Is there a question of safety with continuous wear?

The availability of silicone-containing hydrogel contact lenses (SCHCLs) has refocused attention on the risks associated with continuous wear (CW). The major barrier to optometrists prescribing CW in Western societies is a perceived danger of microbial keratitis (MK). This perception has been shaped largely by educators who have developed their opinions from case reports in the ophthalmic literature, sensationalist lay press reports and later epidemiological studies and from prominent physicians in tertiary referral centres, following an increased incidence of MK with extended wear (EW) of traditional hydrogel materials. The basis for the perceived lack of safety is the higher risk of MK with EW compared to daily wear and incidence figures that suggest an unacceptable level of MK in a population at risk, albeit a small risk on an individual basis. In this paper, I re-evaluate the validity of the previous data and challenge the conclusions regarding the nature of the risk with traditional hydrogel lens materials. Areas under scrutiny include diagnostic criteria, morbidity caused by different micro-organisms, potential bias in studies and reports, analysis of visual outcomes and cost to the community, and improvements over time in the understanding and handling of contact lens-related complications. Significant loss of vision with EW appears to be less frequent than is the common perception. When the risks are placed in the perspective of other data such as that for refractive surgery, the arguments against EW do not seem so compelling. The high oxygen transmissibility of SCHCLs may enable safe CW but a large-scale epidemiological study is needed to allay remaining doubts. Any such future studies should note the points outlined in this document.