Contact Lens Knowledge and Practices Among Students in the College of Health Sciences, University of Ghana: A Cross-Sectional Study

Abstract

Background: Contact lenses (CLs) are increasingly used worldwide for refractive error correction because of their optical, cosmetic, and functional advantages over spectacles. However, although their safe and effective use depends on adequate knowledge and proper hygiene practices, there is limited evidence on contact lens-related knowledge, attitudes, and practices among university students in Ghana.

Objectives: This study sought to assess the knowledge, attitudes, and practices related to CL wear among students in selected schools at the College of Health Sciences (CHS), University of Ghana.

Method: A cross-sectional study among CHS students on the Korle Bu campus, University of Ghana, from April 21 to May 19, 2023. The sociodemographic characteristics (age, sex, and education) of the participants were documented using a predesigned questionnaire. Descriptive and inferential statistics were performed on the data using SPSS version 26. p-values < 0.05 were considered statistically significant.

Results: Data from 236 students were analyzed, with the majority (83.1%, 196) aged 18–24 years. Females made up 58.9% (139). The highest education level among participants was a university degree (171, 72.5%). A significant relationship was found between education level and overall acceptability of CLs (p = 0.007). Although 231 (97.9%) participants knew about CLs, only 5 (2.7%) actually used them. Overall understanding of proper contact lens care and usage was 26.8% (64). Spectacle wearers mainly hesitated to switch to CLs due to concerns about maintenance.

Conclusion: The overall knowledge of the proper care and usage of CLs was low (26.8%), and the prevalence in the study population was low (2.7%). Most individuals who wear glasses are reluctant to use CLs, mainly due to the extensive maintenance they require.

Graphical abstract

Keywords

attitude / contact lenses / Ghana / knowledge / practices

1 Introduction

The global prevalence of refractive error is increasing, with resulting implications on the health, education, finances, and general quality of life of affected patients [1,2]. Over the past decade, there has been a global surge in the general public's adoption and utilisation of contact lenses (CLs), largely owing to technological advancements and the growing demand for better options for correcting visual impairment associated with refractive errors [3].

CLs are artificial prosthetic devices worn on the surface of the eye as substitutes for the anterior corneal surface [4]. Compared with spectacles, they offer less image distortion, a wider visual field, and a more natural visual experience [5]. They are also preferable for outdoor and sporting activities because they do not collect moisture from rain, snow, or perspiration [6]. Their flexibility and superior cosmesis have also been associated with improved quality of life among users [1].

An estimated 125 million people use CLs globally, with annual increases of approximately 6% projected [7,8]. In developed countries such as the United States and Japan, the use of CLs is widespread, with prevalence rates ranging from 17% to 70% [9]. Data on their use in Africa, however, remain limited, and overall utilization is believed to be comparatively lower [10]. In Ghana, although CL use is increasing, prevalence remains low at 3.3% [9]. This trend may be influenced by factors such as a limited number of CL providers and generally low patronage [11].

As with all treatment options, CL use is associated with complications, and the growing number of users worldwide has been accompanied by a rise in CL-related problems [12]. Prolonged CL wear has been linked to symptoms such as burning, itching, and tearing [13]. More serious complications, including endophthalmitis and keratitis, may occur, often unbeknownst to users, particularly when compliance with lens-care guidelines is poor [1,14]. Conditions such as conjunctival hyperemia are also common and may lead to ocular discomfort and reduced lens use [15,16]. The prevalence of CL-related complications is further exacerbated when lenses are obtained or used without prior consultation with eye-care professionals, as demonstrated in a study conducted in Riyadh, Saudi Arabia [17].

Although CLs are increasingly used for vision correction, there remains limited information on the knowledge, attitudes, and practices associated with their use among Ghanaian students. While CLs offer several optical advantages [4–6], their safe and effective use depends on factors such as appropriate lens fitting, correct insertion and removal techniques, and adherence to proper hygiene and handling practices [18]. Such practices help reduce the risk of sight-threatening infections, including microbial keratitis [1,13,14]. Furthermore, inadequate knowledge of the factors influencing acceptance of CLs and adherence to safety and hygiene practices among students may contribute to visual impairment and ocular infections. Tertiary institutions in Ghana continue to experience growth in their youthful populations, some of whom use CLs for refractive correction. However, younger individuals are more likely to engage in inappropriate or prolonged use [19].

Given these gaps, it is important to assess the knowledge, attitudes, and practices of this population to address misinformation and promote interventions that enhance knowledge, acceptance, accessibility, and safe CL use among students. This study, therefore, sought to evaluate the knowledge, attitudes, and practices related to CL wear among students in selected schools within the College of Health Sciences (CHS), University of Ghana.

2 Materials and Methods

2.1 Study Area and Design

This descriptive cross-sectional study was conducted from April 21 to May 19, 2023, in the CHS of the University of Ghana. The CHS is the premier college of the University and comprises the University of Ghana Medical School (UGMS), University of Ghana Dental School (UGDS), School of Biomedical and Allied Health Sciences, School of Public Health, School of Nursing and Midwifery, School of Pharmacy, and Noguchi Memorial Institute for Medical Research. It remains the leading institution for training healthcare professionals in Ghana. Of the seven constituent institutions, this study focused on those located on the Korle Bu campus: the UGMS, the UGDS, and the School of Biomedical and Allied Health Sciences (SBAHS).

2.2 Sample Size, Sampling Strategy, and Recruitment

After adjusting for a 10% non-response rate, a minimum sample size of 236 participants was calculated using Cochran's formula [20], with a prevalence estimate of 34.8% from a comparable study [9]. A convenience sampling technique was used to recruit the participants from the study sites. Students were approached after their lectures in the respective lecture halls, and the investigators explained the purpose and voluntary nature of the study. Written informed consent was obtained from all students who agreed to participate. Eligible participants included all students from the selected institutions who had no communication difficulties and were willing to participate. Students who declined to participate or were absent during the study period were excluded.

2.3 Data Collection

A structured and validated questionnaire was developed following a thorough review of the literature and was administered by the investigators after obtaining informed consent. The instrument was pre-tested among 15 students from the College of Humanities, University of Ghana; their responses were excluded from the final dataset.

Data collected included sociodemographic characteristics such as age, sex, current and highest level of education, school, religious affiliation, ethnicity, and nationality, as well as information on participants' knowledge, attitudes, acceptability, and practices related to CL use.

In this study, knowledge was defined as facts and awareness about CL use obtained through experience and/or education [21,22]. Attitude was described as the feelings or beliefs that one has toward the use of CL [21,22]. Participants' knowledge about CL was assessed by asking the following five questions with yes/no as possible responses: “Have you heard about contact lenses (yes/no)?”, “Have you ever used contact lenses before (yes/no)?”, “Do you currently use contact lenses (yes/no)?”, “How knowledgeable do you feel about the proper usage and care of contact lenses?” (Very knowledgeable-1, somewhat knowledgeable-2, neutral-3, somewhat unknowledgeable-4, very unknowledgeable-5).

A score of 1 was assigned for each “yes” response and 0 for each “no” response. The Likert-scale question was converted into a binary variable: “very knowledgeable” and “somewhat knowledgeable” were scored as 1, while “neutral,” “somewhat unknowledgeable,” and “very unknowledgeable” were scored as 0. Final scores were converted into percentages, with scores ≥ 70% classified as adequate knowledge and scores ≤ 69% as inadequate knowledge.

Attitudes and practices were assessed based on participants' willingness or unwillingness to switch to CLs, reasons for switching or not switching among spectacle wearers, willingness to use CLs among non-spectacle wearers, acceptability of CLs, and reasons for CL use. Responses for attitudes and practices were summarized as percentages.

2.4 Data Entry and Analysis

Data were entered into Microsoft Excel version 13, and inconsistencies were corrected. Analyses were conducted using SPSS version 26 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies and percentages, were used to summarize the variables, and findings were presented using charts, graphs, and tables. The chi-square test was used to examine the association between CL acceptability and participants' highest level of education. Statistical significance was set at p < 0.05.

3 Results

3.1 Sociodemographic Characteristics

The sociodemographic characteristics of the participants are summarized in Table 1. Of the 236 participants, the majority were female (139/236, 58.9%). Most participants were between 18 and 24 years of age (196/236, 83.1%). A large proportion (171/236, 72.5%) had attained an undergraduate level of education. The highest participation was from the UGMS, with 163 students (69.1%) taking part in the study (Table 1).

3.2 Knowledge and Acceptability of CLs

Table 2 presents the findings on participants' knowledge and acceptability of CLs. Of the 236 respondents, 231 (97.9%) had adequate knowledge of CLs, while 5 (2.1%) demonstrated inadequate knowledge. Most participants (225/236, 95.3%) had never used CLs. Among the 11 participants who had ever used CLs, 5 (45.5%) were current users.

Regarding spectacle use, 137 participants (58.1%) did not wear spectacles, whereas 99 (41.9%) did. Figure 1 illustrates the reasons given by spectacle wearers for their willingness or unwillingness to switch to CLs. Figure 2 shows the corresponding reasons among non-spectacle wearers. A statistically significant association was found between participants' highest level of education and the overall acceptability of CLs (p = 0.007) (Table 3).

3.3 CL Practices

Among current CL wearers, three of the five participants (60.0%) had been using CLs for one to 2 years, while the remaining two (40.0%) had used them for more than 2 years. All current users (5/5, 100.0%) reported washing their hands before handling their lenses, and four (80.0%) stated that they did not sleep with their CLs.

Two participants (40.0%) reported never replacing their lenses, while four (80.0%) indicated that they changed their CL solution during continued use. Four participants (80.0%) obtained their CLs following consultation with an ophthalmologist. Four participants (66.7%) reported that they did not share their lenses with friends.

Most current users (3/5, 60.0%) had never undergone a medical check-up related to their CL use. Two participants (40.0%) cleaned their lenses daily, while another two (40.0%) cleaned them every two to four days. Four users (80.0%) wore their lenses for between 5 h and 12 h at a time, and one participant (20.0%) wore them for less than 5 h.

Most participants who had ever used CLs reported doing so for the correction of refractive errors (Figure 3).

4 Discussion

This study included a higher proportion of female students (58.9%), a finding similar to a study conducted in coastal Karnataka, India, where females constituted 79.5% of the sample [23]. The wide discrepancy between the two proportions may be due to the smaller sample size in the present study (236 participants compared with 6850 in the Indian study). Most participants (72.5%) had attained an undergraduate degree. Educational level was found to be a significant predictor of contact lens acceptability (p = 0.007). This is unsurprising, as higher educational attainment has been shown to enhance individuals' ability to seek, understand, and evaluate information related to alternative methods of vision correction [24].

In this study, 97.1% of participants were aware of CLs, similar to findings from Karachi, Pakistan, where awareness was 97% [25]. This may be attributed to university students' extensive access to digital resources and global technological information. Conversely, studies conducted in Ghana and India [26–28] largely exhibited poor awareness of contact lenses, contradicting the findings from our study.

Only 4.7% of participants had ever used CLs, consistent with findings from a Ghanaian population where CL wear was also low (3.3%) [9]. Awareness, however, does not necessarily translate to use. Factors such as cost [27] and satisfaction with spectacles [9], may influence the decision to wear CLs, and some of these factors were explored in this study.

Among the 11 participants who had ever used CLs, 5 (45.5%) were current users. In contrast, a cross-sectional study among college students in Saudi Arabia reported that 50.1% had previous or current CL experience, and 72.4% were current wearers [29]. This difference may be explained by the relatively lower prevalence of CL use in Ghana. Other studies similarly report higher CL use elsewhere [12,30].

Most current users (60%) had worn CLs for one to 2 years, while the remainder had used them for more than 2 years. This mirrors findings from a South African adolescent population, where 72.2% had used CLs for more than 1 year [5]. No participant reported using CLs for more than 12 h daily, which aligns with recommended practice, as extended wear increases the risk of discomfort, redness, and infection [31].

Consistent with previous studies [23,24,32], a higher proportion of CL users were female (54.5%), which may be partly attributed to the higher number of females in the sample and the tendency for females to select CLs for cosmetic purposes [12].

Among CL users, more than half (54.5%) wore lenses for refractive error correction, while 18.2% used them for cosmetic or fashion purposes. These findings align with a Ghanaian study [24], in which 52.9% used CLs for refractive correction. In emerging economies, the limited availability of CL products may restrict the use of lenses for non-optical purposes. Additionally, practitioners' prescribing preferences strongly influence consumers' choices. In contrast, studies from other regions report cosmetic use as the primary reason for contact lens wear [17,23,33,34]. Differences in economic context and population demographics may explain this variation.

Although most participants were aware of CLs, 73.2% lacked adequate knowledge of their proper care and use. This agrees with a Ghanaian study reporting a knowledge level of 34.8% [9]. Limited availability of CL services and low patronage in Ghana [11] may contribute to this gap.

Among spectacle wearers, 70.7% were unwilling to switch to CLs. The main reasons included high maintenance requirements (23%), eye irritation (19.0%), and convenience (14.7%). Improving awareness of CL care and safety could help reduce these barriers by empowering students with accurate information. This contrasts with another Ghanaian study where spectacle wearers were more receptive to CLs [24].

Among participants who did not wear spectacles, 35.8% were unwilling to use CLs if needed, with eye irritation (22.8%) being the most reported concern. In contrast, studies elsewhere have identified cost as the primary barrier to CL wear in developing countries [27,28]. In Kenya, CL acceptance was low, believed to result from infrequent prescription by eye care professionals [10], a trend also reported in Malaysia [35], Singapore [36], and Saudi Arabia [17]. This may likewise be a factor in Ghana.

Encouragingly, 83.3% of CL users refrained from sleeping with their lenses, reducing the risk of severe infections such as microbial keratitis [37]. This is comparable to another study where 90.5% of users avoided overnight wear [24]. However, 16.7% still slept with their lenses, a practice that should be strongly discouraged. This finding is consistent with other reports [32]. Studies have shown that prolonged use, overnight wear, and poor cleaning practices significantly increase the risk of CL complications [29]. Poor hygiene (33%) and overnight wear (43%) are the two most common risk factors for CL-related infectious keratitis [38].

In this study, all CL users (100%) washed their hands before handling their lenses, a higher rate than reported in Riyadh (89.4%) [17], where students had received prior education about hygienic care of CLs, Khartoum State (79.8%), and the Maldives (44.2%) [12,39].

Most participants (66.7%) obtained prescribed lenses following consultation with an eye specialist, reflecting practitioner influence on CL uptake [24]. In Sudan, only two-thirds acquired their lenses from practitioners [39], while in an urban Saudi population, only one-third of CL users procured their lenses with a prescription [33].

Compliance with changing CL solution during continued use was moderate (66.7%), comparable to other studies [24,39]. These solutions contain antimicrobial agents, preservatives, buffers, and surfactants designed to clean, lubricate, and disinfect lenses [40]. Failure to replace solutions regularly increases contamination risk and predisposes users to infection.

Half of the CL users in this study did not visit an ophthalmologist for periodic check-ups, contrasting with a Ghanaian study where 57.1% attended yearly reviews [24].

There is a pressing need for greater awareness and education about proper CL hygiene and care practices, as ignoring recommended practices may lead to complications and potentially severe vision problems. Consequently, introducing health education programs on CL use and proper hygiene practices could encourage secure and healthy CL use among students.

This study had several limitations. This study did not assess whether participants washed their CLs under running water, handled lenses with wet hands, and stored their lenses in water, nor the complications associated with CL use. Including these variables would have enhanced the comparison with other studies. The study was also limited to one university; future research should include students from other major institutions to provide a more comprehensive national perspective. This study would have greatly benefited from a sub-analysis of the acceptance of CLs based on the refractive status of participants. Further studies on this topic should consider this. Additionally, subgroup analyses based on participants' refractive status and comparisons of cleaning and replacement frequency across CL types would have yielded more detailed insights and should be considered in future studies.

5 Conclusion

Participants in this study generally had poor knowledge of the proper care and usage of CLs, and the prevalence of CL usage in the study population is low. Students generally did not show a positive attitude toward CLs. The majority of individuals who wore glasses showed reluctance toward using CLs, mainly due to the extensive maintenance they require. Generally, CL care and hygiene practices among study participants who use CLs were fairly satisfactory.

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