Quality-of-life outcomes of long-term contact lens wear: a systematic review

Author: Kandel H.

Geographical coverage: USA, Spain, China and Russia

Sector: Biomedical

Sub-sector: Treatment

Equity focus: None specified

Study population: Long-term contact lens wearers (2+ years).

Review type: Other review

Quantitative synthesis method: Narrative review

Qualitative synthesis method: Not applicable

Background: Contact lens wear may offer several advantages over spectacles for optical correction of refractive error: they enhance cosmetic appearance, provide better peripheral vision, are easier to wear during sports and in difficult conditions such as rain, and allow to wear sunglasses. Patient reported outcomes (PROs) are important for evaluating the impact of contact lens use on quality of life, compared with spectacles. However, most of the evidence on PROs of contact lens wear is limited to short-term wear.

Objectives: To evaluate the evidence on quality-of-life outcomes of long-term contact lens wear, and to evaluate the content and quality of the PRO measures used in the included studies.

Main findings:

Overall, this review found that contact lens use improved quality-of-life status in children and adults.

A total of seven articles evaluated the PROs of long-term contact lens wear and met the inclusion criteria.

The median (range) number of contact lens wearers in these studies was 116 (31-247). Included studies were conducted in four countries: the USA, Spain, China and Russia. All studies were conducted in myopic populations. Authors observed that none of the studies provided information on psychometric properties, validity and reliability of the PRO measures used. Five studies were conducted in children of which three studies evaluated PROs of myopia control contact lens wear.

The studies reported that contact lens wear, including myopia control lens wear, was an effective method of refractive correction in children and adults in the long term in PRO-perspective, and resulted in a better quality-of-life status than with glasses. However, long-term dry eye and discomfort-related symptoms were reported.

Authors note the need for more research to better understand the long-term quality-of-life outcomes of contact lens wear.

Methodology:

This review included original, full-length studies that used named and externally validated Patient-Reported Outcome (PRO) measures to assess the quality-of-life outcomes of long-term contact lens wear. Articles that described generic, ophthalmic, or contact-lens specific PRO measures used to evaluate one or more quality-of-life domains in contact lens populations were also included. However, studies that indirectly evaluated the impact of contact lens wear on quality of life, used questionnaires on lens cleanliness, dryness, and handling, or described the use of self-developed questionnaires without meeting minimum criteria for questionnaire development were excluded. Additionally, mixed population studies that did not explicitly provide PROs of contact lens wear and studies that used PRO measures for classification purposes rather than evaluation were also excluded.

A  literature search was carried out in Medline Ovid, PubMed, Scopus, Web of Science, Cochrane, CINAHL and PsycInfo databases. The search was restricted to the English language. The references of a review paper that evaluated PRO measures in refractive errors (including contact lens wear for refractive error) were also screened. The titles and abstracts of the search yield were screened, followed by a full-text review of the potential articles.

No information was provided on how the narrative review was undertaken.

Applicability/external validity: The author points out several constraints that may limit the review’s applicability, primarily that it only encompasses data from “successful” contact lens users, defined as those who have worn them for a period of two years or more.

Geographic focus: The review included two low- and middle-income countries (LMICs), namely China and Russia. However, the author did not discuss how the findings might specifically vary for LMICs.

Summary of quality assessment:

There were a number of limitations to the approaches used to identify, include and critically appraise studies. The search was restricted to English and to published material, and there is no evidence that more than one author contributed to the search. In addition, there was no attempt to assess the quality and risk of bias for included studies. In addition, only one author extracted data from the included studies. Further, the author notes that the review only covers the quality of life impacts for successful contact lens wearers (those who had managed to wear them for 2+ years), making the results less applicable to the population of contact lens wearers as a whole. For these reasons, we attributed a low confidence in the findings of this review.