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No Water Stickers Effective to Reduce Ocular Infections

A ‘no-water’ infographic, adhered to contact lens cases, is an effective mechanism to educate and remind patients of the dangers of exposing contact lenses to water, according to a new study from University of New South Wales School of Optometry and Vision Sciences.

It is well known that water exposure is associated with contact lens disease including microbial keratitis and sterile corneal infiltrates. Yet despite this, water contact is common, with wearers handling contact lenses with wet hands, showering or swimming in contact lenses, or using water to rinse their lenses and/or storage cases.

The prospective, masked, randomised controlled trial study, by Memoona Arshad, Dr Nicole Carnt, Dr Jacqueline Tan and Professor Fiona Stapleton, looked at these behaviours and examined whether providing a visual reminder on their storage cases as a prompt to avoid water could change behaviour.

Two hundred daily lens wearers were randomised to either receive a storage case with a ‘no-water’ sticker (test) or without a ‘no-water’ sticker (control). Both groups received written compliance information. Participants completed a self-administered lens hygiene questionnaire at baseline and after six weeks.

A ‘no-water’ infographic is an effective mechanism to educate and remind patients of the dangers of exposing contact lenses to water

Microbial analysis of used storage cases, collected at both study visits, was conducted using ATP and limulus amebocyte lysate (LAL) assays for overall microbial contamination and endotoxin levels, respectively. A one-way ANCOVA and multiple logistic regression determined the change in water-contact behaviours and storage case contamination over time.

Of the 200 participants, 188 lens wearers (95 test and 93 control participants) completed both study visits comprising 128 females and 60 males; average age 29 ± 13 (range 18–78 years).

The researchers found that after six weeks, endotoxin levels reduced significantly in the test group compared with the control group (p < 0.05). Additionally, they found that ‘no-water’ lens case stickers improved overall water-contact behaviours. They reported that further refining the messaging may be beneficial in future to improve other aspects of compliance.

Speaking of the study, Dr Carnt said, “this is an exciting development, as this simple and cost effective intervention can improve behaviour and lower water bourne case contaminants. The concept, devised by a patient with a severe eye infection, has the potential to save vision through the novel application of a safety messaging system that we are familiar with in daily life.”

Dr Carnt, as Chair of the Australian Standards committee for contact lenses and International Standards Organisation (ISO) expert said, “we are thrilled to see it included as part of an ISO series of safety symbols to undergo further consumer testing.”

The hope is that it is becomes a standard printed warning on contact lens paraphernalia. For now, optometrists can purchase the stickers from the Cornea & Contact Lens Society of Australia.