Tuesday, September 05, 2006

Serious Eye Infections May Be Linked to Contact Lens Solution

(HealthDay News) -- U.S. eye doctors expressed alarm Tuesday at a new warning that a rare but serious fungal infection may be linked to a popular contact lens solution.
Tens of millions of Americans may be at risk for the infection, which, in worst cases, can cause blindness, U.S. health officials said in the warning issued late Monday.
"This is troubling because there are about 35 million contact-lens wearers in the USA and, of those, roughly 25 million or 26 million are soft lens wearers," said Dr. Robert Cykiert, clinical associate professor of ophthalmology at New York University School of Medicine. "Basically, everybody who wears soft lenses is at risk for this type of infection."
A large proportion of these people may use Bausch & Lomb's ReNu with MoistureLoc. Twenty-six of 30 patients who suffered infections used this product or a generic brand manufactured by the same company.
"That product is probably the market leader in contact lens solutions, so you're talking about millions of people who are using Bausch & Lomb solutions," Cykiert said.
Bausch & Lomb has suspended shipments of the multipurpose product, although it is still on store shelves.
At the same time, the U.S. Food and Drug Administration and U.S. Centers for Disease Control and Prevention issued an alert to health-care professionals and patients who wear soft contact lenses of the risk.
A fungus called Fusarium has been identified as the cause of the reported infections. As of April 9, there were 109 cases of suspected Fusarium keratitis under investigation by the CDC and health authorities in 17 states. The risk of contracting contact lens-related infection from the fungus, which is commonly found in soil, tap water and many plants, is estimated to be four to 21 per 100,000 patients.
The current cluster of cases represents a "staggering increase in the number of cases" typically seen in the United States, Cykiert said. "This is an extremely serious infection of the cornea. If you get it, this takes weeks or months to treat, some need to be hospitalized for weeks, and very often wind up needing corneal transplants. So this is a very major issue."
Eight U.S. patients have already required corneal transplants, The New York Times reported.
Clusters of the same infection were reported among contact lens users in Asia beginning in November 2005. In February 2006, Bausch & Lomb voluntarily suspended sales of the ReNu multipurpose solutions in Singapore and Hong Kong, according to the FDA.
Investigators have not definitively proven that the ReNu product is the culprit, but Cykiert and others are advising consumers to stop using the product.
"Even though no one is saying it's definitely that solution, when the company suspends shipment and the FDA says they should be careful, why would you test it and use it?" Cykiert said.
"People should not panic, but this is a serious infection. So if people have symptoms and it doesn't get any better, they need to look for help," said Dr. Eduardo Alfonso, a professor of ophthalmology at the Bascom Palmer Eye Institute at the University of Miami. "If left and not taken care of, the fungus gets deeper into the cornea and the chances of recovery are markedly diminished."
Besides urging discontinued use of ReNu and generic brands manufactured by Bausch & Lomb, experts are recommending practicing good contact lens hygiene.
"Patients must remember that contact lenses are a medical device and that you are sticking a foreign item in your eye," said Dr. Norman Saffra, director of ophthalmology at Maimonides Medical Center in New York City. "When you're using medical devices in your eye, prudence should take priority over both looks and ease of use."
Among experts' suggestions:
Do not use contact lenses if your eye is irritated.
Wash your hands with soap and water, and dry them (lint-free method) before handling lenses.
Wear and replace lenses according to the schedule prescribed by the doctor.
Follow specific lens cleaning and storage guidelines from the doctor and solution manufacturer.
Keep the contact lens case clean and replace it every three to six months.
Don't sleep in your lenses, even if the lenses are approved for that use. Nine of the current cases reported wearing contact lenses overnight, a known risk factor for the infection.
Avoid multi-purpose lens solutions that are used both for storage and disinfection. "If it's safe enough to put in your eye after you've cleaned the lens with it, it's not going to be the best disinfectant in the world," Saffra said. "The best burn like hell because they don't belong in your eye."
Talk to your doctor about disposable lenses that involve "no solutions, no mess," Saffra said.
Remove the lenses and contact your doctor immediately if you experience symptoms such as redness, pain, tearing, increased light sensitivity, blurry vision, discharge, or swelling.
"Early diagnosis for this problem can prevent some fearful complications," Saffra said. "These are difficult infections and they're unusual in this part of the world. The cluster associated with this solution is unfortunate but prudence and careful care can help avoid problems."
More information
Visit the FDA to see the public health notice.

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