Asymptomatic contact lens wearers may have undiagnosed eye disease and contact lens wear-related complications and may benefit from routine screening.
Contact lens wear complications may be vision threatening, as in a corneal infection, or may be mild but insidious, such as eye dryness. (Image source)
Contact lenses are usually an aesthetic choice for correcting vision compared to glasses. In a population-based survey in 2015, it was shown that 40.9 M persons in the United States who were over the age of 18 years wore contact lenses, and 90.3% of them wore soft contact lenses. The survey also showed that 99% of them had at least one risky behavior that may lead to contact lens complications. Risky behavior included sleeping overnight in contacts, storing lenses in tap water, and showering and swimming with contact lenses on .
These risky behaviors are associated with contact lens use complications, the most important of which is microbial keratitis (infection and inflammation of the cornea). However, there are also complications that are not immediately vision threatening but can, over time, lead to extreme discomfort and some vision loss and disability.
This study hypothesizes that adults who wear contact lenses are not evaluated sufficiently prior to prescription renewal; hence, this is a missed opportunity to examine the eyes for new ocular diseases, whether driven by contact lenses or no. It was also an opportunity to address issues in contact lens fit and care compliance .
In this prospective study, asymptomatic patients who wore soft contact lenses and consulted at the University Eye Center at Ketchum Health (Anaheim, CA) and the Eye and Vision Center at the Massachusetts College of Pharmacy and Health Sciences (Worcester, MA) for routine contact lens comprehensive exams to renew existing contact lens prescriptions were professionally evaluated and their complications documented. Patients who had less than 1 year of contact lens use, as well as previous known ocular disease, were excluded from the study .
From these criteria, a total of 202 subjects were recruited. More than half of the patients (52%, 105 patients) had at least one undiagnosed complication. Of these patients, 70% had contact lens driven complications, 54% had non-contact lens driven eye disease (glaucoma, retina and optic nerve diseases), and 4% possibly had undiagnosed systemic disease (i.e. hypertension, diabetes) and would benefit from referral for medical workup .
Contact lens-related complications included conjunctivitis, peripheral ulcers, corneal edema, scarring, and staining, neovascularization, and endothelial polymegathism. Lens fit problems identified included discrepancies in optical power and curvature, while patients did not adhere to care recommendations, including overwear limits and handwashing. The study also noted that the prevalence of complications increased to 72% overall if issues in contact lens fit and care both existed .
In conclusion, because these undiagnosed diseases and complications were seen in patients who were asymptomatic, the study recommended that contact lens wearers should receive routine professional evaluations and screening eye examinations for prompt diagnosis and timely care, if necessary .
 Cope J, Collier S, Rao M et al. Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections – United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(32):865-870. doi:10.15585/mmwr.mm6432a2
 Chen E, Myung Lee E, Loc-Nguyen A, Frank L, Parsons Malloy J, Weissman B. Value of routine evaluation in asymptomatic soft contact lens wearers. Contact Lens and Anterior Eye. 2020;43(5):484-488. doi:10.1016/j.clae.2020.02.014