title: The effect of daily lens replacement during overnight wear on ocular adverse events.
abstract: OBJECTIVE
  Compared with daily disposable wear schedule, continuous wear (CW) or extended wear of contact lenses has been associated with an increased risk of developing an ocular infection. Proof-of-principle studies were conducted to investigate the impact of daily replacement of lenses on the rate of contact lens-related ocular adverse events (AEs) during 30-night CW.
  
  
  METHODS
  A total of 215 subjects were dispensed with silicone hydrogel lenses on a 30-night CW schedule but replaced lenses daily either each night before sleeping (n = 178 eyes) or each morning after waking (n = 252 eyes). Scheduled clinic visits were conducted at 1 week and 1 month. Neophytes were required to complete 1 week of daily wear before commencing CW. A historical control (n = 191 eyes) using the same site, subject demographics, and visit schedule but monthly lens replacement was used for AE rates.
  
  
  RESULTS
  Logistic regression analysis showed a significant reduction in mechanical AEs (0.8 vs 5.2%, p = 0.01) and overall AEs (inflammatory and mechanical events) (4.0 vs 8.9%, p = 0.04) when lenses were replaced each morning compared with being replaced monthly. Estimation of handling-related lens contamination of unworn lenses in a subgroup of subjects showed isolation of Staphylococcus aureus from the lenses of 35% of subjects, and 65% of subjects had more than 1000 colony-forming units per lens of gram-positive bacterial contamination.
  
  
  CONCLUSIONS
  Morning lens replacement during CW reduced mechanical and overall ocular AEs. Replacing lenses at night had no beneficial effects perhaps because the benefit of a fresh lens at night might be partially negated by contamination of the contact lens caused by lens handling before overnight eye closure. Contact lens wearers on an extended wear or CW schedule should be advised to minimize lens handling before sleep to reduce the risk of complications.
authors.affiliation: Brien Holden Vision Institute, Sydney, New South Wales, Australia. j.ozkan@brienholdenvision.org
authors.forename: Jerome
authors.initials: J
authors.lastname: Ozkan
authors.forename: Mark D P
authors.initials: MD
authors.lastname: Willcox
authors.forename: Percy Lazon
authors.initials: PL
authors.lastname: de la Jara
authors.forename: Preeji S
authors.initials: PS
authors.lastname: Mandathara
authors.forename: Varsha M
authors.initials: VM
authors.lastname: Rathi
authors.forename: Varghese
authors.initials: V
authors.lastname: Thomas
authors.forename: Brien A
authors.initials: BA
authors.lastname: Holden
mesh_terms: D015169:Colony Count, Microbial; D003262:Contact Lenses, Extended-Wear / Q000009:adverse effects* / Q000382:microbiology*; D004209:Disposable Equipment; D015818:Eye Infections, Bacterial / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000254:growth & development*; D055815:Young Adult