Abstract
Purpose: :
To determine the opinion regarding the prescribing practices of bandage contact lenses (BCL) amongst members of the Bowman Club (UK Cornea Society).
Methods: :
In June 2011, followed by a reminder in July, a questionnaire was sent to all 128 members of the Bowman Club. The survey included 19 questions regarding indications, preferred type, methods of insertion, concomitant medication, complications related to BCL use and other questions.
Results: :
The survey was completed anonymously by 52 (40.6%) consultant ophthalmologists either online (88.5%) or by post (11.5%). Indication: The most common indication is pain relief (e.g. bullous keratopathy or recurrent erosion syndrome) by 51 (98%), followed by promotion of epithelial healing (e.g. persistent epithelial defects, recurrent erosion syndrome), by 49 (94.2%) respondants. Furthermore, 43 (82.7%) corneal consultants use BCL for postoperative protection (e.g. following conjunctival/corneal surgery); 40 (76.9%) for apposition of wound edges (e.g. corneal perforation, after suture removal); 38 (73.1%) for mechanical protection of ocular surface (e.g.trichiasis, entropion) and 24 (46.2%) for maintenance of ocular hydration (e.g. dry eye, corneal exposure). Type of BCL: Silicon hydrogel soft contact lens is the most commonly used BCL by 39 (75%) consultants, PureVisionTM being the most frequently used followed by ACUVUE® and NIGHT&DAY®. High-water content hydrogel soft contact lens is used by 29 (55.8%) consultants. Handling of BCL: 39 (75%) consultants insert the BCL manually (e.g. fingertips), 19 (36.5%) with sterile forceps (or equivalent). BCL replacement protocol is at monthly (48.1%) or six-weekly (19.2%) time interval, but varies according to 25 (48.1%) respondants on the underlying diagnosis. Concomitant use of Pharmaceuticals: All consultants use concomitant topical treatment for the underlying condition. 22 (42.3%) usually prescribe prophylactic topical antibiotics such as G. Chloramphenicol (95.5%). Complications: Infected corneal ulcer secondary to BCL use is reported by 67.3% consultants (1-3 ulcers/year by 48.1%, 4-6 by 15.4%, and >10 by 3.8%).
Conclusions: :
This is the first survey on practice pattern of BCL use amongst consultant ophthalmologists with a subspecialty in cornea in the UK. It demonstrates that the most common indication for BCL use is pain relief, with silicone hydrogel soft contact lenses being the most frequently used. A high incidence of secondary corneal ulcers per year is reported, but topical prophylactic antibiotic management is only used by 42.3% consultants and 67.3% report non-sterile BCL insertion technique. Therefore, we recommend a review of BCL practice including sterile lens insertion using forceps and the use of prophylactic topical antibiotic.
Keywords: contact lens • cornea: clinical science • keratitis