Contact Lens Wear, Corneal Complications, and U.S. Service Member Readiness

Introduction: Ulcerative keratitis (UK), or corneal ulcer, is a sight-threatening and readiness-lowering medical condition that begins with a corneal infiltrative event (CIE). Contact lens (CL) wear poses a particular risk for a CIE and therefore is restricted for most active duty service members (SMs). In this study, we explored a large Department of Defense/Veterans Affairs (DoD/VA) database to estimate the prevalence of UK and CIE and their association with CL wear. Materials and Methods: The DoD/VA Defense and Veterans Eye Injury Vision Registry, an initiative of the DoD/VA Vision Center of Excellence, was explored using natural language processing software to search for words and diagnostic codes that might identify cornea injuries and CL wear. The effect of UK and CIE on readiness was explored by evaluating the duration between the first and final visits noted in the database. Results: A total of 213 UK cases were identified among the 27,402 SMs for whom data were recorded in Defense and Veterans Eye Injury Vision Registry. The odds ratios of UK and CIE being associated with CL wear were 13.34 and 2.20, respectively. A less specific code (superficial corneal injury) was found to be the most commonly used diagnosis in the database, and the odds ratio of CL wearers having that diagnosis was 2.25. CL-wearing patients with corneal disease also required more clinic encounters than those who did not wear CLs. Conclusions: This study supports the current restriction on CL wear among nonpilot active duty SMs and quantifies the significantly enhanced risk of developing corneal ulcers posed by that habit.