Pediatric and Teen CL Care
Swimming and Contact Lenses
BY JEFFREY J. WALLINE, OD, PHD, FAAO
As summer begins, parents frequently ask, “Can my child swim in contact lenses?” Practitioner responses to this question can range from “Absolutely not!” to “Sure, you don’t have to do anything different just because you wear contact lenses.” (Table 1).
|Do not wear contact lenses in the pool.|
|Wear contact lenses in the pool, but don’t open your eyes under water.|
|You can wear contact lenses in the pool if you wear goggles.|
|You can wear contact lenses in the pool if you disinfect them immediately after swimming.|
|You can wear contact lenses in the pool if you discard them immediately after swimming.|
|You can wear contact lenses in the pool if you disinfect or discard them that night.|
|You don’t need to do anything special if you wear contact lenses in the pool.|
What Are the Risks?
Choo et al (2005) found bacterial colonization on 27 of 28 lenses worn during swimming, compared to only three of 16 lenses worn outside of the pool. The bacteria most commonly isolated from both the contact lenses and the pool water was Staphylococcus epidermidis. In another study, the risk of corneal ulcers in the Philadelphia area was higher between June and September, which is thought to be prime swimming season (Rabinovitch et al, 1987).
However, the primary concern is contamination by Acanthamoeba (Kaji et al, 2005). Approximately one-third of Acanthamoeba cases are associated with swimming (Radford et al, 2002; Kaiserman et al, 2012; Radford et al, 1998). Such cases result in an average of 19 months of follow up and 20/50 visual acuity (Kaiserman et al, 2012; Stapleton et al, 2009), so ocular infections resulting from swimming in contact lenses can be devastating. One study found that the chance of getting Acanthamoeba keratitis is more than six times greater for those who wear their contact lenses while swimming (Stehr-Green et al, 1987).
What Guidelines Are Available?
Unfortunately, there are very few evidence-based guidelines for swimming in contact lenses. Zeri et al (2011) surveyed physical education teachers, coaches, and final year students of physical education about contact lens wear in sports. On a scale from 1 (completely disagree) to 6 (completely agree), the average rating that vision correction was important was 4.5, while the average rating for recommending contact lenses for swimming was only 3.8 for recreational swimming and 4.1 for competitive swimming. Therefore, coaches may not often recommend contact lenses for swimming even though they feel that clear vision is important.
Wearing goggles over contact lenses while swimming results in significantly less contamination by microorganisms (Wu et al, 2011), but it is unknown whether the risk of ocular infections is improved by wearing goggles or by disinfecting or disposing of contact lenses after swimming. Certainly, more research needs to be conducted to provide parents with evidence-based information about the risks of swimming in contact lenses.
Use Your Best Judgement
Swimming in contact lenses certainly increases ocular infection risk, but there is a dearth of information on mitigating these risks through lens disinfection, goggles, or contact lens disposal. Given these limitations, we should counsel our patients about the risks of contact lens wear in swimming pools and provide them with options for lowering these risks. Eyecare practitioners can provide a list of choices or pick a method that most suits them and their patients. CLS
For references, please visit www.clspectrum.com/references and click on document #223.
Dr. Walline is an associate professor at The Ohio State University College of Optometry. His research interests primarily involve pediatric contact lenses and myopia control. He has received research funding from Johnson & Johnson Vision Care. You can reach him at firstname.lastname@example.org.