Purpose: To investigate independent risk factors for contact lens-related microbial keratitis in Singapore and estimate their impact on disease load. Methods: Cases were contact lens wearers presenting to Singapore National Eye Centre with microbial keratitis between 2008 and 2010. Community contact lens wearers were recruited as controls. All wearers completed a previously validated questionnaire describing contact lens wear history, hygiene and compliance habits, and demographics. Risk factors significant in univariate analysis (Po0.2) were evaluated in a multivariate model. Results: In all, 58 cases of microbial keratitis and 152 contemporaneous controls were identified. When controlling for other variables, Chinese had a 7 × lower risk compared with other races (95% CI: 2.3-21.3, P = 0.001). Those aged between 25 and 44 years were at 3 × increased risk compared with younger wearers (95% CI: 1.1-9.6, P = 0.04). Occasional overnight contact lens wear (less often than one night per week) was associated with a 4 × higher risk (95% CI: 1.2-15.4, P = 0.03) compared with daily use. Not washing hands before handling was associated with a 13 × increased risk (95% CI: 1.9-84.8, P = 0.008). Use of multipurpose solution A carried a 16 × higher risk compared with hydrogen peroxide (95% CI: 1.5-174.0, P = 0.02). The combined PAR% for modifiable risk factors (occasional overnight wear, not washing of hands, and MPS A) was 82%. Conclusions: Consistent with previous findings, independent risk factors for contact lens-related microbial keratitis include poor hand hygiene, occasional overnight wear, and type of lens care solution. Prolonged overnight or extended contact lens use was infrequent in this population.

Indian participants had the steepest corneas among the three major ethnic groups in Singapore. Central corneal refractive power was related to several ocular parameters including anterior chamber depth, axial length and central corneal thickness. These data have important clinical implications for understanding the risk of keratoconus.

No abstract

To identify genetic variants associated with refractive astigmatism in the general population, meta-analyses of genome-wide association studies were performed for: White Europeans aged at least 25 years (20 cohorts, N = 31,968); Asian subjects aged at least 25 years (7 cohorts, N = 9,295); White Europeans aged <25 years (4 cohorts, N = 5,640); and all independent individuals from the above three samples combined with a sample of Chinese subjects aged <25 years (N = 45,931). Participants were classified as cases with refractive astigmatism if the average cylinder power in their two eyes was at least 1.00 diopter and as controls otherwise. Genome-wide association analysis was carried out for each cohort separately using logistic regression. Meta-analysis was conducted using a fixed effects model. In the older European group the most strongly associated marker was downstream of the neurexin-1 (NRXN1) gene (rs1401327, P = 3.92E−8). No other region reached genome-wide significance, and association signals were lower for the younger European group and Asian group. In the meta-analysis of all cohorts, no marker reached genome-wide significance: The most strongly associated regions were, NRXN1 (rs1401327, P = 2.93E−07), TOX (rs7823467, P = 3.47E−07) and LINC00340 (rs12212674, P = 1.49E−06). For 34 markers identified in prior GWAS for spherical equivalent refractive error, the beta coefficients for genotype versus spherical equivalent, and genotype versus refractive astigmatism, were highly correlated (r = −0.59, P = 2.10E−04). This work revealed no consistent or strong genetic signals for refractive astigmatism; however, the TOX gene region previously identified in GWAS for spherical equivalent refractive error was the second most strongly associated region. Analysis of additional markers provided evidence supporting widespread genetic co-susceptibility for spherical and astigmatic refractive errors.Electronic supplementary materialThe online version of this article (doi:10.1007/s00439-014-1500-y) contains supplementary material, which is available to authorized users.