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Fungal infection outbreak makes case for proper contact lens care

Apr 30, 2006 | Washington Post

The recent withdrawal from the market of a popular contact lens solution under investigation in an outbreak of a rare eye infection has left many contact lens users confused and concerned. Eye doctors report a surge in calls from users of Bausch & Lomb's ReNu with MoistureLoc MultiPurpose Solution, which the company has asked retailers to stop selling.

The Food and Drug Administration recently recommended that those who use the product immediately stop using it and throw away any remaining supplies.

"We've gotten a lot of calls from people" worried about fusarium keratitis, a fungal eye infection that can cause corneal scarring and permanent blindness, said Roy Rubinfeld, a spokesman for the American Academy of Ophthalmology who is an ophthalmologist at Washington Eye Physicians & Surgeons in Chevy Chase, Md. "Fortunately, we haven't seen any" cases.

"People are calling my office saying, 'My eyes itch. Is that the fungus?' "According to the Centers for Disease Control and Prevention, 176 cases of fusarium keratitis are suspected or confirmed in 27 states. The infection is linked to fusarium, a fungus found in plants, tap water and soil. Risk factors include trauma (usually involving plant material), immuno-deficiency, chronic ocular surface diseases and, on rare occasions, contact lens use, according to the FDA. The FDA says in a population of 10,000 people, four to 21 cases of severe eye infection called microbial keratitis, which includes fusarium will occur annually. Fusarium infection is so rare, many eye doctors say they've never seen a case. Symptoms include redness, blurry vision, discharge, swelling, tearing, pain and increased sensitivity to light.

Eye itchiness is more likely due to spring allergies and is not a cause for alarm, Rubinfeld said.

He advises contact wearers who experience eye irritation to switch to glasses. If symptoms persist beyond a few hours, experts recommend seeing a doctor or going to the emergency room if symptoms are severe.

A fusarium keratitis infection can be confirmed through a culture taken at a doctor's office. Treatment for the infection usually begins with medications; if that's not effective, surgery including a cornea transplant may be necessary.

Experts said the outbreak should remind contact lens users about 30 million of them in the United States that contacts carry risks.

"I think this is a real wake-up call for both patients and the medical community," said Arthur Epstein, chair of the American Optometric Association's contact lens and cornea section. Eye care professionals are advising lens wearers to follow basic precautions such as washing your hands with soap and water before handling your contacts; see "Lens Care Basics" box for a list of other tips.

Bausch & Lomb voluntarily pulled ReNu with MoistureLoc from U.S. stores on April 13; other ReNu products are still available. Of the 30 cases that the CDC and the FDA had fully investigated as of last week, 28 involved contact lens wearers. Of these, 26 "reported using a Bausch & Lomb ReNu brand contact lens solution or a generic brand manufactured by the same company" during the previous month, according to an FDA statement.

Five patients reported using other contact lens solutions, including solutions made by Alcon and Advanced Medical Optics Inc. Nine reported wearing their contacts overnight, which is a known risk factor for severe corneal infection. Eight people needed cornea transplants as a result of the infection.

So far, no evidence has directly linked MoistureLoc solution to the fungal infections, reports the FDA. Bausch & Lomb says it is conducting tests on its products and has thoroughly inspected the U.S. plant that makes the solution; nothing has turned up to date implicating MoistureLoc, according to a statement from the company.

Consumers with supplies of MoistureLoc can receive a refund or a coupon to purchase other products by completing a form at Bausch & Lomb's Web site (www.bausch.com/renu). Epstein recommends sticking to major name brands when looking for a replacement solution.

Maureen Thomas, 52, of Vista, Calif., scheduled an appointment with her eye doctor after hearing about the infections. Thomas used MoistureLoc for several months and says she has experienced discharge, pain and blurriness since she switched to the solution. Suspecting an eye infection, her primary care doctor prescribed antibiotic eyedrops twice to no avail.

"I've stopped wearing my contacts and have gone to glasses," said Thomas, who said she'd always taken proper care of her contact lenses.

Not all patients are so diligent. Jay Klessman, a Washington optometrist, said, "An awful lot of people have been lazy... putting lenses back into the same solution — reusing the same solution over and over," he said. He endorsed a step the FDA has suggested in the wake of the fungal infections that patients rub their lenses even if the solution container says it is not necessary.

"I've always told patients that I don't believe in the no-rub concept," Klessman said. "You're trying to clean and disinfect your" contacts, he said. "There are just some things that will get on lenses that just won't come off" without rubbing, he said.

Thomas has an appointment to see her eye doctor this week to evaluate her symptoms.

"My first thought" upon hearing about the infections, she said, was, "Maybe that's what the problem with my eyes are."


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