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Medical Forum / General / Vision / June 2006will acuvvue oasys or advance 2 be okay for swimming?
will acuvvue oasys or advance 2 be okay for swimming? i would like some contacts for swimming in the ocean Salt water shrinks all soft contacts. Soft lenses are between 1/3 and 2/3 water, and that water content is needed for the lens to hold its shape. Our "normal" tears are like normal saline, and have a little bit of salt in them. When we cry an emotional tear, the salt content is much higher. This is why soft contacts hurt more and misbehave when you have been crying over the loss of a loved one, etc. Also, there is an infection risk. Ocean water grows many microbes, plus your lenses will stick like glue to your corneas. Buy a really airtight goggle if you swim in soft contacts, and throw them away after each swim. If you are nearsighted and don't have a lot of astigmatism there are ready-made swim goggles with minus lenses in them from -1.00 to -6.00. They retail for about 35 bucks and they are worth every penny! Here's a link to the website of the prescription swim goggle company. http://www.hilco.com/catalog/catalog_browse.asp?ResultType=single&prodID=3226&ID Type=internal > When we cry an emotional tear, the salt content >is much higher. Really? I always thought the major lacrimals secreted a lower salinity than that of the normal precorneal film. Where does all that salt come from? If it's stored up in the lacrimal gland, it must deplete with continued crying, no? > This is why soft contacts hurt more and misbehave when >you have been crying over the loss of a loved one, etc. I thought it was because of just the opposite, more dilute salinity in the cry tears causing the cornea and contacts to take on too much fluid and swell. > Also, there is >an infection risk. Ocean water grows many microbes, plus your lenses >will stick like glue to your corneas. > Infection risk in the ocean is pretty low. The high salinity there is strongly anti-microbial. Like glue? I would think low water lenses (like modern silicone based ones) are less prone to osmotic dehydration, and unless swimming under the surface with eyes open, not a big factor. >Buy a really airtight goggle if you swim in soft contacts, and throw >them away after each swim. > I don't think so, unless you happen to swim into a plume of recently released marine mammal excrement. w.stacy, o.d. Doctor_my_Eyes wrote: >>Buy a really airtight goggle if you swim in soft contacts, and throw >>them away after each swim. Bill Stacy replied: >I don't think so, unless you happen to swim into a plume of recently >released marine mammal excrement. Candidly ... not so much since Otis reduced his posting frequeny here ;-) > will acuvvue oasys or advance 2 be okay for swimming? > > i would like some contacts for swimming in the ocean IMHO, silicone lenses provide a certain degree of safety for those who swim with lenses on the eye. They tend to not dehydrate in hypertonic saline ocean water as much as other materials and therefore less likely to adhere to the cornea. They are also less likely to harbor pathogens--bacteria and viruses that are found (sadly at intolerable levels in some places) in ocean water. Lenses that have been exposed to ocean and even swimming pool water should not *ever* *ever* be slept in without prior cleaning and disinfection. For extra safety, remove lenses following swimming and disinfect them prior to re-use. For even better safety, use daily disposable lenses and toss them (not in the ocean) after your swim. The "official" rule is: do not swim with contact on. The safest route is to use prescription swim goggles. But if you must, follow the guidelines above. LB, O.D. > IMHO, silicone lenses provide a certain degree of safety for those who > swim with lenses on the eye. They tend to not dehydrate in hypertonic > saline ocean water as much as other materials and therefore less likely > to adhere to the cornea. They are also less likely to harbor > pathogens--bacteria and viruses that are found (sadly at intolerable > levels in some places) in ocean water. Studies show that acanthamoeba has a prediliction for attachment to silicone-hydrogel lenses. What this means in terms of infection is not clear at this time. However, I would not want to be wearing a lens that had attracted thousands of little amoebic organisms from swimming. DrG >> IMHO, silicone lenses provide a certain degree of safety for those who >> swim with lenses on the eye. They tend to not dehydrate in hypertonic [quoted text clipped - 7 lines] >clear at this time. However, I would not want to be wearing a lens >that had attracted thousands of little amoebic organisms from swimming. Mmmmm. Data. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 6360208&dopt=Abstract OR: http://tinyurl.com/p5mvj Attachment of Acanthamoeba to first- and second-generation silicone hydrogel contact lenses. Beattie TK, Tomlinson A, McFadyen AK. Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom. t.k.beattie@gcal.ac.uk PURPOSE: To investigate the attachment of Acanthamoeba to first- and second-generation silicone hydrogel contact lenses, and to determine if patient wear or the presence of a bacterial biofilm coating affects attachment characteristics. DESIGN: Experimental study. PARTICIPANTS AND CONTROLS: Attachment to the silicone hydrogel lenses was compared with that to a conventional hydrogel control lens. Sixteen replicates (n = 16) were carried out for unworn, worn, and biofilm-coated lenses of each type. METHODS: Unworn, worn, and Pseudomonas aeruginosa biofilm-coated first-generation (lotrafilcon A) and second-generation (galyfilcon A) silicone hydrogel and conventional hydrogel (etafilcon A) lens quarters were incubated for 90 minutes in suspensions of plate-cultured Acanthamoeba castellanii trophozoites. MAIN OUTCOME MEASURES: Trophozoites attached to one surface of each lens quarter were counted by direct light microscopy. Logarithmic transformation of data allowed the use of parametric analysis of variance for statistical analysis. RESULTS: Attachment of Acanthamoeba was affected significantly by lens material type (P<0.001), with higher numbers of trophozoites attaching to the first-generation lotrafilcon A silicone hydrogel lens, compared with the second-generation galyfilcon A lens and the conventional hydrogel lens. Attachments to the latter 2 lenses did not differ significantly from each other (P = 0.126). Patient wear and the presence of a bacterial biofilm had no significant effect on attachment to the lotrafilcon A lens (P = 0.426) but did significantly increase attachment to the galyfilcon A (P<0.001) and the etafilcon A (P = 0.009) lenses; attachment to the latter 2 lenses was still significantly less than that found with the first-generation silicone hydrogel (P<0.001). CONCLUSIONS: Acanthamoeba demonstrated a significantly greater affinity for the first-generation silicone hydrogel lens as compared with the second-generation silicone hydrogel and the conventional hydrogel. If exposed to Acanthamoeba (e.g., when showering or swimming, through noncontinuous wear and ineffective lens care regimes), first-generation silicone hydrogel lenses may promote a greater risk of Acanthamoeba infection due to the enhanced attachment characteristics of this lens material. However, prospective studies in patients are required to determine if these experimental results are clinically significant. nice find on the abstract Neil! new information for me! wouldn't one expect that overnight hydrogen peroxide treatment (e.g. ClearCare) might appropriatedly disinfect SiHy lenses that were worn for swimming? i usually recommend that but i admittedly haven't seen any proof that it actually works (for bacteria, acanthamoeba, and other organisms). anyone know or have an opinion? ========== > >> IMHO, silicone lenses provide a certain degree of safety for those who > >> swim with lenses on the eye. They tend to not dehydrate in hypertonic [quoted text clipped - 58 lines] > patients are required to determine if these experimental results are > clinically significant. > nice find on the abstract Neil! new information for me! > [quoted text clipped - 3 lines] > any proof that it actually works (for bacteria, acanthamoeba, and other > organisms). anyone know or have an opinion? Actually, I'm glad you asked. Some 15 or so years ago, during THE acanthamoeba scare, I remember receiving an advisory from the University of Texas Southwestern Medical Center about appropriate lens disinfection. The advisory recommended a minimum 6 hour soak in 3% hydrogen peroxide to kill the acanthamoeba trophozoa and spores. Unfortunately, with commercially available hydrogen peroxide systems, the concentration begins to drop immediately as soon as the peroxide comes into contact with the catalyst. However, the Optifree solution with Aldox also kills acanthamoeba spores following a 6 hour exposure. DrG >> nice find on the abstract Neil! new information for me! >> [quoted text clipped - 15 lines] >However, the Optifree solution with Aldox also kills acanthamoeba >spores following a 6 hour exposure. After the Renu MoistureLoc thing, I got smart/silly/scared/wise and bought the PuriLens system (no financial interest, blah, blah, blah). The few studies I saw seemed to indicate pretty good efficacy against most of the creepy-crawlies ... except ... of course ... acanthamoeiba. Not sure I really plan to be *that* careful or *that* meticulous, BUT ... if I did swim in the ocean, I would likely use a "standard" chemical method in addition. So far, the PuriLens seems to do a heck of a job taking my potential exhaustion/laziness out of the equation and maintaining at least a high (if not ultimate) level of cleanliness and sterility. The whole "15 minutes" thing, too ... neat. Kind of wonder, by the way, whether a *second* 15-minute cycle would be any more effective against acanthamoeba than just one go..... http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=14722469&query_hl=13&itool=pubmed_docsum OR: http://tinyurl.com/ord42 Disinfection capacity of PuriLens contact lens cleaning unit against Acanthamoeba. Hwang TS, Hyon JY, Song JK, Reviglio VE, Spahr HT, O'Brien TP. Ocular Microbiology and Immunology Laboratory, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Woods 259, Baltimore, MD 21287-9121, USA. PURPOSE: The PuriLens contact lens system is indicated for cleaning and disinfection of soft (hydrophilic) contact lenses by means of subsonic agitation to remove lens deposits and microorganisms, and ultraviolet irradiation of the storage solution for disinfection. The capacity of the PuriLens system to disinfect storage solutions contaminated with known concentrations of Staphylococcus aureus, Pseudomonas aeruginosa, and Acanthamoeba species was evaluated. METHODS: An in vitro assessment of the antibacterial and antiparasitic efficacy of the PuriLens system was performed. Separated batches of the storage solution for the cleansing system were contaminated with stock strains of S. aureus and P. aeruginosa. A comparison of the microbiologic content was made between the solution before and after the cycle. RESULTS: The PuriLens system effectively eradicated S. aureus and P. aeruginosa organisms after a 15-minute cycle. However, viable cysts of acanthamoeba were recovered in the solution after the 15-minute cycle. CONCLUSIONS: The PuriLens system is highly efficient in protecting against contamination with common bacterial ocular pathogens. Acanthamoeba cysts, however, can survive in the solution or contact lens bath undergoing integrated subsonic debridement and indirect ultraviolet light disinfection. Use of chemical disinfecting solutions that contain agents such as chlorhexidine or other cationic antiseptics may be advisable in conjunction with use of the PuriLens device, especially in high-risk settings. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=10946984&query_hl=13&itool=pubmed_docsum OR: http://tinyurl.com/p82fk Evaluation of the PuriLens contact lens care system: an automatic care system incorporating UV disinfection and hydrodynamic shear cleaning. Choate W, Fontana F, Potter J, Schachet J, Shaw R, Soulsby M, White E. Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock 72205, USA. PURPOSE: This study evaluates lens care using the PuriLens System, an advanced way to clean and disinfect soft hydrophilic lenses using subsonic agitation and UV radiation, respectively. METHODS: A two-period crossover lens cleaning and safety investigation was conducted using 80 patients. Disinfecting efficacy was tested in accordance with standard FDA protocols. Lens compatibility was studied with Group I and Group IV lenses during the equivalent of a 6-month care regimen by measuring: lens power, base curve, wet diameter, refractive index, clarity, and tint. Safety was evaluated through slit-lamp findings, wearing time, comfort, and visual acuity. RESULTS: The mean wearing time of patients in the study was 13.79 hours. No slit lamp findings greater than grade 2 were noted. Visual acuity was 20/25 or better in 92.5% of examinations. None of the patients lost more than two lines of acuity. Lens surface evaluation showed no deposits (grade 0) to very slight deposits (grade 1) in 94.4% of examinations. Lenses cleaned with the PuriLens System were cleaner by a statistically significant margin (P=0.02) compared to lenses digitally cleaned with a leading multi-purpose solution (ReNu, Bausch & Lomb). Overall, neither the Group I nor Group IV lenses were affected after 180 cleaning cycles. CONCLUSIONS: The PuriLens System provides automatic lens care compliance, superior antimicrobial efficacy, and eliminates the need for daily digital cleaning. The better option would be to buy a set of dailies and use them. Once you get to waist depth, squint your eyes a bit and splash some water on the lenses. This will tighten them and stop them from coming off. I have a few ocean swimmers and triathletes as patients and this is the procedure we use. Discard the lenses after swimming.\ dr grant >Studies show that acanthamoeba has a prediliction for attachment to >silicone-hydrogel lenses. In vitro or in vivo? Most eye doctors will never see a case of acanthomeba keratitis in the course of their entire career, so I think the risk is quite low. Of course, not swimming in your contacts is safest, but does one want to be a caricature of caution? > >Studies show that acanthamoeba has a prediliction for attachment to > >silicone-hydrogel lenses. [quoted text clipped - 3 lines] > Most eye doctors will never see a case of acanthomeba keratitis in the > course of their entire career, so I think the risk is quite low. True, but I saw four cases in a 6 month period two years ago. > Of course, not swimming in your contacts is safest, but does one want > to be a caricature of caution? You should speak to the mother who emailed me today about her daughter's experience with acanthamoeba keratitis and 3 subsequent corneal transplants. I'm pretty sure how she would answer your question. DrG >> >Studies show that acanthamoeba has a prediliction for attachment to >> >silicone-hydrogel lenses. [quoted text clipped - 5 lines] > >True, but I saw four cases in a 6 month period two years ago. Regardless, acanthamoeba keratitis is extremely rare -- especially if you do not work in large University setting or major referral center. Even more so since people stopped preparing their own saline with water and tablets. >> Of course, not swimming in your contacts is safest, but does one want >> to be a caricature of caution? [quoted text clipped - 3 lines] >corneal transplants. I'm pretty sure how she would answer your >question. Regardless, the incidence of acanthamoebal keratitis is extremely low (less than 1 in 1.6 MILLION!) When I educate patients, I do NOT recommend people swim in their lenses. But I give them the REALISTIC risk of developing an infection. After that, patients make up their mind whether they choose to swim in their lenses or not <-- informed consent. As an OD, have no undue fear about personally swimming in my silicone hydrogel contact lenses. The risk of severe injury by car accident or cancer is much greater. Everyone has their comfort zone. > Regardless, the incidence of acanthamoebal keratitis is extremely low > (less than 1 in 1.6 MILLION!) I think you are in need of updating your numbers, which reflect the annual incidence in the overall population. Contact lens wearer is one of the chief risk factors for this disease. The updated incidence is 1 in 30,000 soft contact lens wearers per year. > When I educate patients, I do NOT recommend people swim in their > lenses. But I give them the REALISTIC risk of developing an > infection. After that, patients make up their mind whether they > choose to swim in their lenses or not <-- informed consent. Then, you should be telling them that their risk of contracting the disease is 1 in 30,000 per year, which will go up significantly if they swim in their lenses, rinse them with non-sterile solution, or fail to disinfect them properly. > As an OD, have no undue fear about personally swimming in my silicone > hydrogel contact lenses. The risk of severe injury by car accident or > cancer is much greater. Everyone has their comfort zone. Cancer may not be preventable, but acanthamoeba keratitis is highly preventable if patients avoid the major risk factors, which include swimming in their contact lenses (34%), and failure to disinfect their lenses (62%). DrG http://www.copfameye.com >> Regardless, the incidence of acanthamoebal keratitis is extremely low >> (less than 1 in 1.6 MILLION!) [quoted text clipped - 3 lines] >of the chief risk factors for this disease. The updated incidence is 1 >in 30,000 soft contact lens wearers per year. Correct. >> When I educate patients, I do NOT recommend people swim in their >> lenses. But I give them the REALISTIC risk of developing an [quoted text clipped - 5 lines] >swim in their lenses, rinse them with non-sterile solution, or fail to >disinfect them properly. I go over rare things such as acanthamoebal keratitis very quickly. I have been spending a lot more time lately answering questions about fusarium keratitis which is also *extremely* rare. I *emphasize* and spend more time on the more common conditions and risk factors such as bacterial keratitis/GPC and extended wear/proper lens care/hygiene. >> As an OD, have no undue fear about personally swimming in my silicone >> hydrogel contact lenses. The risk of severe injury by car accident or [quoted text clipped - 4 lines] >swimming in their contact lenses (34%), and failure to disinfect their >lenses (62%). Still, the risk is extremely low. Contact lens wear, in and of itself, is a huge risk factor for acanthamoebal keratitis. I am more concerned with endophthalmitis (no more than 1 in 3,000) after cataract surgery or iatrogenic corneal ectasia after LASIK than acanthamoebal keratitis due to swimming in contact lenses. Some patients are willing to accept that risk, some are not after given the epidemiology, natural history and risk factors. Good discussion. > Still, the risk is extremely low. > [quoted text clipped - 8 lines] > > Good discussion. I agree, except that we don't really know what the risk is for people who routinely swim in their lenses. It could be 1 in 500. Overall, contact lens wear is the least risky form of vision correction other than wearing spectacles. DrG I think it would make a huge difference WHERE they are swimming. To me, swimming in the ocean is very safe for your eyes (only) due to the antimicrobial effect of strong saline, more risky in private swimming pools, riskier yet in public pools, very risky in hot tubs, and extremely risky in freshwater ponds. w.stacy, o.d. > I agree, except that we don't really know what the risk is for people > who routinely swim in their lenses. It could be 1 in 500. I'm not aware of any studies that would either support or contradict your view. I know that one study of acanthamoeba claimed that the risk was greater if the water was soft rather than hard. Then someone came along and debunked that idea. If acanthamoeba didn't like salt water, then they wouldn't inhabit the salty environment of contact lens solutions. I think that the risks need to be clearly spelled out, and that patients who insist on swimming in contact lenses avail themselves of daily disposables so that the lenses can be thrown away. There is also the role of hypoxia and corneal integrity, and extended wear may also enter the mix as a risk factor. You can only go so far to warn people. DrG I doubt a study is needed on the disinfecting properties of strong saline the sea as compared to the exceedingly weak salines of tears and/or ophthalmic solutions, or even saline swimming pools (which are also of the "normal" saline variety). Certainly if it were not the case, the oceans would be teeming with all kinds of bacteria, which they are not. Normal saline is under 1%, sea water is at least 3.5% salt. Here's a quote from: http://141.150.157.117:8080/prokPUB/chaphtm/004/04_04.htm "High salt concentrations represent a special case of low water activity. Sea water (aw = 0.98) is not tolerated by the majority of bacteria living in soil and in fresh water. Ecosystems containing salt (sodium chloride) at saturating concentrations are inhabited by only a few organisms." w.stacy, o.d. > I'm not aware of any studies that would either support or contradict > your view. I know that one study of acanthamoeba claimed that the risk [quoted text clipped - 10 lines] > > DrG I am talking about acanthamoeba, not bacteria. Just Google on the search terms of acanthamoeba and salt water and see how many hits you get. Quite a few (I didn't count). DrG Of course they grow very well in NORMAL saline, and the tons of articles are mostly about normal saline, not brine. I'm sure they can survive up to a certain amount of salinity, but I'm just betting they don't do well in the open ocean. w.stacy, o.d. > I am talking about acanthamoeba, not bacteria. Just Google on the > search terms of acanthamoeba and salt water and see how many hits you > get. Quite a few (I didn't count). > > DrG Then type in the search terms "acanthamoeba and ocean water." You will get the same number of hits. The size of your corner is getting ever smaller. DrG > Then type in the search terms "acanthamoeba and ocean water." You will > get the same number of hits. The size of your corner is getting ever > smaller. Many people believe that life evolved in the ocean. Go to any large aquarium (I've mostly been to the Monterrey Bay Aquarium, a fascinating place) and see how many critters live in salt water. Some are filter feeders, living on microscopic organisms. A theory is that the concentration of salt in our blood matches that of the ocean at the time we evolved.  SignatureDan Abel dabel@sonic.net Petaluma, California, USA I have to make a strong case for the risks of ocean water. At least here in Southern Cal, and especially after the rains wash tons of human and animal excretement, dead carcasses and agricultural waste into the ocean---well, not a good time to be getting that water in your eyes or any body orafice. Beaches are routinely posted "avoid contact with ocean water---may cause illness." Ear infection, eye infection, fever and cough, cases of Hep A and even B, colitis, vomiting and "the big D". Yeah, it's a sad state of affairs but real. I get my arsenal of antibiotic eye drops and referral documents to MDs ready and away we go. It does not please me that contaminated ocean water is good for my business. I ALWAYS make it quite clear that swimming with contact lenses on the eye is a risk that MUST be mitigated by either not doing it, using single-use lenses or careful disinfection following ocean water contact. And NEVER EVER sleep in those same lenses that day and prior to disinfection. Yet that being said, I have had but a handful of patients who have experienced cornea pathology as a possible result of water sports and zero have lost any vision. Then again I routinely dismiss (eg: "go find another doctor") patients who are non compliant with lens hygiene and replacement protocols. LB, O.D. PS: Doc (apparently) Anon E Mus: feel free to be who you are. We don't bite. > Then type in the search terms "acanthamoeba and ocean water." You will > get the same number of hits. The size of your corner is getting ever > smaller. > > DrG Using the following google searches, I get the indicated # of hits: acanthamoeba and salt water 24700 acanthamoeba and sea water 29000 acanthamoeba and "salt water" 1340 acanthamoeba and "sea water" 864 It is very important when doing such searches to place in quotes key word pairs. The following quote is from the first hit on the last search: Acanthamoebae have also been isolated from salt water of low salinity, presumably from cysts. One author (AR) has never managed to maintain 'marine strains' on full salinity media for more than a few generations. I still say that swimming in the ocean is very safe for the eyes, except possibly near active sewage inlets. w.stacy, o.d. > > Then type in the search terms "acanthamoeba and ocean water." You will > > get the same number of hits. The size of your corner is getting ever [quoted text clipped - 23 lines] > > w.stacy, o.d. Who cares just so long as the fact remains that acanthamoeba are present in the ocean, as is evident within the first page of returns. They are also present in soil. There are also strains of bacteria that have adapted quite well to not only the salinity of the ocean, but also survive at great depths. In a related topic, in reading about methods of food preservation, it is generally accepted that a minimum concentration of 10% sodium chloride is necessary. So, given those facts, if someone still wants to wear their contacts in the ocean instead of wearing prescription goggles, then I am not going to give it my blessing. They assume the risk solely and completely. If they want to have LASIK so that they don't have to worry about any of this, then that is another set of risks. DrG > Who cares just so long as the fact remains that acanthamoeba are > present in the ocean, Anyone who is interested in the science behind the professions. They assume the risk solely and completely. What a joke. Tell *that* to the jury. w.stacy, o.d. > I'm not aware of any studies that would either support or contradict > your view. I know that one study of acanthamoeba claimed that the risk [quoted text clipped - 10 lines] > > DrG > > >Studies show that acanthamoeba has a prediliction for attachment to > > >silicone-hydrogel lenses. [quoted text clipped - 15 lines] > > DrG I am the mother who Dr. G spoke to several weeks ago. I share the following information with you. There is a risk with swimming in contacts. The problem is consumers are not fully aware of this risk. We should be fully informed and if you want to take that risk, go ahead, but let us know ALL the risks. There is an increasing trend of Acanthamoeba infections in the last several years in certain areas in this country. Some of our ophthalmologists are very concerned. This infection has been more common abroad because of the older water systems. Acanthamoeba is ubiquitous in nature. It is in our tap water, lakes, pools, hot tubs, air, soil. Most contact lens solutions do not kill Acanthamoeba even in the required disinfectant times. Prevention and education is critical to keep our eyes safe. We need to question why it is on the FDA website that you do not swim with contacts yet most consumers are clueless about this risk as well as our eye health practitioners. We also need to question why a non-prescription contact lens was deregulated and sold in dolllar stores for four years. Our youth started getting this infection. Prevent Blindness Amercia and other concerned eye health organizations had to draft legislation, which was passed this year after pending in Congress for two years, to make it illegal to prescribe any contact lens without going through a licensed eye practitioner. I make these statements and have become involved in eye health advocacy because my daugther who was fourteen at the time contracted Acanthamoeba keratitis when she swam with her contacts. She battled this infection for two years and received three corneal transplants. The parasite simply would not die. Medical therapies were astronomical not to mention her pain and suffering. She is now bug free, but her vision in her left eye has been compromised the rest of her life. You can read her story on the Prevent Blindness America website, "Eyes on Capitol Hill" and her advocacy efforts when she told her story to legislators and the importance of the Vision Preservation Act, legislation that must be passed. Please write your Congressman supporting this legislation. 15-20 years ago you just lost your eye as we had no medical therapies to fight this parasite. At the time, I sought out other people who also had this infection as I felt very alone and needed support. We have formed a support group called MAAD (Mothers Against Acanthamoeba Disease). I believe this is the only support group of its kind in this country. Please read these stories of our other MAAD group members who have suffered this tragedy. We want to be involved to protect and support other people as we would not wish this infection on our worst enemies. Our eyesight is too precious not to be protected. mary beth my daugther who was fourteen at the time contracted > Acanthamoeba keratitis when she swam with her contacts. Can you share with us where she was swimming? (pool, pond, ocean?) thanks w.stacy, o.d. > my daugther who was fourteen at the time contracted > > Acanthamoeba keratitis when she swam with her contacts. [quoted text clipped - 4 lines] > > w.stacy, o.d. She swam in a self enclosed private lake which included a pond. When she was finally diagnosed correctly, our doctor said it was a slow growing infection to start and slow to leave. She first was diagnosed with pink eye for two weeks. Did not get to the right doctor for about 5-6 weeks, by that time it was out of control and burrowed deeper into her cornea. > I am the mother who Dr. G spoke to several weeks ago. I share the > following information with you. There is a risk with swimming in > contacts. The problem is consumers are not fully aware of this risk. > We should be fully informed and if you want to take that risk, go > ahead, but let us know ALL the risks. Dr. G and I agree with you, of course. We make every effort to carefully educate our patients about the risks and ways to mitigate them. The contact industry has responded by producing lenses that have less impact on cornea physiology and disinfection products that do the job. Our peer journals have articles addressing this issue, most recently this month: the big cover story in one such journal. We hear the warnings and advice at continuing education seminars. Most professional and competent eye doctors do indeed tell their patients how to manage their eye care. Helping to keep our patient's eyes healthy is our job and ethical responsibility, not to mention it's good for business. But the wearer must take the ultimate responsibility to "do the right thing" after they are fully informed and this, I think is where the problem lies. Save a buck, stretch out the longevity of the lens, re-use (or don't use) appropriate lens care products, re-order lenses by mail without a prescription and without routine eye doctor visits, dig in the garden and forget about washing up before handling lenses, ignore symptoms of things gone wrong until it's too late. There's only so much education and hand-holding we can do. The problem is not with the contact lenses but with how they are used and handled. Look at the recent fungus scare. Less than a dozen people with "severe" problems and a hundred or so affected people out of 30 million regular contact lens wearers is an issue blown way out of proportion. The reality of thousands of people with completely avoidable and preventable "minor "eye health issues that can escalate to "serious" and resulting from poor lens fitting or lens care is a major concern. I'm sorry to hear about your daughter. Your advocacy will help to prevent these kinds of tragedies from affecting others. It's been difficult to get the US federal and state governments to do their part. We try. You are trying. Thanks for your efforts. LB, O.D. > > I am the mother who Dr. G spoke to several weeks ago. I share the > > following information with you. There is a risk with swimming in [quoted text clipped - 40 lines] > > LB, O.D. I highly dispute your statement, this issue was "blown out of proportion." First of all, you NEVER would have even heard about this fusarium outbreak if the Singapore health ministry did not demand answers and pull this product from the market. That is the only reason why the CDC and FDA stepped in. These infections would have continued to occur. This product was NEVER tested for its efficacy against fusarium yet it was allowed to be purchased by consumers with the FDA's stamp of approval. The company blatantly admitted this. If there was one death with this product, it would have been pulled from the market, yet 200 people going blind is nothing? If your own child was affected with this infection or Acanthamoeba, I am sure your mindset would be different. mb >This product was NEVER tested for its efficacy against >fusarium yet it was allowed to be purchased by consumers with the >FDA's stamp of approval. The company blatantly admitted this. I don't know if this was true, but it wouldn't be surprising. Fusarium is/was an extremely rare cause of keratitis. Like acanthamoeba, most eye doctors will never see even ONE case of these in their entire career. For a contact lens solution to be tested against every potential pathogen was unrealistic. However, that may change now. >If there was one death with this product, it would have been pulled >from the market, yet 200 people going blind is nothing? Where do you get this number? 200 people being affected is certainly not necessarily the same as 200 people "going blind". The vast majority of people with acanthamoeba or fungal keratitis certainly do NOT go blind. > >This product was NEVER tested for its efficacy against > >fusarium yet it was allowed to be purchased by consumers with the [quoted text clipped - 16 lines] > majority of people with acanthamoeba or fungal keratitis certainly do > NOT go blind. If one person goes blind because of a faulty product, that is very sad. A corneal transplant will affect your vision the rest of your life. Below is one man who trusted a product he was putting in his eye. On May 15, 2006 the FDA issued a press release stating: "Based on this scientific and epidemiological data suggesting that ReNu with MoistureLoc may increase susceptibility to Fusarium, Bausch & Lomb has decided to permanently remove the ReNu with MoistureLoc product worldwide." The recall followed Bausch & Lomb's conclusion that the product's formula may increase the risk of fungal eye infections in certain situations. Bausch & Lomb, Inc. and the FDA both acknowledged there is a problem in the chemical properties of ReNu with MoistureLoc after testing confirmed that the solution allows a polymer film to form around the Fusarium fungus, preventing the disinfectant in the product from killing the fungus. The injured party, who resides in upstate New York, was diagnosed with a fungal infection in his left eye in October 2005, and was referred to a cornea specialist at Columbia Presbyterian in New York City. The specialist performed a corneal confocal microscope exam and several biopsies, which confirmed the diagnosis of Fusarium keratitis. The specialist notified the plaintiff that a cornea transplant would be necessary. Because the transplant procedure could not be performed until the infection was under control, the victim was prescribed voriconazole, a potent anti-fungal medication, which had to be administered approximately every 2 hours, 24 hours each day, over the course of several months. After the infection appeared to be under control, the cornea transplant procedure was performed. During the cornea transplant surgery, additional signs of the fungal infection were discovered. This later led to approximately 5 flush-out surgeries, which involved accessing the back of the left eye through an incision in order to remove additional evidence of the Fusarium fungal infection. The infection returned following the flush-out surgeries, requiring the victim to undergo a lengthy and invasive surgery with the following procedures performed on his left eye: lensectomy, capsulectomy, removal of the iris, removal of vitreous fluid, and removal of the fungal infection. The victim is left with only 15% vision in his left eye and is currently awaiting FDA approval for an iris transplant. >> >This product was NEVER tested for its efficacy against >> >fusarium yet it was allowed to be purchased by consumers with the [quoted text clipped - 18 lines] > >If one person goes blind because of a faulty product, that is very sad. Yes, but you are flat-out distorting the truth rather than engaging in hyoerbole. Also, we are talking semantics here, but I hardly think "Renu with MoisturLoc" (RWM) was a "faulty product". And there still is no determind direct cause/effect relationship with fusarium keratitis and RWM -- i.e., there has still not been a "this is what caused the problem" revealed cause. But initial and subsequent reports DO suggest an extremely strong association. FWIW, and this is just my opinion, I think that there is probably something in the RWM formulation that either doesn't kill fusarium well or something in it that works like culture medium for fusarium -- just like the below FDA press release states. And once again, I do not fault B&L for producing a product that perhaps was not tested (adequately) against fusarium. It was (and is) a rare pathogen. But you can bet any FUTURE product better be tested against it! > A corneal transplant will affect your vision the rest of your life. This is true, but having (to have) a penetrating keratoplasty (PKP) does not mean the same thing as having gone blind. And one person going blind is not the same as "200 people going blind." >Below is one man who trusted a product he was putting in his eye. One man going blind in ONE eye is unfortunate, but let's not make a mountain out of a molehill here. From all initial reports, I think B&L acted in good faith, did everything they should have, and there is (from what I can tell) *no negligence* on their part. Just BAD LUCK. However, with the limited brain power of the average juror (if brains were dynamite, they couldn't blow their nose), I wouldn't be surprised if they award this guy trillions of dollars. It happened to Mark Speaker (<http://www.crstoday.com/PDF%20Articles/1005/CRST1005_F4_Kopff.html>). [Partial quote from <http://www.newsinferno.com/archives/1193> SNIPed] > >> >This product was NEVER tested for its efficacy against > >> >fusarium yet it was allowed to be purchased by consumers with the [quoted text clipped - 60 lines] > > [Partial quote from <http://www.newsinferno.com/archives/1193> SNIPed] Maybe they should have disclosed on their product, this solution may cause a "rare" infection which could result in blindness. And we haven't bothered to test this product against this fungus either. However, the risk is less than .01%, but if you are a bad luck person, this could happen to you. > Maybe they should have disclosed on their product, this > solution may cause a "rare" infection which could result > in blindness. And we haven't bothered to test this > product against this fungus either. However, the risk is > less than .01%, but if you are a bad luck person, this > could happen to you. So some people are using the term "cause". Is it that the solution "may *cause* a 'rare' infection" or is it the case that it may not prevent it. Is there a difference? -Quick > > Maybe they should have disclosed on their product, this > > solution may cause a "rare" infection which could result [quoted text clipped - 8 lines] > > -Quick You bet. Or, more accurately: In the incredibly unusual situation in which a contact lens wearer handles fusarium fungus contaminated soil (which exists only in certain specific climate zones) and fails to wash their hands prior to handling their contact lenses, and then uses MoisturLoc solution (no longer available) and subsequently develops symptoms of infection, and then ignores those symptoms for a period of time prior to seeking medical care from a doctor who misdiagnoses the causative organism for the infection, then that person will be at risk for possibly permanent loss of vision in the affected eye. Still, the risk of death from being struck by lightening while holding a golf club while standing on the green in a middle of thunderstorm is possibly greater than that of blindness from fusarium. Of course one has be rather strange to be playing golf standing in the pouring rain with lightening all around. And pretty negligent digging in the dirt and not washing up before sticking their fingers in the eye. All of which is easily prevented by simple wearing plus lenses! LB, O.D. > Of course one has be rather strange to be playing golf > standing in the pouring rain with lightening all around. > And pretty negligent digging in the dirt and not washing > up before sticking their fingers in the eye. Ummm, I'll agree with the dirt part. Pouring rain with a bit of lightening has to be weighed against finishing this round so you can make the tee time for your afternoon round at the other course... -Quick > > Of course one has be rather strange to be playing golf > > standing in the pouring rain with lightening all around. [quoted text clipped - 7 lines] > > -Quick ...or, you could get struck by lightening and contract fusarium from lying face down in a mud puddle afterwards. DrG > > > Of course one has be rather strange to be playing golf > > > standing in the pouring rain with lightening all around. [quoted text clipped - 12 lines] > > DrG I needed a good laugh. You guys a tooooo funny. Go play some golf, but before that... explain to me how a 16 year old contracts this fusarium infection in the dead of winter in North Dakota using this product when at the time they claimed you could only get it in tropical climates? >>>> Of course one has be rather strange to be playing golf >>>> standing in the pouring rain with lightening all [quoted text clipped - 21 lines] > this product when at the time they claimed you could only > get it in tropical climates? Are you implying that the product itself is contaminated? So far I've only heard that it might not kill fusarium. -Quick > >>>> Of course one has be rather strange to be playing golf > >>>> standing in the pouring rain with lightening all [quoted text clipped - 26 lines] > > -Quick Well, here's an interesting article. Any comments? I am more concerned about Acanthamoeba than fusarium. Lens inventor warns of eye infection risk May 23, 2006 | www.scottsman.com The man who invented the daily disposable contact lens has warned that anyone who uses a solution to clean their lenses is at risk of serious eye infections. The warning comes after a contact lens solution used by millions of people worldwide was withdrawn from sale over fears that it could cause blindness. Living.scotsman.com MPU Ron Hamilton, from Bruntsfield, Edinburgh, today said the risk was not isolated to one type of lens cleaning solution. He said: "What happens is the bacteria builds up in the cleaning cases because when you put in your modern solutions it doesn't kill all the bacteria. "If you are asking me if cleaning solutions are dangerous then I would say yes they are, in varying degrees. Some people get by quite adequately with it while others, from time to time, will encounter problems." One brand of lens cleaner, called Renu with MoistureLoc, was withdrawn from the market this week after its manufacturer admitted the product was linked with a rare fungal eye infection. The Renu cleaner, made by pharmaceutical giant Bausch & Lomb, was withdrawn after 122 cases of keratitis, a rare fungal infection, were confirmed in the United States. Many of those infected had used the Renu solution. > > >>>> Of course one has be rather strange to be playing golf > > >>>> standing in the pouring rain with lightening all [quoted text clipped - 36 lines] > anyone who uses a solution to clean their lenses is at risk of serious > eye infections. Hmmm. Wonder if he gets royalties? DrG > > > >>>> Of course one has be rather strange to be playing golf > > > >>>> standing in the pouring rain with lightening all [quoted text clipped - 40 lines] > > DrG Of course, he's hyping his own product. Good for him if it keeps our eyes safer. But he must have seen some problems (and money potential, of course) to develop a daily throw away. If people feel it is safer and more hygienic for their eyes, given what has happened with one disinfectant out there, the better option is daily disposable (not completely riskfree) if they are too afraid of lasik. god forbid if someone should opt for glasses. either bacteria is becoming more resilient and/or disinfectants are just not currently strong enough or monitored closely enough. and you think the FDA is watching any of these companies, highly unlikely. >>>>>>>> Of course one has be rather strange to be playing >>>>>>>> golf standing in the pouring rain with lightening [quoted text clipped - 47 lines] > problems (and money potential, of course) to develop a > daily throw away. Really? Don't you think it more likely the objective was entirely for convenience? People love disposable things for the convenience and will tolerate a much greater cost for it. The added safety may well have been a secondary bonus. -Quick > >>>>>>>> Of course one has be rather strange to be playing > >>>>>>>> golf standing in the pouring rain with lightening [quoted text clipped - 55 lines] > > -Quick Well, I could certainly ask him what his motive was if I wanted to. Given what happened to my daughter, I am glad we had the option of a daily disposable. My son was very content in glasses until he turned 18 and met a girl who said he looked better without them. Other family members and friends have turned to a daily disposable as well also because of what happened to my daughter. If everyone has such poor hygiene habits like all of you claim and what an industry wants everyone to believe (that is debatable in my opinion), then daily disposables remain a good choice whatever his objective. Profits remain a key to any business and that will never change. What needs to change is the FDA's total protection to the consumer. >>>>>>>>>> Of course one has be rather strange to be playing >>>>>>>>>> golf standing in the pouring rain with lightening [quoted text clipped - 71 lines] > to any business and that will never change. What needs > to change is the FDA's total protection to the consumer. Alright. I think I'm getting a better picture of your adgenda. My feeling is there should be some responsibility on the patient. I don't want "total" protection by the FDA. I DO want to be completely informed of risks and then make my own decision. I'm aware there is an increased risk of eye infection by wearing contacts. I thought about it, I'm OK with it and decided to go ahead. -Quick > >>>>>>>>>> Of course one has be rather strange to be playing > >>>>>>>>>> golf standing in the pouring rain with lightening [quoted text clipped - 81 lines] > > -Quick Exactly right! I want to be FULLY informed of ALL risks and then make my own decision as well. That is all I believe any of us want. Total protection by the FDA will never happen, but that is supposed to be the only job of the FDA, to protect the public, not the companies. Of course, patients bear some responsibility, but how can they if they are not aware of all risks, i.e., swimming with contacts, hots tubs, lakes, pools, tap water? Where are these disclosures on any of these products. We have a medical profession that is not even aware of and/or debates these risks as insignificant statistics. >> Alright. I think I'm getting a better picture of your >> agenda. My feeling is there should be some [quoted text clipped - 19 lines] > a medical profession that is not even aware of and/or > debates these risks as insignificant statistics. Life has inherent risks. We don't and can't know all of them. You will never know all the risks. You will never be FULLY informed. Now or in the future. The medical profession can't know all of them. No one and no organization can give you total protection. Sometimes people are injured, maimed, and die due to no fault of their own or anyone else. It can't be totally prevented. That's life It's an accepted practice with products to say what they *will* do and not what they won't do. It's well known that there is an increased risk of infection as a result of wearing contacts. I don't know what the B&L product says. If it states that it will kill *all* bad organisms then I would feel they are at fault. If the product itself actively caused some harm without any disclosure of the risk I would feel they were at fault. If the product was contaminated while in control of the company I would feel they were at fault. I don't expect any product to list all the things it *won't* do unless one of those things is generally (statistic) expected from like products. -Quick > >> Alright. I think I'm getting a better picture of your > >> agenda. My feeling is there should be some [quoted text clipped - 46 lines] > > -Quick I agree life has inherent risks. That is not what I am disputing. They have already admitted their product was not fully tested for its efficacies. Now they are facing damage control and liability. The public will forget, but the people who it affected will not forget. All I am saying is that we need prominently displayed warning labels of ALL water related risks on all contact lens products. I don't think that is asking too much, especially if the FDA website already states "no swimming in contacts." We were clueless when it affected by daughter and quite frankly, I was shocked and angry why we did not know. Why don't most consumers know of this risk? If the industry told you there were any water related risks, it would be difficult for them to sell their 30 day lens. They bank on the assumption this statistic is low and will absorb the liability when it hits them. The problem is Acanthamoeba is a sight threatening parasite that does not die easily. 15-20 years you just lost your eye. It is not just a "pink eye" infection. It is devastating and as I have stated before, every good ophthalmologist will tell you, do not go swimming in contacts or do so at your own risk. They further would not even recommend a 30 day lens. Now those are the good doctors. And if you don't like that advise, then go to another doctor who will fit you. There are plenty out there as well. > Well, I could certainly ask him what his motive was if I wanted to. > [quoted text clipped - 8 lines] > remain a key to any business and that will never change. What needs to > change is the FDA's total protection to the consumer. Yes, but some patients still want clear vision 24/7 which means continuous wear lenses, and not daily disposables. There will always be risk. I have noted that your daughter's eye doctor is fellowship trained in LASIK. DrG > > Well, I could certainly ask him what his motive was if I wanted to. > > [quoted text clipped - 18 lines] > > DrG Yes, he is a renowned lasik surgeon. My daughter would let no one touch her eye except him. His hands are gifted as well as his mind. We could not have been under better care than that, facing the prospect that she almost lost her eye battling this infection. > Yes, he is a renowned lasik surgeon. My daughter would let no one > touch her eye except him. His hands are gifted as well as his mind. > We could not have been under better care than that, facing the prospect > that she almost lost her eye battling this infection. Interestingly, I know what that is like first hand. One of my most recent patients was damaged by LASIK in 1998, performed by a very gifted surgeon. She hasn't let anyone touch her eyes until now. DrG > > Yes, he is a renowned lasik surgeon. My daughter would let no one > > touch her eye except him. His hands are gifted as well as his mind. [quoted text clipped - 6 lines] > > DrG My naivete must be showing. All of us common people put so much trust in our doctors when they help us, but even gifted doctors make mistakes or procedures just simply go wrong. Yes, lasik can be blindness as well as better sight. You are right, of course, no one is protecting the consumer on that front either. I am just not surprised anymore. Our eyesight has been underprotected for years on all fronts. Something needs to change. I hope your gifted hands can restore your patient's sight. > > > Yes, he is a renowned lasik surgeon. My daughter would let no one > > > touch her eye except him. His hands are gifted as well as his mind. [quoted text clipped - 16 lines] > > I hope your gifted hands can restore your patient's sight. She is quite happy. I just like to keep things in perspective. There is a jungle of misinformation out there. By the way, I have been told repeatedly by Alcon that their Optifree kills acanthamoeba cysts after 6 hours. I know that hydrogen peroxide kills the cysts as well after a 6 hour soak. This means a 6 hour soak in the full 3% strength. The unfortunate thing is that the leading hydrogen peroxide disinfection system begins to neutralize the hydrogen peroxide as soon as the contact lenses are put into the container. I am referring of course to the one with the grey disk at the bottom. It might interest you that at the time of the last "acanthamoeba scare" almost twenty years ago, there was no effective pharmaceutical agent against it initially. DrG > > > > Yes, he is a renowned lasik surgeon. My daughter would let no one > > > > touch her eye except him. His hands are gifted as well as his mind. [quoted text clipped - 33 lines] > > DrG Yes, I need you experts to keep me in perspective as my passion on this issue overcomes me sometimes. And I am glad there are good doctors like you out there who truly care about their patients. We need you and sometimes rely solely on your expertise. Optifree Express is one of the solutions I would feel comfortable using if I wore contacts, and they have validated that for you. Since some solutions cannot even claim acanthamoebicidal, all the more reason for "no swimming" and water related disclosures on all products as that clearly puts you at risk; regardless of how low the risk, there is a risk. Sadly so, yes, you just lost your eye 15-20 years ago. Jackie's doctor was involved in some of the original research during that epidemic that was studied at the CDC while he was a Fellow at Emory University in Atlanta, between 1984-86. He has been clearly aware and has treated these infections for quite a long time. Obviously, since this is such a virulent parasite as we cannot even develop effective antibiotics to kill this parasite, let alone put these cleaning agents in our contact lens solutions, all the more reason for warnings. I am fearful this Acanthamoeba trend will continue and we are entitled to find out why. > Obviously, since this is such a virulent parasite as we cannot even > develop effective antibiotics to kill this parasite, let alone put > these cleaning agents in our contact lens solutions, all the more > reason for warnings. I am fearful this Acanthamoeba trend will > continue and we are entitled to find out why. I guess I need to see some statistics supporting this "trend." Or, is it just a "spike" caused by temporary local environmental factors such as warmer water, less rainfall causing lakes to be lower, etc. Here at the University of Texas Southwestern Medical Center, they are looking at the immunological aspects, i.e. what keeps most people from contracting the infection. My own pet theory, for which I have no proof whatsoever, is the changing perception of the contact lens as a consumer product rather than a medical device caused by a number of variables, and increasing emphasis on convenience. For some reason, it seems that more people consider it their right not to be inconvenienced. The end result? Less attention paid to lens hygeine. DrG > > Obviously, since this is such a virulent parasite as we cannot even > > develop effective antibiotics to kill this parasite, let alone put [quoted text clipped - 17 lines] > > DrG We had plenty of doctors very interested in my daughter's case and one doctor too stated it could possibly be a missing gene in their immune system that protects others from this parasite. Allergies, possibly, with medicines that cause the eye to be dryer, don't know. Our tears do perform a protective barrier against most bacteria. I will email you the Chicago and Philadelphia studies. The doctors in these two cities are very concerned about this spike as well. I would like to know how many cases of Acanthamoeba have occurred in Texas in the last several years. I have read with interest about Dr. Niederkorn and his studies on the immunity issue. Absolutely on your pet theory. We have that proof, as the FDA 4 years ago deregulated the plano contact lens as cosmetic, which was sold in dollar stores, because it was a non-prescription lens. It took another two years to get Congress to pass the Plano Contact Lens bill. I emailed 100 senators in July 2005 about this issue and other appalling facts that I discovered. Two days later that legislation was passed in full and now is a law that all contact lenses are medical devices, not to be sold without a prescription. Were they listening to me and my anguished pleas for change? And do you believe there are now states trying to overturn this legislation. Daniel Troy, acting administrator, at that time, saw no problem with deregulating this medical device. And who suffered the consequences - our youth, the ultimate risktakers. It is also an industry marketing their products as quick and convenient. It is a very powerful industry regardless of what good doctors recommend to their patients. > > > Obviously, since this is such a virulent parasite as we cannot even > > > develop effective antibiotics to kill this parasite, let alone put [quoted text clipped - 28 lines] > several years. I have read with interest about Dr. Niederkorn and his > studies on the immunity issue. I know Dr. Niederkorn, and we're practically neighbors. DrG > > > > Obviously, since this is such a virulent parasite as we cannot even > > > > develop effective antibiotics to kill this parasite, let alone put [quoted text clipped - 32 lines] > > DrG Small world. Would be interested to get his expert opinion on these issues and to ascertain if there are increasing trends in Texas. My guess is his expertise in this field already demonstrates there is a heightened concern. > > > > > Obviously, since this is such a virulent parasite as we cannot even > > > > > develop effective antibiotics to kill this parasite, let alone put [quoted text clipped - 37 lines] > guess is his expertise in this field already demonstrates there is a > heightened concern. I would guess that time frame was atypical, which explains the interest. As I said earlier, 4 cases in 6 months, without any during the previous 19 years, and none since. Sounds like an environmental cause to me. Plus none of the residents got it right. DrG > > > > > > Obviously, since this is such a virulent parasite as we cannot even > > > > > > develop effective antibiotics to kill this parasite, let alone put [quoted text clipped - 44 lines] > > DrG I added another mother to my support group from Louisana. 16 year old boy got the infection in Jan. 2006, a woman from Indiana in January, and a man from Kansas city last week. they fought his as herpes for 13 months. wonder what kind of solution your patients had used. > I added another mother to my support group from Louisana. 16 year old > boy got the infection in Jan. 2006, a woman from Indiana in January, > and a man from Kansas city last week. they fought his as herpes for 13 > months. wonder what kind of solution your patients had used. I wish I knew. We have traditionally favored Optifree Express over ReNu because of the broader spectrum of action. One girl had been hit in the eye with a toy hockey puck from a game. She mentioned that she had put an ice pack on her eye. She had been wearing her contact lens at the time. Another was wearing 30 day continuous wear and had been swimming in them. The third was wearing disposable lenses, with no known risk factors...denied swimming, using tap water, etc. The fourth was in continuous wear contacts and got dust in her eye out in west Texas. All four had atypical presentation, with small dense central infiltrates under an intact epithelium...too dense in my opinion to be mistaken for herpes. High magnification revealed faint tracks or filaments, which are basically tunnels created by the organism. They all looked septic. All were positively diagnosed with confocal microscopy. The first three had similar appearance, which helped with the diagnosis. The fourth patient was highly atypical in that the infiltrate was small and peripheral. The department head, who is also an expert on acanthamoeba, stated that these were the earliest cases he had ever seen. He later commended me on my early "catch," and for resisting the urge to reach for the steroids, which causes the organism to spread quicker. It was not that I was able to correctly diagnose the first case, but had simply ruled out anything with which I was familiar. I reasoned first that it was infectious, and secondly that it was anaerobic. With a medical school nearby, it would have been foolish to begin treatment without a positive diagnosis. DrG > > I added another mother to my support group from Louisana. 16 year old > > boy got the infection in Jan. 2006, a woman from Indiana in January, [quoted text clipped - 37 lines] > > DrG hmmm.... water and swimming culprits..... Your brilliant analysis at the onset saved these patients from further destruction of their eye. If we could clone you excellent doctors, it would be a great benefit to us all. More continuing education in the eye health medical field on this infection is a must. There continues to be a mindset that this infection is so "rare" that doctors are not inclined to even suspect it. That needs to change, but if that won't happen, then prominently displayed warning labels of all water related risks on all contact lens products would reduce this risk as well. Another change on my list is mandatory reporting mechanisms to the CDC on these infections as no one has any clue about increasing or decreasing trends without current or previous statistics. Another stat. that should be in place is lasik gone bad. Thus, my continuing support for passage of the Vision Preservation Act. This legislation is critical...... >>>>>> Of course one has be rather strange to be playing >>>>>> golf standing in the pouring rain with lightening all [quoted text clipped - 65 lines] > fungal infection, were confirmed in the United States. > Many of those infected had used the Renu solution. Comments? All I see here are some article blurbs with no substance or references. And a quote supposedly from the inventor of the *daily* disposable contact lens that says cleaners are dangerous. You didn't supply anything to comment on one way or the other. Is the inventor of the daily disposable a doctor? And could you possibly see a vested interest in saying that cleaners are dangerous? -:) -Quick > > > > Of course one has be rather strange to be playing golf > > > > standing in the pouring rain with lightening all around. [quoted text clipped - 19 lines] > the dead of winter in North Dakota using this product when at the time > they claimed you could only get it in tropical climates? You mean that ND doesn't have a tropical climate? DrG > Maybe they should have disclosed on their product, this solution may > cause a "rare" infection which could result in blindness. And we > haven't bothered to test this product against this fungus either. If they listed ALL the specific organisms not tested, there'd be no room on the label for the product name. If they TESTED all those organisms, each bottle would cost about $3500.00. -MT > > Maybe they should have disclosed on their product, this solution may > > cause a "rare" infection which could result in blindness. And we [quoted text clipped - 6 lines] > > -MT B & L has otherwise good products. Their mistake was their arrogance and denial of any problems at the onset. Fusarium eye infections will be rare again now that this specific product has been removed from the market. Companies continue to get FDA approvals for policing their own products. hmmm.... something's wrong with that picture. Federal inspectors criticize Bausch & Lomb May 17, 2006 | Alison Young | Atlanta Journal-Constitution The Bausch & Lomb contact lens solution being recalled worldwide and linked to an outbreak of serious eye infections was put on the market without being fully tested for effectiveness in killing bacteria and fungus, according to an inspection report by the U.S. Food and Drug Administration. ReNu with MoistureLoc, used by 2.3 million Americans, never went through a full FDA approval process, the report indicates, and the company's new-product design team failed to complete a wide range of tests both before and after it was sold to consumers. After its introduction, as complaints came in that the product could be linked to a spike in cases of rare fungal infections, the company failed to quickly notify the FDA, as required by law, according to the report released Tuesday of inspectors' observations at Bausch & Lomb's lens solution plant in Greenville, S.C. FDA and Bausch & Lomb officials said they don't think any of the eight pages of problems cited in the report contributed to the worldwide outbreak of fusarium keratitis, a potentially blinding eye infection caused by a common fungus. > B & L has otherwise good products. Their mistake was their arrogance > and denial of any problems at the onset. Fusarium eye infections will > be rare again 120/2300000 still seems rare to me. I don't recall B&L denying anything. Between November and April, they cultured the product in the affected markets and initiated a recall despite negative culture results. There are better examples of corporate arrogance. Have you ever checked the price of natamycin, the drug used to treat fusarium? That's the price of meeting your standard. -MT Based on my admittedly brief study of this subject, it seems that acanthamoeba corneal infections are caused primarily by soft contact lens wearers who come in contact with contaminated fresh water like ponds and lakes, and even tap water (in areas where the public water supply has been recently flooded). I concur with strongly cautioning cl wearers about swimming, bathing, or otherwise contaminating their contacts with such waters. However, as I posted earlier, I think swimming in the 3.5% saline ocean waters, away from sewer and river discharge areas is relatively safe for contact lens wearers, probably safer than ordinary lens care (where sterile techniques are NEVER observed). I have not found a single case that can be definitively traced to clean ocean swimming (if anyone can find me one, please post it and I will modify my opinion appropriately). My interest in this is that I want our recommendations to patients to be based on both scientific evidence and its logical extensions. w.stacy, o.d. |
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