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R. L. Chalmers, H. Wagner, G. Mitchell, M. E. Jansen, B. Kinoshita, D. Lam, K. L. Richdale, L. Sorbara, CLAY Study Group; Age and Other Risk Factors for Serious & Significant Events With Contact Lens Wear in Youth. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1524.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the risk factors for significant and serious events (CCLRU grid) in soft contact lens (SCL) wearers and to find the lower and upper age at which increased risk abates.
A retrospective chart review of 3,549 SCL patients aged 8 to 33 yrs (+8.00 to -12.00D CL powers and over-sampling < 17 yrs) recorded all clinical visits and scanned records for any events from January 2006 to Fall 2009. Age, health history, CL power, brand, yrs of wear, replacement, extended wear (EW), care system (LCP), slit lamp findings were noted for all visits. All events were adjudicated by reviewers masked to identifiers, age, CL brand and power; serious and significant events later adjudicated to consensus by an expert panel. Significant univariate risk factors were tested by a multivariate survival analysis model.
Review of 14,327 visits and 4,642 yrs of follow-up yielded 187 events in 159 wearers (8 MK, 41 CLPU, 27 CLARE, 110 IK and 1 Iritis). Unadjusted risk peaked between age 15-25 yrs; 1.9% of visits in that age group, with lower risk <15 yrs 0.9% and >25 yrs 1.1% (Chi-square 16.3, p<0.001). By univariate analysis, EW, CL material group, replacement schedule (daily disposable protective) and use of multi-purpose (MPS) LCPs were all significant factors (all p<0.004). By multivariate analysis, EW (2.5X, 1.6, 3.7), and MPS LCP use (2.9X, 1.1, 7.8) were significantly associated with these events.
Extended wear of SCLs and use of MPS LCPs play a critical role in the development of serious and significant events with SCL wear. In this post-market observational study, use of SCLs in young patients aged 8 to 13 was associated with low risk of corneal infiltrative events or infections compared to teen and young adult patients. Soft CLs appear to be an acceptable method to deliver appropriate optics to manage refractive error in children.
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