. Acanthamoeba keratitis risks for DD lens users can be minimized by adherence to safe use guidelines (no reuse, overnight wear, or contamination by water). Safe CL use can be improved by increasing the prominence of risk avoidance information from manufacturers and regulators. Because AK accounts for half of severe keratitis in CL users, these measures can be expected to have public health benefits.

中文翻译：

---

日常佩戴隐形眼镜使用者的棘阿米巴角膜炎危险因素

目的

本研究旨在确定日抛 (DD) 隐形眼镜 (CL) 用户与日戴 (DW) 可重复使用镜片用户相比发生棘阿米巴角膜炎 (AK) 的风险因素，以及 DD 用户独有的风险。这很重要，因为在许多主要经济体中，使用 CL 是微生物性角膜炎的主要原因，其中 AK 约占视力丧失病例的 50%。确定这些 AK 风险可为从业者的建议和消费者行为提供信息。

设计

病例对照研究。

参加者

病例和对照是从服务于英格兰东南部的事故和急诊部门招募的。案例是 2011 年 1 月至 2013 年 2 月回顾性招募 AK 的新 CL 用户，此后直至 2014 年 8 月前瞻性招募。对照组是 2014 年 2 月至 2015 年 6 月前瞻性招募的。

方法

自填问卷分析。

主要观察指标

AK 的独立风险因素和人群归因风险百分比 (PAR%)。

结果

共招募了 83 个 AK 病例和 122 个对照；20 例 (24%) 病例和 66 例 (54%) 对照报告使用 DD。在针对潜在混杂因素调整的多变量分析中，DW 可重复使用软镜片（优势比 [OR]，3.84；95% 置信区间 [CI]，1.75–8.43）和硬质镜片（OR，4.56；95%）的 AK 几率更高CI, 1.03–20.19) 高于 DD 镜头。在使用 DD 的子集中，AK 与以下可改变的风险因素相关：专业随访频率较低（OR，10.12；95% CI，5.01–20.46）；戴镜片淋浴（OR, 3.29, 95% CI, 1.17–9.23）；镜片重复使用（OR，5.41；95% CI，1.55–18.89）；和夜间佩戴（OR，3.93；95% CI，1.15–13.46）。PAR% 估计 30% 到 62% 的病例可以通过从可重复使用的软镜片切换到使用 DD 镜片来预防。

结论

与使用 DD 镜片相比，DW 可重复使用镜片用户的棘阿米巴角膜炎风险增加了 > 三倍。遵守安全使用指南（不得重复使用、过夜佩戴或被水污染）可以将 DD 镜片使用者的棘阿米巴角膜炎风险降至最低。通过增加来自制造商和监管机构的风险规避信息的重要性，可以提高 CL 的安全使用。由于 AK 占 CL 使用者严重角膜炎的一半，因此这些措施有望带来公共卫生益处。