The problem of taking risks

We had a contact lens patient’s mother in today to order her son more contact lenses. She was concerned that he was on occasions sleeping in them, despite being clearly instructed by us not to.

Statistically, sleeping in contact lenses is the number one risk of eye infections in contact lens wear – every one of our new contact lens patients has had this explained to them, and the reasons why it is a bad idea.

I recently had a young girl woman in Kingscourt on a Saturday afternoon for a routine contact lens check. When questioned, she denied ever sleeping in them, and told me that she had put them in at 9.00am that morning. After looking at her eyes with the slit lamp, there were clearly signs suggestive that she was not being “entirely truthful”. She wore daily disposable contact lenses which are unsuitable for overnight wear, at all, ever.

I asked her “When was the last time you slept with the lenses in?”.

She replied “last night”.

“So how long have you had them in for?”.

“I put them in on Wednesday”!

The problem is that, when you are told you should not do something, and you do it (perhaps accidentally) it is maybe not unreasonable to think “They said I shouldn’t do that, BUT I CAN, I was OK”. That is the way we perceive risk- by our individual experience. Statistically, young men are the worst for not heeding advise about what they should and should not do with contact lenses, and statistically they are the group most likely to present with Microbial Keratitis.

Statistics are they way we should assess risk, not by our own experience. Drink drivers are more likely to crash cars than sober people – FACT, most people would agree with that, but many who do drink drive think that they are OK, because they have “done it for years and never had an accident”.

I advised a lady once that she should not spit on her contact lenses before putting them in, she should use contact lens conditioning solution, to which she told me that she had been doing that since I was in nappies! That might be true, but as I advised her, that doesn’t make it a good idea, though it was obvious she was never going to listen.

No-one would ever think that playing Russian Roulette with one bullet in six chambers is a good idea, nor would they argue that “I did it, I’m OK, I can do it” Everyone knows there is a 1 in 6 chance of being wrong, and also that eventually you would blow your head off- it probably will not take too many turns to achieve it. Very few people would ever consider playing that game. The risks of contact lens infections are much, much less than blowing a hole in your head playing Russian Roulette, but do not think “I’m OK I can do it”- sight is precious, you only get two eyes, and they need to last you a lifetime.

And like silly games with guns, you could have a problem the very first time! Though it is true that infections increase with every consecutive night of sleeping with them in, and overwearers are more likely to fall prey to infection, there is a chance it could be you, first time, next time…

Estimates are that approximately 15-20 in every 100000 soft contact lens wearers per year will suffer a microbial keratitis, and there are probably a lot more than 15-20 in every 100 thousand lens wearers who are complete lunatics, doing everything wrong and mostly getting away with it, but don’t take the chance.

There is a refresher “Contact Lens Dos and Don’ts” here. If you are a contact lens wearer it will take 2 minutes to read it.

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