Dear Doctor Column, September 11, 2006

CDC Reports Recent Outbreak of Eye Infections Likely Over

Question:

Did health officials ever discover the source of the recent epidemic of eye infections in soft contact lens wearers?

Answer:

Health authorities reported an outbreak of fungal keratitis, a severe and painful corneal infection caused by the Fusarium fungus, among soft contact lens wearers in May 2006. Fusarium fungus occurs naturally in plants, soil, and tap water and typically infects people with compromised immune systems, certain chronic corneal diseases, or individuals who get fungus-containing plant material or soil in their eyes. Until this rash of infections, fungal keratitis caused by Fusarium infection occurred only rarely in people who wear contact lenses, affecting fewer than 2% of users, according to the Centers for Disease Control and Prevention (CDC).

The CDC and the Food and Drug Administration (FDA) have now completed an initial investigation of the outbreak. Researchers have identified 164 confirmed cases of patients with the fungal infection; 94% wore soft contact lenses, and the majority of these individuals reported using a particular type of contact lens solution „Ÿ Bausch & Lombfs ReNu with MoistureLoc, which the manufacturer has now permanently removed from the market.

After examining samples of the solution from the factory, warehouse, and unopened bottles of the product, investigators conclude that contamination of the product with Fusarium most likely occurred outside the production and distribution pipeline, according to a paper authored by CDC scientists and published in the Journal of the American Medical Association. The investigators found no Fusarium organisms in any of the samples and say these infections probably resulted from outside contamination, possibly occurring in usersf homes. They also note, however, that poor contact lens hygiene, which creates a setting where germs spread more easily, cannot by itself account for the recent outbreak. The CDC says it needs to conduct further investigations, but currently hypothesizes that some aspect of the multipurpose MoistureLoc formulation may increase the risk of Fusarium infection, especially when users take short cuts with their contact lens-care regimens. Bad habits that might increase the risk of infection include reusing old solution, not cleaning lenses as often as directed, or wearing contacts overnight.

The recent Fusarium infections highlight the need to take all contact lens precautions seriously and maintain high hygiene standards to protect your eyes and vision. Some ocular infections, including fungal keratitis, can result in permanent vision loss. About 34% of those infected in the Fusarium outbreak required a corneal transplant to preserve their sight. People also need to be sure to remove their contact lenses and get in touch with their health care provider at the first sign of ocular irritation. Fungal keratitis often is difficult to treat and becomes more so when appropriate care is not begun early in the course of infection.

Symptoms of the sight-threatening eye fungus and of eye infections in general include sudden blurred or fuzzy vision, a red, irritated eye that does not improve when the contact lens is removed, pain in or around the eyes, increased sensitivity to light, and excessive tearing or discharge. If you have any of these symptoms, you should remove your lenses and see your eye doctor right away. Treating fungal keratitis often involves using prescription antifungal eyedrops for as long as 3 months, but surgery is sometimes necessary to prevent corneal scarring and blindness.

Despite recent outbreak, the American Optometric Association says contact lenses remain a safe and effective form of vision correction as long as wearers maintain proper hygiene practices. This organization and the FDA offer the following recommendations:

• Stop using Bausch & Lomb ReNu with MoistureLoc products and discard all remaining solution including partially used or opened bottles.
• Consult your eye-care professional for advice on appropriate alternatives for cleaning and disinfecting your contact lenses.
• Even if you are using a "no-rub" solution, consider a "rub-and-rinse" lens cleaning method rather than a no-rub technique to minimize germs and reduce chances of infection.
• Always wash your hands with soap and water and dry them before handling lenses.
• Carefully clean contact lenses immediately after removing them from your eyes. The lens should be rubbed and rinsed thoroughly before you place it in the lens case.
• Store lenses in a clean and appropriate case, using fresh solution each time.
• Never reuse old solution.
• Keep your contact lens case clean and replace every 3 months.
• Wear and replace lenses as prescribed by your doctor.
• Follow specific lens cleaning and storage guidelines from both your doctor and the solution manufacturer.
• Remove your lenses immediately and consult with your doctor if your eyes become red or irritated or your vision changes.

Visit the FDA Web site for the latest updates.