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  Table of Contents 
ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 9  |  Page : 1350-1359

Adolescents' Usage and Attitude Toward Contact Lenses: A Descriptive Study In Saudi Arabia


Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia

Date of Submission22-Apr-2020
Date of Acceptance12-Jan-2021
Date of Web Publication16-Sep-2021

Correspondence Address:
Dr. A M AlSaqr
Associate Professor, King Saud University, Riyadh - 12372
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_202_20

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   Abstract 


Aims: The aim of this study was to explore adolescents' (11–20 years) usage of, beliefs in, attitudes toward, and barriers to contact lens use in Riyadh, Saudi Arabia. Method: The study recruited 1252 healthy participants from 20 highly populated schools. The schools were selected at random from middle and high schools in Riyadh. A self-administered contact lens questionnaire was used directed towards glasses usage and contact lens knowledge, usage, attitudes, and barriers. Result: A total of 726 of the 1252 participants had refractive errors, and 47% of those wore glasses. The proportion of non-compliance was 24%. One of the main reasons of non-compliance was cosmetic appearance (26%). Fewer than 10% were offered contact lenses for refractive error correction. One hundred and fifty-nine participants used contact lenses, and most obtained them without proper professional consultation. About 90% of contact lens-wearing participants did not sleep with the lenses and about 50% had no complications wearing them. Conclusion: The percentage of contact lens users was relatively low. A substantial number of older adolescents and females were found to wear contact lenses, although without proper professional consultation. Knowledge of and attitudes toward contact lenses among adolescents were in acceptable levels. These results gave indications that contact lens usage in adolescents can be achievable and valuable for refractive error correction, especially for those who are non-compliant with glasses.

Keywords: Adolescents, contact lens use, eye care practitioners, refractive error, Saudi Arabia


How to cite this article:
AlSaqr A M, Al-Zahrani H A, Alghamdi S K. Adolescents' Usage and Attitude Toward Contact Lenses: A Descriptive Study In Saudi Arabia. Niger J Clin Pract 2021;24:1350-9

How to cite this URL:
AlSaqr A M, Al-Zahrani H A, Alghamdi S K. Adolescents' Usage and Attitude Toward Contact Lenses: A Descriptive Study In Saudi Arabia. Niger J Clin Pract [serial online] 2021 [cited 2022 Nov 29];24:1350-9. Available from: https://www.njcponline.com/text.asp?2021/24/9/1350/325908




   Introduction Top


Refractive errors are a global problem.[1],[2] Uncorrected refractive errors are considered a serious vision problem, and if left untreated could cause visual impairment or corrective visual impairment.[2],[3],[4] This disorder could affect the educational performance of children and adolescents and/or performance in their future occupation.[2],[5] The most common type of refractive error is myopia.[6]

There are several approaches for correcting refractive error including refractive surgeries, glasses, and contact lenses. The use of glasses comes with challenges of non-compliance, and this ranges from 20% to 60%.[7],[8],[9],[10],[11],[12] The main reasons for non-compliance were parental disapproval of wearing glasses and unwillingness to wear glasses due to concerns about their appearance or teasing.

Despite the high success rate of refractive surgeries, contact lenses continue to be a good modality to overcome this disorder. Soft contact lenses are more common, as they are comfortable, disposable, and easy to fit.[13],[14] Wearing contact lenses has many benefits, including a better visual field and more freedom, but may sometimes lead to vision problems and complications,[15] which include inflammatory, hypoxic, and infectious complications.[16] Previous studies have shown that soft contact lenses are more susceptible to bacterial adhesion and penetration, which could lead to more infectious complications.[17],[18],[19] However, in a study reviewing the safety of soft contact lenses in children (7 to 19 years),[20] the authors concluded that the percentage of corneal infiltrative events in children is no larger than in adults, and in younger participants (8 to 11 years) it might be markedly lower. A study from India found that instances of contact lenses complications rose with increased wearing duration, that the incidence of contact lenses complications was higher among soft contact lenses wearers compared to hard contact lenses wearers, and that the most common complication was giant papillary conjunctivitis.[15] The incidence of problems associated with contact lenses wear within the first 6 months of use is 0.9% for soft daily-wear contact lenses and 0.8% for rigid contact lenses.[21]

A previous study investigated adolescent beliefs and attitudes toward contact lenses.[22] About 63% of participants used glasses, and about 30% used contact lenses. Parental attitudes differ from adolescent attitudes, in that parents are more conservative toward the use of contact lenses and adolescents were more motivated to use contact lenses. In a study from Spain and Portugal on contact lenses use, about 88% wore glasses, but none of them used contact lenses.[22] About 77% expressed high interest in wearing contact lenses. Adolescents suggested that contact lenses provide comfort, confidence, and ease of movement. However, they were concerned about the difficulty of inserting contact lenses, discomfort, and potential damage to the eye. Parents had similar concerns, although they were willing to satisfy their teenager's request for contact lenses. Another study conducted a survey in 2013 on 1466 female students in 3 universities,[23] where 70% of them wore contact lenses. Their main reasons were cosmetic (63%) and for refractive error correction (19%). Only 61% of these participants got contact lenses after visiting an optometrist, and 39% of them had not had an eye examination.

Many parents disapprove of glasses, and many children do not like their appearance with them.[7] Therefore, contact lenses usage might be a better option for them as contact lenses are associated with higher self-esteem.[24],[25],[26] Furthermore, it has been suggested that contact lenses wearers had greater self-perceptions of physical appearance, athletic competence, and social acceptance.[26],[27]

Studies on contact lenses usage and barriers to their use in Saudi Arabia are scarce. This study aims to identify beliefs, attitudes, and concerns toward contact lenses usage for correcting refractive error among adolescent students and their related complications. The study would also estimate the prevalence of contact lenses use in Riyadh.


   Methods Top


Approval was obtained from the institutional ethical board, the Ministry of Education, and the school headmasters, and the tenets of the Declaration of Helsinki were followed. Self-informed consent was obtained, and the aims of the study were fully described to participants. Parental permission and participant consent was collected from all participants younger than 18 years.

This was a qualitative cross-sectional population-based study conducted on a sample of middle and high school students aged 11 to 21 years. The study design, sample calculation methodology, and visual function results were previously described.[12] Any student with a history of ocular disorder or systemic disease was excluded and was recommended to visit a specialized center. This study included healthy participants from 20 highly populated schools randomly selected from middle and high schools in Riyadh. Adolescents with unknown visual status were examined by another group.[12] The data was collected using self-administered contact lens questionnaire regarding glasses usage and contact lens knowledge, usage, attitude, and barriers [Table 1].
Table 1: The contact lens survey directed toward the respondents in Arabic

Click here to view



   Results Top


A total of 1252 participants were recruited with a response rate of 70%. The remaining questionnaires were not returned or were returned unanswered. Participants were aged 11 to 21 years (median IQR = 16[3] years), with 655 females (52%) and 597 males (48%). Further, 598 participants (48%) were from 11 – 15 years and 654 participants (52%) were from 16 – 21 years. Overall, 726 (58%, 385 females and 341 males) participants had refractive error, 40.8% of the participants were emmetropic, and 1.2% had unknown visual status. Those with unknown visual status were excluded from further analysis. Out of the 726 participants, 53% of them were myopic, more details can be obtained from previously published data.[12]

Visual status and glasses compliance

Less than half of participants with refractive error used glasses (47%, 343 out of 726). The females used the glasses more than the males [Table 2]. Further, the older participants also used the glasses more than the younger participants did [Table 2]. Among 343 participants who wore glasses, 47 participants (13.6%) had worn them for less than 1 year, 223 participants (65%) for 1-6 years, 55 participants (16%) for 7-12 years, and 4 participants (1%) for more than 12 years. The proportion of glasses wear compliance was explored. Of the participants who wore glasses, 248 were compliant (73%). Almost one-fourth of the participants did not wear the glasses prescribed for them (79 participants; 24%). Males were more compliant than females [Table 2]. The compliance rate was similar in both group of age [Table 2].
Table 2: Summary of the survey responses based on the age and gender group

Click here to view


The 79 non-compliant participants reported that the reasons for non-compliance included concerns about cosmetic appearance (26%), discomfort (25%), broken glasses (8%), and having headaches while wearing glasses (7%). In addition, 13% of participants reported that they did not need correction because their vision became better. About 19% of participants reported that they had no specific reasons. Other reasons for non-compliance included becoming bored of wearing glasses and not being used to them.

Regarding daily usage of glasses in compliant wearers, 11 participants (5%) used glasses for 1-5 hours, 60 participants (26%) for 5-12 hours, and 159 participants (69%) for more than 12 hours. In both older and younger group, about two third of the participants (68%) used the glasses for more than 12 hours.

Contact lens use, attitudes, and beliefs

When participants with refractive error were asked if the contact lens as alternative tool for correcting refractive error was introduced, only 70 (9.5%) answered positively. Between gender, 14 males and 56 females were offered contact lens. Most of the offered contact lens was toward participants between the age of 16 – 21 years old (85%, 59 out of 70). The Ophthalmologist offered the contact lens more than the Optometrist [Table 3]. The optical store was the main place for offering contact lens to participants [Table 3].
Table 3: Summary of the responses of whom and where the CL was offered

Click here to view


Even with the low rate of prescription of contact lenses by eye care professionals, A total of 159 participants have used contact lens; 128 participants (80%) where over 16 years and 31 participants were less than 15 years in age. The vast majority of those where females (156 females compared to 3 males). Furthermore, 153 females (98.1%) used soft contact lens and one female (0.60%) did not specify the type of contact lens. Among the 156 female contact lens users, 111 (71.2%) used monthly contact lens, 23 (14.7%) used daily disposable contact lens, 16 (10.3%) used weekly contact lens. The three males reported that they used soft daily disposable contact lens.

In the contact lens group, 50% of the older group used the contact lens for more than one year, while in the younger group only 25% used them for same period [Table 4]. Among female contact lens users, 48% used the contact lens for more than one year [Table 4]. In the males' group, one used contact lens for less than 6 months and the other 2 had been using them for 6 months to one year. Regarding the daily usage enquiry, the majority of the participants used the contact lens less than 12 hours per day [Table 4]. When asked for their weekly contact lens usage, the majority (67-70%) wore contact lens for 1-3 days [Table 4]. In addition, participants were asked whether they taught how to use and take care of the contact lens. About 40% of the participants were not instructed how to use and/or take care of the contact lens [Table 2].
Table 4: Summary of the survey responses age and gender based

Click here to view


In the older and younger group, the main reasons for using contact lens were cosmetic and correcting the refractive error (60% and 20%, respectively). Among female contact lens users, 98 female (62%) reported cosmetic purposes, 20 female (13%) wore them for refractive error correction, 36 (23%) for both corrective and cosmetic purposes. Two males reported that they used them for corrective and cosmetic purposes and one for correction of refractive error. Concerning contact lens prescription, 70% of the younger and older group knew their prescription. Further, 114 females (73.1%) also knew their prescription. Two males said they knew their prescription.

Concerning contact lens solution, the older and younger group responses spread across the choices provided, although 40% of the older group changes the solution with new contact lens [Table 4]. In the female group, having solution every month and with new contact lens was corresponding to 68% of their responses [Table 4]. About 50% of the older group change the contact lens case with new ones [Table 4]. While the younger group responses spread across the choices provided. The majority of the older and younger participants did not sleep with the contact lens (86% and 77%, respectively) [Table 2]. Further, 89% of the female and all three males did not sleep with the contact lens [Table 2]. The participants reported that they had complications or have them sometimes in more than 50% of the responses [Table 2].


   Discussion Top


Several studies have showed that refractive error is a leading cause of visual impairment.[12],[28],[29] Uncorrected refractive error is a leading cause of correctable vision impairment, affecting individuals' education, self-confidence, and quality of life, and can cause economic burdens.[2],[30],[31] Compliance with use of glasses is a major challenge in managing refractive errors.[7],[8],[9] To our knowledge, there are no studies investigating adolescents use of contact lens in Saudi Arabia or their potential to correct refractive error as an alternative to glasses for non-compliant individuals.

There are many reasons for using contact lenses, including refractive error correction, treating certain eye conditions (e.g patching for amblyopia and diplopia, drug delivery for keratopathy), and for cosmetic reasons.[32],[33] contact lenses have many benefits but may lead to some complications,[15] like acute red eye (related to extended-wear lenses), giant papillary conjunctivitis, and microbial keratitis.[34],[35] However, the most common corneal complication is superficial punctate keratitis, caused by care solution, dry eye, or contact lenses over wear.[36] There are many advantages and disadvantages of soft contact lenses. The advantages over glasses include minimal incidence of glare, lower risk of corneal distortion, higher level of comfort, faster adaptation, flexible wearing schedules, no effect on vision quality by lens rotation, and that they are very simple to fit. The disadvantages include a higher risk of bacterial infection, reduced visual acuity in uncorrected astigmatism ≥ 0.75 D, deposit formation, limited durability of soft contact lens, and limited refractive error correction by soft contact lens.[37],[38]

Previous studies suggested that adolescents could benefit more from contact lens than glasses by improving self-esteem and vision-related quality of life.[25],[26],[39] Several studies reported successful contact lens wear among children and adolescents.[40],[41],[42] Additionally, in terms of satisfaction, compliance, and ease of fit, Walline et al. suggested that the results in children aged 12 or younger are comparable to those fitted with lenses as teenagers (aged 13-17).[39]

Specially designed contact lens can change peripheral vision, slowing myopia progression.[43],[44] There is accumulating evidence that contact lens do not cause a significant increase in myopia in children and adolescents.[45],[46],[47] However, more randomized controlled population-based studies are needed to show that contact lens are more effective in slowing myopia progression than glasses.

In this study, the prevalence of refractive error was 58%, which is higher than that found in previous studies.[48],[49],[50],[51] The most prominent type of refractive error in this study was myopia. This could partially explain the differences with previous studies as it has been reported that myopia increases with age.[45],[52],[53],[54],[55] It could also be explained by age differences, as our study was conducted on adolescents, who may spend longer periods using smart devices unlike children who may spend less time due to parental monitoring.

Among participants with refractive error, 43% were uncorrected, leading to a large number of participants at risk of learning difficulties, which could impact their lifestyle and limit their job prospects and income. This high percentage could be attributed to low awareness from both the larger community and from parents about the importance of frequent vision screening. Some participants reported that they did not note blurred or decreased vision; or did not take it as a serious problem because they thought everyone sees as they do. Thus, optometrists should put extra effort in conducting eye health education programs as well as frequent screening programs.[34]

In this study, the older participants used the glasses more than the younger group, which could indicate the importance of the age factor in taking decision in health-related issues. Further, more females wore glasses than males. This may indicate that females are keener to have clear and detailed vision. However, the non-compliance rate was one fourth of the sample and also was higher in females. Concerns over cosmetic appearance is still a major reason for non-compliance. Therefore, contact lens should be professionally offered as a tool to correct refractive error. The overall non-compliance rate matched those in previous studies.[7],[10],[11] And, numerous participants responded that they were uncomfortable with their glasses. These results pointing out to the importance of finding alternative correcting tools of refractive error such as the contact lens. One third of the participants did not use the glasses for considerable time of the day, indicating that this age group may be uninformed about the importance of wearing glasses all day and not just for specific times. This practice may increase the risk of blurred vision, and can develop into habitual non-compliance. Thus, professional care and follow-up visits are needed in this critical age for patient education and comfort. In addition, understanding their reasons behind their own wearing hours and non-compliance is important for successful management. Finally, using other optical corrections like contact lens can be useful in these conditions.

Contact lens were offered to fewer than 10% of participants with refractive error. And the most efforts were toward the older age group. Indicating that prescribing contact lens to patients less than 15 years may not be considered from practicing professionals as an option for correcting refractive error. This significantly low proportion could be explained by low numbers of optometrists willing to prescribe them due to concerns about hygiene in both age groups. The prevalence of those using contact lens for RE correction was less than that found in female university students.[23] This difference could be due to age differences: many optometrists do not prescribe contact lens for adolescents as they are more encouraged to prescribe them for older patients. Furthermore, adolescents are more closely monitored by their families, and many parents refuse contact lens either due to hygienic or financial reasons. Although, the contact lens was offered in a very limited approach, 159 participants have used contact lens. Most of them were female and more than 16 years of age. Indicating that there is needs for alternative correcting approach.

The participants reported that contact lens were more offered by ophthalmologists than optometrists. This may indicate that ophthalmologists more frequently suggest alternatives for RE correction, or that participants could not tell the difference between ophthalmologists and optometrists, as both are eye care professionals. Also, some participants reported that did not know whether an optometrist, ophthalmologist, or another professional made the offer, which may refer to the absence of self-introduction, which is an important professional skill to strengthen the relationship between the examiner and the patient. Contact lens were most frequently offered in optical stores, which might be due to profit interests and that these stores might be more accessible to this age group.

The soft contact lens was the dominating type, and this high proportion could be attributed to the high percentage of cosmetic soft contact lens users (63%). This result was similar to that found by Abahussin et al. where 63.3% of respondents used cosmetic contact lens.[23] Both studies had females in the majority of contact lens users, who might be more cosmetically driven. The low proportion of those who wore contact lens for refractive error correction (12.8%) could be attributed to the low number of optometrists who prescribe contact lens for adolescents.

The current study observed that monthly contact lens was the main type, more than the study by Abahussin et al. in which 47% of participants used monthly contact lens.[23] The monthly contact lens were most frequently used in both studies, which may be due to financial reasons as using daily disposable contact lens can be more expensive. Daily contact lens might be more suitable for adolescents, as monthly contact lens require more care. The males stated that they used soft and daily disposable contact lens, indicating that they may prefer more practical options.

Half of our participants used contact lens for more than one year, and cosmetic contact lens users might be a reason for this high percentage. About the third of our participants was not taught how to use and take care of contact lens. These significantly high proportions of low education could lead to low levels of lens care and other complications such as wearing damage or inverted lens, wearing contact lens without hand washing, or using the same container several times without proper cleaning, leading to a higher risk of corneal disorders. This also could explain why 50% of our study participants reported complications with contact lens.

The current study found that some participants used the contact lens for more than 12 hours in a day. This result must be taken into account even if it represented a low proportion, as most of those participants wore them for cosmetic or corrective cosmetic reasons. Those participants are at risk from tinted contact lens for more than 12 hours. The pigmented area of tinted lenses was suggested to have a greater surface roughness than the clear area,[56] and microbial adherence may increase as the surface roughness increases.[57],[58] Thus, special attention should be paid to those people in terms of maintaining a high standard of hygiene. Further, considerable proportion of our participants used contact lens most of the week and the main reason was cosmetic factor. The optometrists shall spend a greater effort to inform and educate those wearers about the importance of contact lens care, since using them many times would require more hygienic care.

There was large proportions of those who did not use a new solution or container until they got new contact lens indicating a very concerning low levels of care regarding cleaning solutions and containers. This might be explained by the high proportion of those who were not informed on how to take care and clean their contact lens.

The current study found low responses of sleeping with contact lens, but concerning level of sometimes sleeping with contact lens. This proportion was similar to that found by Abahussin et al. (2014).[23] This low proportion may reflect a good awareness among this age group about the risks of wearing contact lens while sleeping. However, raises serious concerns about the corneal health of those sleeping with the contact lens.

With more involvement from optometrists, and under parental supervision, adolescents can wear contact lens successfully in the long term.[27],[39],[59],[60] Previous studies have also suggested that children interested in daily activities such as sports and dance, who are motivated to wear contact lens or do not like their appearance with glasses, would benefit the most from wearing contact lens.[26],[39],[41]

In conclusion, this study aimed to evaluate the beliefs toward using contact lens as an alternative to glasses for correcting refractive error among non-compliant adolescents in Riyadh, who represented a high proportion in this study. It seems that contact lens could be a valuable tool in managing such cases. Therefore, this study recommends optometrists increase the compliance of refractive error correction by prescribing contact lens, but with greater emphasis on patient education and follow-ups.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

The authors extend their appreciation to the College of Applied Medical Sci-ences Research Centre and the Deanship of Scientific Research at King Saud University for fund-ing this research.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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