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Contact lens water exposure risk focus of UNSW campaign   

Lens Wear with Care 2021

The UNSW School of Optometry and Vision Science (SOVS) is urging eyecare professionals to better utilise follow-up appointments to re-educate patients on safe contact lens wear as part of its new ‘Lens Wear with Care 2021’ campaign.

From 17 to 21 August, the university is running the awareness initiative focussing on the theme of water exposure and contact lens use. It includes a series of free resources that optometrists can use to inform wearers on the risks of non-sterile water that can contain microorganisms, particularly Acanthamoeba.

The campaign has been developed by the UNSW SOVS’s Dr Nicole Carnt and her final year Masters students Ms Danica Chua and Mr Gerry Wang. It also involves optometrists Mr Adam Samuels and Ms Stephanie Yeo who work with Carnt and their PhDs who are looking at interventions to help contact lens wearers become more adherent and hygienic, as well as research into the effects of contact lens information online.

The UNSW has generated downloadable graphics for eyecare professionals to use.

Apart from the use of contact lenses during water sports like surfing and swimming – which are popular in Australia – they said recent evidence had indicated that showering with contact lenses increased risk of microbial keratitis by three to seven times [1].

“In Australia and New Zealand, we generally have good standards of hygiene however when it comes to contact lens hygiene there is still room for improvement. A study done a few years ago showed that in Australia, we have similar contact lens hygiene compliance levels as Germany and Canada. However, most countries could benefit from improved contact lens hygiene [2],” Yeo said.

“Contact lens non-adherence rates range between studies and it seems that one in three contact lens wearers are putting their vision at risk. It has also been suggested that eyecare practitioners are not fully utilising follow-up visits to re-educate contact lens wearers [3]. The attitude towards safe lens wear should be similar to preventative medicine – healthy contact lens wear is a long-term task and requires a collective effort.”

Swimming is one area where poor contact lens adherence can occur.

This year’s ‘Lens Wear with Care 2021’ campaign was designed by Wang and Chua as part of their research project. They reflected on their experience observing contact lens wearers during their clinics and found many were oblivious to the importance of hand drying and other water exposure behaviours. This lack of awareness is also consistent with research [4].

With the proliferation of contact lens technologies, which include myopia control lenses and augmented virtual reality lenses that will be available in the not-so-distant future, they believe contact lens use is set to increase [5].

The UNSW team also noted the importance of language. The campaign has chosen to use the word “adherence” rather than the more commonly used “compliance”.

“Literature suggests that eyecare practitioners are not promoting safe lens wear enough, and as mentioned, promoting healthy contact lens wearing habits is a long-term task that requires a collective effort,” Yeo and Samuels said.

“Compliance is a more passive behaviour that suggests a more ‘doctor-centred’ model, whereas adherence is a more positive, proactive behaviour that is more patient-centric. The emphasis needs to be on understanding how to overcome the barriers instead of emphasis on a provider’s judgment.”

The campaign’s Social Media Toolkit can be downloaded here.

‘No water’ stickers

In a similar campaign last year, UNSW promoted Contact Lens Health week in collaboration with the US-based Centers for Disease Control and Prevention (CDC) as part of the 7th Annual International Contact Lens Health Week.

It involved promoting ‘No-water’ stickers which are a warning sticker on contact lens cases that aim to help wearers improve contact lens safety.

The Australian version of the ‘No-water’ stickers launched by the Cornea and Contact Lens Association of Australia.

The stickers were the brainchild of a contact lens wearer, Ms Irenie Ekkeshis, who developed a severe case of microbial keratitis in 2011. She noticed many contact lens wearers were oblivious to the dangers of water mixing with their lenses.

She lobbied the British Contact Lens Association and, in 2013, the stickers were first produced and distributed in the UK. Since then, they have been adopted by the Cornea, Contact Lens and Refractive Section of the American Academy of Optometry. In 2019, an Australian version of the ‘No-water’ stickers were launched by the Cornea and Contact Lens Association of Australia.

Along with the stickers, there is an informational website for practitioners and wearers. To find out more about the development of the ‘No-water’ sticker, can listen to Ekkeshis and Carnt on the BCLA Podcast: Raising-public-awareness-of-nowater-and-AK.


  1. Stellwagen, A., et al., Personal hygiene risk factors for contact lens-related microbial keratitis. BMJ Open Ophthalmology, 2020. 5(1): p. e000476.
  2. Morgan, P.B., et al., An international analysis of contact lens compliance. Contact Lens and Anterior Eye, 2011. 34(5): p. 223-228.
  3. Wolffsohn, J.S., et al., CLEAR – Evidence-based contact lens practice. Contact Lens and Anterior Eye, 2021. 44(2): p. 368-397.
  4. Stapleton, F., Contact lensrelated corneal infection in Australia. Clinical and Experimental Optometry, 2020. 103(4): p. 408-417.
  5. Jones, L., et al., CLEAR – Contact lens technologies of the future. Contact Lens and Anterior Eye, 2021. 44(2): p. 398-430.

More reading

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‘No water’ stickers improve CL compliance

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