PLOS ONE

RESEARCH ARTICLE

Demographic profiles of contact lens wearers

and their association with lens wear
characteristics in Trinidad and Tobago: A
retrospective study
Ngozika E. Ezinne1,2☯, Dipesh Bhattarai3‡, Kingsley K. Ekemiri1,2, Gabrielle N. Harbajan1‡,
Anesha C. Crooks1‡, Khathutshelo P. Mashige ID2‡, Alex A. Ilechie4‡, Ferial M. Zeried5‡,
Uchechukwu L. Osuagwu ID6☯*
a1111111111
1 Optometry Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, University of the
a1111111111
West Indies, St Augustine, Trinidad and Tobago, 2 African Vision Research Institute (AVRI), Discipline of
a1111111111 Optometry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, 3 School of
a1111111111 Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia, 4 Department of Optometry and
a1111111111 Vision Science, University of Cape Coast, Cape Coast, Ghana, 5 Department of Optometry & Vision
Sciences College of Applied Medical Sciences, King Saud University, Ilesha, Saudi Arabia, 6 Translational
Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, Australia

☯ These authors contributed equally to this work.

‡ DB, GNH, ACC, KPM, AAI and FMZ also contributed equally to this work
OPEN ACCESS * [email protected]
Citation: Ezinne NE, Bhattarai D, Ekemiri KK,
Harbajan GN, Crooks AC, Mashige KP, et al. (2022)
Demographic profiles of contact lens wearers and
their association with lens wear characteristics in
Abstract
Trinidad and Tobago: A retrospective study. PLoS
ONE 17(7): e0264659. https://doi.org/10.1371/
Purpose
journal.pone.0264659 Contact lenses (CL) remain a popular mode of refractive error correction globally and in the
Editor: Diego Garcı́a-Ayuso, Universidad de Caribbean, mostly among young people. However, no data on the characteristics of the CL
Murcia, SPAIN population wearers in the Caribbean is available. This study reported on the characteristics
Received: February 8, 2022 of CL wearers and the associated factors in Trinidad and Tobago (T&T).
Accepted: July 10, 2022
Methods
Published: July 22, 2022
This retrospective study reviewed the clinical records of 243 CL wearers who attended the
Peer Review History: PLOS recognizes the
University of the West Indies (UWI) optometry clinic between 2017 and 2018. Data on their
benefits of transparency in the peer review
process; therefore, we enable the publication of demographic profiles, CL wearing characteristics including lens type, material, purpose of
all of the content of peer review and author wear, replacement schedule and lens care systems were extracted and analyzed. The asso-
responses alongside final, published articles. The
ciations between the demographic characteristics and CL wearing characteristics were also
editorial history of this article is available here:
https://doi.org/10.1371/journal.pone.0264659 determined.

Copyright: © 2022 Ezinne et al. This is an open

access article distributed under the terms of the
Results
Creative Commons Attribution License, which About half of the CL wearers used them for fashion (more among those aged 18 to 30 years,
permits unrestricted use, distribution, and
61.0%), therapeutic (more among those <18 years, 43.8%, P = 0.001) and refractive error
reproduction in any medium, provided the original
author and source are credited. correction purposes (more in those >40 years, P = 0.001). Females were more likely to use
CLs for fashion compared with males (67.0% versus 40.7%). Age (P<0.0005) and gender
Data Availability Statement: All relevant data are
within the paper and its Supporting Information (P = 0.030) were associated with the lens materials. Those aged 18–30 years were more
files. likely use hydrogels compared with the younger ones (64.1% versus 25.0%). Rigid gas

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PLOS ONE Profiling of Contact lens wearers and associated factors in T&T

Funding: No. The authors had no funding for this permeable (RGP) CL use was more common in males than females (21.8% versus 10.9%,
study. P = 0.031). Daily disposables were predominantly used by younger respondents (18–30
Competing interests: No. The authors have years old, 31.3%, P < 0.001) and more in females than males (66.7% vs 49.4%, P = 0.040).
declared that no competing interests exist.

Conclusion
The study found that the CL appears to be more commonly worn for fashion in younger females
and for refractive error correction in older males. Age, gender, and employment status were
the main determinants of lens wear among respondents attending the university clinic in T&T.

Introduction
Contact lenses (CL) are used for the correction of refractive errors as well as fashion and thera-
peutic purposes [1]. It is estimated that there are over 140 million CL wearers globally [2].
However, over the past decade, the CL industry has experienced advancements in terms of
lens designs and materials which has influenced the choice of wear [3–5]. The use of CL has
been in existence for the past two decades, with ongoing evaluation of different types of CL
worn around the world, to better understand and identify some of the common factors which
influence choice of wear. Global trends indicate that soft CL for daily wear is more popular,
and majority of wearers were females [6–9]. In addition, an increase in silicone hydrogel CL
for daily wear has been reported globally [1, 10, 11]. Rigid CL lens fitting has been shown to
represent a small percentage of the market, particularly in developing countries [7, 12]. The
common factors reported to affect CL wear are demographic profiles of the population,
income, purpose of wear, prevailing eye condition in that area, the range of CL available, level
of education of the optometrist and socio-cultural issues [8, 10, 13].
Trinidad and Tobago (T&T) is a small twin Island republic state in the Caribbean [14] with
a population of 1.4 million people and is regarded as the power house of the English speaking
Caribbean due to its large natural oil and gas reserves [15]. It has only one optometry school
which is located at the University of the West Indies, Saint Augustine campus and started in
2011. Prior to 2009, most optometrists in T&T were foreign trained (UK, USA, Nigeria, and
South Africa) because there was no optometry training institution in the country and across
the Caribbean region. To meet the growing demand for eye care services by increasing the
number of optometrists in the region, the first Bachelor of Science programme in Optometry
was started in T&T at the University of the West Indies and this training brought a lot of
changes in optometry profession across the Caribbean [16].
CL practice in T&T has evolved over the last decades following the emergence of the
optometry programme and together with some other countries in the Caribbean including
Barbados, Guyana, Saint Lucia and Jamaica, the country has benefitted enormously from this
Programme [16] with increase in the optometry manpower. The increase in the number of
optometry graduate from the University of West Indies led to the expansion of optometry
practice with many of the optometrists embarking on different areas of interests including CL
practice. This is possibly due to a high demand for CL wear in private practices because of the
improvement in the socio-economic condition of many in the country.
CL practice in T&T is regulated by the Trinidad and Tobago Optometrists Association
(TTOA) [17]. Optometrists and Ophthalmologists are the only professionals permitted to pre-
scribe CL for the management of refractive error, keratoconus and anisometropia in T&T. The
use of cosmetic CL is not regulated as individuals are free to purchase them from beauty par-
lor, over-the-counter pharmacy shops, online and even supermarkets. Most of the big CL

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PLOS ONE Profiling of Contact lens wearers and associated factors in T&T

companies such as Johnson and Johnson, Acuvue, Bausch and Lomb have their representatives
in the country making various CLs readily available.
CL are gaining popularity worldwide as an alternative to spectacles for the correction of
refractive errors and across different countries, their usage varies with various demographic
characteristics [5, 6, 8, 9]. Approximately 7.2%, 12.0%, 14.6% and 14.7% adult CL usage rates
were reported in the UK, Norway, Japan, and the USA respectively [11]. Unlike the neighbor-
ing countries like the United States, there is a paucity of published data on CL use across the
Caribbean and the characteristics of lens wearers in T&T remain unknown. Considering the
growing popularity of CL use and the fact that demographic profile of lens wearers and associ-
ated factors might vary between countries due to the variations in socioeconomic factors,
more studies are needed to provide an insight into CL wear in different countries including
T&T. The information will aid eye care practitioners and lens manufacturers in T&T to under-
stand the local CL market to assess demand, growth in relation to other countries. The aim of
this study was to determine the demographic characteristic of CL wearers and associated fac-
tors among respondents who attended a university optometry clinic in T&T. This will provide
data for comparison with the global findings.

Materials and methods

Study setting
This study was carried out at the University of the West Indies (UWI) optometry clinic situ-
ated in Couva, an urban town (48,858 in 2011 census) in West-central Trinidad, south of Port
of Spain and Chaguanas [18]. It is the capital and main urban centre of Couva–Tabaquite–Tal-
paro located directly adjacent to the Venezuelan state of Monagas [18]. It is the fourth least
populated city in T&T and has very few optometry clinics. Most (80%) of the optometry prac-
tices in T&T are situated in Port of Spain, which is the nation capital, and it can be assumed
that most CL wearers live there.
The UWI optometry clinic in T&T provides optometry training and services to the public.
It is well equipped and has a highly qualified academic staff complement. CL practice includ-
ing fitting and prescribing CL for keratoconus management is among the eye care services
provided.

Ethical considerations
Approval to conduct the study was obtained from the University of the West Indies, St Augus-
tine campus, Research and Ethics Committee (registration number: CREC.SA.0037/09/2019).
Permission to assess patients’ case files was obtained from the university optometry unit Coor-
dinator, however data were fully anonymized before researchers accessed them. The study fol-
lowed the tenets of the Declaration of Helsinki.

Study design
This was a retrospective review of data from patients prescribed with CL at the UWI optome-
try clinic from January 2017 to December 2018. The records of all patients prescribed with CL
were retrieved and reviewed.

Inclusion and exclusion criteria

Data for all patients prescribed with CL at UWI optometry clinic from January 2017 to Decem-
ber 2018 were included. All patients who wore CL prescribed outside UWI optometry clinic
and those whose CLs prescriptions and details could not be verified, were excluded.

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PLOS ONE Profiling of Contact lens wearers and associated factors in T&T

Data collection procedure

Data collection involved the use of a data extraction sheet to obtain information on the demo-
graphic profile of each patient fitted and CL wearing history and characteristics. These were
based on a review of previous studies [1, 6, 7] and included lens type, purpose of wear (fashion
[i.e. those that are used for masking eye flaws and or enhancing appearance], refractive correc-
tion and therapeutic [i.e. CLs used for the purpose of managing cases such as aphakia, kerato-
conus, irregular cornea, amblyopia therapy and conditions such as ocular surface problems
which need specialized lenses for their management]), [9, 13, 19, 20] lens material (hydrogel,
silicon hydrogel and rigid gas permeable), habitual lens replacement schedule (daily dispos-
able, weekly disposable, monthly disposable and yearly disposable) [1], lens wear modality
(fulltime wear was considered as �8hrs per day and seven days a week and part time as <8hrs
per day) [7], and lens care systems including lens solutions advised for each patient, over two
years.

Statistical analysis
Data were analysed using the IBM Statistical package for Social Sciences (SPSS) version 27
(SPSS Inc., Chicago, USA). Descriptive statistics were computed for all variables after the data
had been screened and the assessed for normality of distribution. Continuous and discrete var-
iables were analyzed using student t test for means and Pearson’s Chi-square test for propor-
tions, respectively.

Results
Demographics of contact lens wearers
Table 1 presents the demographic profiles and CL-related characteristics. Two hundred and
forty-three patients were prescribed with CL at the UWI optometry clinic from January 2017
to December 2018. Their mean age was 29.7 ± 12.7 years (range 4–73 years), and the majority
(59.7%) were in the 18 to 30 years age group. Almost two-thirds (64.2%) were females and
54.4% were from urban areas. About half (51.4%) were unemployed and these were mostly
young people (64.8% were aged 18–30 years).

Contact lens wear profile

The main reason for CL wear was fashion (53.5%) followed by refractive correction (27.2%)
(Table 1). More than two-thirds (44.9%) wore soft spherical or soft lenses (43.5%). For more
than half of the wearers, their CLs materials was polymer-hydrogel (53.1%) and 32.1% wore
silicone-hydrogel lenses while (14.8%) wore RGP lenses. Most (60.5%) wore daily disposable
CLs and 15.6% wore monthly disposables.
Most (61%) record cards did not reflect the type of lens care system used. About one-quar-
ter (24.3%) used multipurpose solution [e.gs include Bausch and Lomb Renu advance formula,
Renu fresh, Renu sensitive and Biotrue multipurpose solutions used for soft CLs] and 14%
used Boston solution by Boston Advance1 care system (Bausch & Lomb, Rochester, New
York).

Multipurpose solution
The mean number of the daily hours and the average number of days the wearers used their
lenses were recorded as 7.8 (SD, 3.1; range 1.5–18 hours) per day and for about 4 days per
week. Majority (60%) wore CL for more than 16 hours per day and 44.45% wore them more
than 4 days a week.

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PLOS ONE Profiling of Contact lens wearers and associated factors in T&T

Table 1. Demographic characteristics of the participants and CL-related variables (n = 243 unless otherwise
specified).
Variables Number of participants (%)
Year
2017 101 (41.6)
2018 142 (58.4)
Demography
Age category
<18 years 16 (6.6)
18–30 years 145 (59.7)
31–40 years 38 (15.6)
>40 years 44 (18.1)
Gender
Male 87 (35.8)
Female 156 (64.2)
Residency (n = 240)
Rural 107 (44.6)
Urban 133 (55.4)
Occupation
Employed 118 (48.6)
Unemployed 125 (51.4)
Purpose of CL wear (n = 226)
Fashion 130 (57.5)
Refractive error Correction 66 (29.2)
Therapeutic 30 (13.3)
CL types (n = 207)
Soft spherical 93 (44.9)
Soft toric 90 (43.5)
Soft multifocal 24 (11.6)
CL material
Hydrogel 129 (53.1)
Silicon hydrogel 78 (32.1)
Rigid Gas permeable 36 (14.8)
Habitual CL replacement schedule
Daily disposable 147 (60.5)
Biweekly disposable 22 (9.1)
Monthly disposable 38 (15.6)
Yearly disposable 36 (14.8)
CL care system
Multipurpose solution 59 (24.3)
Boston solution 34 (14.0)
None (not recorded) 150 (61.7)
CL wear modality (n = 200)
Part time (<8hrs/day) 80 (40)
Full time (�8hrs/day) 120 (60)

CL = contact lens, wear modality. Fashion refers to CL used for masking eye flaws and or enhancing appearance;
therapeutic purpose refers to CLs used for the purpose of managing cases such as aphakia, keratoconus, irregular
cornea, amblyopia therapy and conditions such as ocular surface problems which need specialized lenses for their
management. Boston solution = Boston Advance1 care system (Bausch & Lomb, Rochester, New York).

https://doi.org/10.1371/journal.pone.0264659.t001

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PLOS ONE Profiling of Contact lens wearers and associated factors in T&T

Fig 1. Distribution of purpose of contact lens wear by: (A) age group and (B), gender of wearers.
https://doi.org/10.1371/journal.pone.0264659.g001

Association between demographic variables and the purpose of wear

Fig 1 shows the results for the purpose of CL wear by a) age group and b) gender. Chi-square
analysis showed that the purpose of CLs wear differed between age groups (P = 0.001) and gen-
der of the CL wearers (p = 0.001). Compared with other age groups, those in the 18 to 30 years
age group were more likely to wear fashion CLs (61.0%) whereas therapeutic purposes were
the main reason for CL use among those younger than 18 years (43.8%, P = 0.001). In contrast,
CL wearers older than 40 years (35.9%) were more likely to use CLs for refractive error correc-
tion compared to younger wearers (<18 years, 12.5%, P = 0.001).
A higher percentage of females (67.0% versus 40.7%) wore CL for fashion reasons whereas
more males than females (39.5% versus 23.4%) used CLs for refractive error correction
(P = 0.001).

Association between demographic variables and the CLs material

Age and gender were significantly associated with lens materials worn (both P-values <0.05)
(Fig 2). Participants between the ages of 18 and 30 years were more likely to be prescribed
hydrogel CLs compared with teenagers (less than 18 years) (64.1% versus 25.0%, P < 0.001)
and older adults (more than 40 years) (34.1%, P < 0.001), who were more likely to be pre-
scribed silicon hydrogel CL. There was a significant association between CL material and gen-
der, and 58.3% of females compared with 43.7% of males were prescribed hydrogel CLs
(P = 0.031). No other significant association was found between the material prescribed and
other demographic variables.

Fig 2. Distribution of purpose of contact lens materials by: (A) age group and (B), gender of wearers.
https://doi.org/10.1371/journal.pone.0264659.g002

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PLOS ONE Profiling of Contact lens wearers and associated factors in T&T

Fig 3. Distribution of contact lens wear regimen/replacement schedule by: (A) age group and (B), gender of wearers.
https://doi.org/10.1371/journal.pone.0264659.g003

Association between demographic variables and the replacement schedule

(wearing regimen) of CLs
Age and gender were associated with the CL wear regimen (P < 0.001) (Fig 3). A higher pro-
portion of those below 18 years of age used monthly disposable CLs (43.8%) compared with
other age groups (43.8% versus maximum of 29.5% among those aged more than 40 years,
respectively, P < 0.001). Compared with other age groups, teenagers were less likely to use
daily disposable CLs, which was rather more commonly used by females than males (66.7%
versus 49.4%). By contrast, males were more likely to use extended wear CLs (yearly dispos-
ables, 21.8% versus 10.9%, P = 0.040) than females.

Association between demographic variables and the modality of wear

The modality of wear (full time or part time wear) was not dependent on the age group
(P = 0.068) and gender (P = 0.718). However, in those older than 18 years, there was a ten-
dency for more wearers to use their lenses for eight or more hours each day (46.2% in the <18
years age group compared with 55.4%, 75% and 70.6% in the 18–30, 31–40, >40 years age
groups, respectively). Majority of those who were employed wore their lenses for about eight
or more daily hours compared with those who were unemployed at the time of this study
(68.0% versus 52.4%, P = 0.030).

Association of lens care system and wearing modality

Fig 4 shows the distribution of the CLs by wearing modality. Many (71.8%) silicone hydrogel
and 2.3% of hydrogel wearers used multipurpose solutions to care for their lenses while 94.4%
of RGP CL wearers used the Boston solution. There was a significant association between the
lens care systems and the CL wear regimen/replacement schedules (P<0.0005). All CL wearers
who were prescribed weekly replacement lenses used multipurpose solution. However, lens
care system used by some monthly replacements (2.6%) and twice more of the yearly replace-
ment CL wearers (5.6%) were not recorded in their files at the time of the review.

Discussion
This retrospective study investigated the characteristics of CL wearers and their association
with lens characteristics using data from a clinic population in T&T over two years. The study
found that CLs wearers were mostly young, unemployed females who lived in the urban areas

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PLOS ONE Profiling of Contact lens wearers and associated factors in T&T

Fig 4. Distribution of contact lens care systems by wear modality.

https://doi.org/10.1371/journal.pone.0264659.g004

of T&T. Soft, polymer-hydrogel and daily disposable CLs were the most frequently used CL
types, materials and wearing regimen, respectively among the CL wearers. Although most CL
wearers were full time lens wearers, fashion was cited as the main reason for lens wear.
The findings that most CL wearers were females and used them for fashion reasons are con-
sistent with previous studies and this can be attributed to the perception that CLs are used for
fashion [4, 6, 8]. The fact that daily disposable CLs were more common among females than
males suggests that females may be prioritizing their expenditure on facial fashion than males
since wear of daily disposable lenses is a more expensive option than extended wear lenses
[12]. Similarly, cost of daily disposable lenses may explain the finding that daily disposable CLs
was not the lens of choice for teenagers.
Most of the CL wearers in our study were between 18–30 years and only few were above 40
years. This is consistent with findings from other studies [7, 21–23] and Morgan et al [24]
report of 31.70 (± 14.8) years as the global average age of CL wearers. This could be because
this age group is more aware of better optical, occupational, and cosmetic benefit of CL when
compared with spectacles. Contrary to our study findings on older age group, international CL
prescribing surveys in developed countries including Germany, Canada, Australia, Nether-
lands, United Kingdom, and United States recorded a higher use of CLs among older age
groups (�30 years) [25, 26]. CL use is still growing in T&T just like in other developing coun-
tries. More awareness on the availability of various CLs for older age groups in T&T are highly
advised.
Most older CL wearers (> 40 years) in our study used CLs for refractive error correction,
which is consistent with trends observed in the USA where the use of CLs for presbyopia cor-
rection is on the rise [11]. This may be due to the advancement of CL materials [4] and better
understanding of the relationship between the corneal surface and the prescribed CL materials
[3]. In contrast, younger patients showed a preference for fashion CLs use, however, 64.8%
were unemployed compared with only 13.2% of those aged 31–40 years who also had more
people using. While the use of CLs for fashion purpose among young people in this review is
high, there is a tendency for increased ocular complications in this age group due to poor com-
pliance [9]. There is need for targeted CL education either in form of booklet or media cam-
paign to encourage proper lens hygiene and improve compliance [27].

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PLOS ONE Profiling of Contact lens wearers and associated factors in T&T

Half (51%) of the CL wearers in this study were unemployed and this could be because
most of them were students. Proximity of the UWI optometry clinic to the University of the
West Indies, Saint Augustine main campus could be the reason for the high utilization of CL
among students recorded. High utilization of CLs among students were also reported in stud-
ies in Abuja, Nigeria [28] and Sudan [1]. Moreover, students are more conscious of appearance
which explains the reason for fashion as the major indication for CL wear in this study.
Previous studies have shown that CL related complications including discomfort were
higher among presbyopes than non-presbyopes [13, 19] while young lens wearers showed
poorer care/compliance than their older counterparts [9]. In a study done by Young et al., they
reported that silicone-hydrogel CLs provided better comfort than the hydrogel CLs, especially
in the adverse environment [29]. These may explain the preference to fit most teenagers and
presbyopes with silicon-hydrogel CL material compared with most adults aged between 18
and 40 years, who were fitted with hydrogel CLs material in this study.

Limitations and strengths

The following limitations should be considered in the interpretation of the study findings and
when comparing this study to previous or future studies. First, a valid inference could not be
made from our data for the whole T & T population since the data was collected from one
clinic. Second, due to the retrospective nature of the study, individual’s CL wear and care hab-
its could not be investigated. Third, without directly observing the CL wearers, the researchers
could not verify the recorded responses in the patients’ files. In addition, incomplete docu-
mentation common in retrospective studies was another limitation. For example, the type of
lens care system used was not recorded for majority of the patients in this study. Despite the
limitations, our study provided baseline data on the demographical profile of CL in T&T and
could be used for comparison across the Caribbean in future studies. Although, our study sam-
ple may be biased towards clinic population it reflected the small population of the island
(1.399 million) and greater than the sample size used in similar studies elsewhere including
Ghana [8], Australia [30], Malaysia [31], Maldives [32], Saudi Arabia [33], South Africa [34],
and Jordan [35]. Further studies on CL use in the Caribbean including the investigation of
other factors such as types of refractive error, knowledge and attitude of lens wearers and
hygiene are warranted.

Conclusion
CL use appears to be more common among younger females for fashion and older males for
refractive correction. Age, gender, and employment status were the main determinants of lens
wear among CL wearers attending the university clinic in T&T.

Supporting information
S1 Data.
(XLSX)

Author Contributions
Conceptualization: Ngozika E. Ezinne.
Data curation: Ngozika E. Ezinne, Kingsley K. Ekemiri, Gabrielle N. Harbajan, Anesha C.
Crooks.
Formal analysis: Dipesh Bhattarai, Uchechukwu L. Osuagwu.

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PLOS ONE Profiling of Contact lens wearers and associated factors in T&T

Funding acquisition: Ferial M. Zeried.

Investigation: Ngozika E. Ezinne, Kingsley K. Ekemiri, Gabrielle N. Harbajan, Anesha C.
Crooks, Khathutshelo P. Mashige, Uchechukwu L. Osuagwu.
Methodology: Ngozika E. Ezinne, Dipesh Bhattarai, Kingsley K. Ekemiri, Gabrielle N. Harba-
jan, Anesha C. Crooks, Alex A. Ilechie, Ferial M. Zeried, Uchechukwu L. Osuagwu.
Project administration: Ngozika E. Ezinne, Uchechukwu L. Osuagwu.
Software: Dipesh Bhattarai.
Supervision: Ngozika E. Ezinne, Khathutshelo P. Mashige, Alex A. Ilechie, Uchechukwu L.
Osuagwu.
Validation: Khathutshelo P. Mashige, Ferial M. Zeried.
Writing – original draft: Ngozika E. Ezinne, Dipesh Bhattarai, Anesha C. Crooks, Uche-
chukwu L. Osuagwu.
Writing – review & editing: Ngozika E. Ezinne, Dipesh Bhattarai, Kingsley K. Ekemiri, Gab-
rielle N. Harbajan, Khathutshelo P. Mashige, Alex A. Ilechie, Ferial M. Zeried, Uchechukwu
L. Osuagwu.

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