Knowledge, attitudes, and practices regarding contact lens-associated dry eye among contact lens wearers: a...

Contact lens use is a significant modifiable risk factor for contact lens-associated dry eye (CLADE), a distinct and prevalent subtype of dry eye disease. This study aimed to describe CLADE symptoms using the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) and to quantify knowledge, attitude, and practice (KAP) regarding CLADE.

A cross-sectional study was conducted in China between March 20 and May 22, 2025, among contact lens users. Participants completed two independent instruments: the CLDEQ-8 (symptom frequency and intensity; not a KAP scale) and a 25-item CLADE KAP questionnaire (knowledge 0-20, attitude 7-35, and practice 8-40). Domain scores were classified as poor (≤50% of the domain maximum), moderate (>50% to 75%), or good (>75%).

The analysis included 718 valid questionnaires. Nearly 90% of participants reported CLADE-related discomfort at least occasionally, and approximately 40% reported blurred or fluctuating vision at least sometimes. All participants were contact lens wearers, most of whom used soft contact lenses for 4-8 h per day and had worn lenses for at least one year. Among the participants, 6.69% had been diagnosed with CLADE, while 29.11% reported symptoms consistent with CLADE but had not received a formal diagnosis. The mean scores were 10.59 ± 4.21 for knowledge (range 0-20), 25.89 ± 2.53 for attitude (range 7-35), and 27.92 ± 5.05 for practice (range 8-40), reflecting an overall moderate level of KAP. SEM results indicated that attitude had a direct effect on practice (β = 0.285, P = 0.012). Knowledge also exhibited a direct effect on practice (β = 0.427, P = 0.005), as well as an indirect effect mediated through attitude (β = 0.074, P = 0.007).

Contact lens wearers demonstrated a moderate level of KAP related to CLADE. These results underscore the importance of enhanced education to promote positive attitudes and behavioral change. Future public health campaigns and clinical counseling should emphasize systematic education to improve CLADE-related knowledge and self-management.