Compliance behaviour change in contact lens wearers: a randomised controlled trial

Eye (Lond). 2021 Mar;35(3):988-995. doi: 10.1038/s41433-020-1015-9. Epub 2020 Jun 16.


Background: Water exposure during contact lens wear has been associated with contact lens disease including microbial keratitis and sterile corneal infiltrates. Despite the documented risks, water exposure is common amongst lens wearers. This study aimed to determine the effect of water education in the form of "no-water" lens case stickers on water-contact behaviours and storage case contamination.

Methods: In a prospective, masked, randomised controlled trial, 200 daily lens wearers were randomised to either receive a storage case with a "no-water" sticker (test) or without a "no-water" sticker (control). Both groups received written compliance information. Participants completed a self-administered lens hygiene questionnaire at baseline and after 6 weeks. Microbial analysis of used storage cases, collected at both study visits, was conducted using ATP and limulus amebocyte lysate (LAL) assays for overall microbial contamination and endotoxin levels, respectively. A one-way ANCOVA and multiple logistic regression determined the change in water-contact behaviours and storage case contamination over time.

Results: A total of 188 lens wearers completed both study visits; 128 females and 60 males; average age 29 ± 13 (range 18-78 years); 95 test and 93 control participants. After 6 weeks, the overall water exposure score and endotoxin levels reduced significantly in the test group compared with the control group (p < 0.05). There were no significant changes in individual water-contact behaviours or overall storage case contamination.

Conclusion: A no-water infographic on the contact lens case improved overall water-contact behaviours and reduced storage case endotoxin. Refining the messaging may be beneficial in future to improve other aspects of compliance.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Contact Lens Solutions*
  • Contact Lenses*
  • Female
  • Humans
  • Hygiene
  • Male
  • Middle Aged
  • Prospective Studies
  • Surveys and Questionnaires
  • Young Adult


  • Contact Lens Solutions