How Many Ulcer Association with Contact Lens in Taiwan

William Wing-Fung ChengTaipei Medicine University

Wan-Fang Hospital Center

Wing-Fung Cheng Eye Clinic

Database from

National Health Research Institutes

National Health Insurance Research Institutes Database

Institute of Health Policy and management,College of Public Health, National Taiwan University

Contact Lens

About over 2 million users in Taiwan

Including

Soft contact lens,mainly.

hard contact lens

Orthok lens

Presblyopia contact lens

Toric contact lens

Out Patients of K Ulcer in Taiwan (2001~ 2005yrs)

Patients in Year,2001 2002 2003 2004 2005Medical Center 5130 5208 4934 4857 4384Regional Hospital 2961 3163 2834 2887 2475Local Hospital 2095 2181 2281 2438 2289Clinic 21950 22548 25043 27752 28525Total 32136 33100 35092 37934 37673

Out Patients of Cornea Ulcer

Out Patients of K Ulcer in Taiwan

Cornea Ulcer Statistic from 2001 to 2005 year (OPD)

0

5000

10000

15000

20000

25000

30000

OPDP't No.

Medical Center

Regional Hospital

Local Hospital

Clinic

Admission Patients of Cornea Ulcer in Taiwan

Patients in Year,2001 2002 2003 2004 2005Medical center 961 977 905 1018 930Regional Hospital 252 360 215 216 199Local Hospital 26 39 47 31 30Total 1239 1376 1167 1265 1159

Admission Patients of Cornea Ulcer

Admission Patients of K Ulcer in Taiwan

Cornea Ulcer Statistic from 2001 to 2005 year(Admission)

0

200

400

600

800

1000

1200

Year,2001 2002 2003 2004 2005

AdmissionP't NO.

Medical center

Regional Hospital

Local Hospital

Visiting Times of OPD for Cornea Ulcer

Patients in 2001y % 2002 % 2003 % 2004 % 2005 %Medical center 17914 28.3 17920 28.2 17403 25.9 16981 23.5 14351 21.0Regional Hospital 6207 9.8 7190 11.3 7029 10.5 7569 10.5 6153 9.0Local Hospital 4835 7.6 4682 7.4 4982 7.4 5049 7.0 4950 7.2Clinic 34262 54.2 33725 53.1 37691 56.2 42580 59.0 43005 62.8Total 63218 63517 67105 72179 68459

Times of OPD for Cornea Ulcer

Visiting Times of Admission for Cornea Ulcer

2001y % 2002 % 2003 % 2004 % 2005 %Medical center 1084 78.7 1037 71.2 995 78.5 1136 81.4 1009 80.5Regional Hospital 267 19.4 378 26.0 225 17.8 228 16.3 208 16.6Local Hospital 26 1.9 41 2.8 47 3.7 32 2.3 36 2.9Total 1377 1456 1267 1396 1253

Times of Admission for Cornea Ulcer

Visiting Times of OPD &Admission for K Ulcer

Patients in 2001y % 2002 % 2003 % 2004 % 2005 %Medical center 18998 29 18957 29 18398 27 18117 25 15360 22Regional Hospital 6474 10 7568 12 7254 11 7797 11 6361 9.1Local Hospital 4861 7.5 4723 7.3 5029 7.4 5081 6.9 4986 7.2Clinic 34262 53 33725 52 37691 55 42580 58 43005 62Total 64595 64973 68372 73575 69712

Times of OPD & Admission for Cornea Ulcer

OPD & Admission Patients of Cornea Ulcerfrom 2001 year

29%

10%8%

53%

Medical center

Regional Hospital

Local Hospital

Clinic

OPD & Admission Patients of Cornea Ulcerfrom 2002 year

29%

12%7%

52%

Medical center

Regional Hospital

Local Hospital

Clinic

OPD & Admission Patients of Cornea Ulcerfrom 2003 year

27%

11%7%

55%

Medical center

Regional Hospital

Local Hospital

Clinic

OPD & Admission Patients of Cornea Ulcerfrom 2004 year

25%

11%

7%

57%

Medical center

Regional Hospital

Local Hospital

Clinic

OPD&Admission Patients More Care in Clinic

OPD & Admission Patients of Cornea Ulcerfrom 2005 year

22%

9%

7%62%

Medical center

Regional Hospital

Local Hospital

Clinic

OPD&Admission Patients with Cornea Ulcer

OPD+Admission Patients

30000

31000

32000

33000

34000

35000

36000

37000

38000

39000

40000

2001 y 2002 2003 2004 2005

Year

No OPD+Adm.(P't)

OPD&Admission Patients with Cornea Ulcer

OPD+Admission Visiting Times

60000

62000

64000

66000

68000

70000

72000

74000

76000

2001 2002 2003 2004 2005

Year

visitingtimes

OPD+Admission

Compare OPD+Adm.P’t with Visiting No.

OPD+Admission patient and visiting No.

30000

35000

40000

45000

50000

55000

60000

65000

70000

75000

80000

2001 y 2002 2003 2004 2005

Year

No OPD+Adm.(P't)

OPD+Adm.(No)

The Year Complex Growth Rate & Year Growth Rate of Cornea Ulcer Complication

2001y 2002 2003 2004 2005OPD+Adm.(P't) 0 3.30% 5.17% 8.11% -0.94%OPD+Adm.(No) 0 0.58% 5.23% 7.61% -5.25%

2001y 2002 2003 2004 2005OPD+Adm.(P't) 0 3.30% 8.64% 17.45% 16.35%OPD+Adm.(No) 0 0.58% 5.85% 13.90% 7.92%

Year Complex Growth Rate

Year Growth Rate

The Year Complex Growth Rate of Cornea Ulcer Complication

00.58%

5.85%

13.90%

7.92%

16.35%

8.64%

17.45%

3.30%

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

0.18

0.2

2001y 2002 2003 2004 2005

OPD+Adm.(P't)OPD+Adm.(No)

The Year Growth Rate of Cornea Ulcer Complication

-0.06

-0.04

-0.02

0

0.02

0.04

0.06

0.08

0.1

2001y 2002 2003 2004 2005

OPD+Adm.(P't)

OPD+Adm.(No)

Patients in Year,2001 2002 2003 2004 2005OPD+Adm.(P't) 33375 34476 36259 39199 38832OPD+Adm.(No) 64596 64973 68372 73575 69712

OPD & Admission Patients of Cornea Ulcer

Patients numbers & Visiting timesfor Cornea Ulcer in Taiwan (2001~ 2005years)

Percentage of Cornea Ulcer Complication of Contact Lens in Taiwan, 2004 year.

1.96% for patients with cornea ulcer per year ( 39,199¯/2,000,000+ users, users no.estimated from

C.L.company)

Very high cornea ulcer complication rate3.68% growth for OPD visiting with cornea ulcer diagnosis1.88 times visiting OPD per one patient with ulcer

What are the risk factors for high cornea ulcer complication rate ?

Behavior ?

Environment?

Product ?

We design a questionnaire1.      Name:_______________2.      Birth day:_______________3.      Contact Lens Styles:

□Daily disposable □Weekly disposable □Two week disposable □Long term normal styles

4.      Extended wear: Daily□over one day□over two days□over one week Two week□over two weeks□over three week□over one mouth Long term□over night wearing

5.      Dysinfection Method: Cleaning every day□yes□no Cleaning solution□normal saline only□using dysinfection solution Cleaning method with rubbing □yes□no

6.      Wearing Period per Day: □less than 8hrs□8~12hrs□over 12hrs 7. Diagnosis:________________

The questionnaire were done by patientsFrom Apr.2005 to Dec.2006.All patients visiting our OPDDiagnosis with contact lens wearing complication : K ulcer and Infiltrative Keratitis (IK) :47 patientsDiagnosis with cornea ulcer due to contact lens wearing: 30/47 patients (64%)Diagnosis with IK due to contact lens wearing: 17/47 patients (36%)M/F:14/33 (1 ： 2.4)Age: 14~52 years old

(below20:13, 20-30:23, 30-40:9, upper40:2 )

Result from questionnaires :

Extended wear : 47% (22/47) mainly in disposable C L : 73% (16/22) mainly in 2-weeks disposable C L : 95%

Cleaning without dysinfection solution : 49% (23/47) mainly in disposable C L : 70% (16/23)

Cleaning without rubbing: 75% (35/47) mainly in long term C L : 57% (20/35)

Discussion

MoistureLoe dysinfection solution

induce Fungus infection due to without rubbing.

Without rubbing is a key point

Conclusion:

The high complication rate nearly 2% and the rapid 3 years complex growth rate 17.5% of cornea ulcer in contact lens users in Taiwan (2001~2004) due to wrong contact lens wearing behaviors :

(1) Extended wear

(2) Cleaning without dysinfection solution

(3) Esp. Cleaning without rubbing

Thank you very much

William Wing-Fung Cheng