Eye Care - Blog

Contact Lens Care Guidelines - Thursday, May 31, 2007

An increase in the incidence of Acanthamoeba and fungal keratitis since 2004 has been noted. The etiology of this rise is currently being investigated1-6 but may be associated with inadequate antimicrobial efficacy of multipurpose solutions.

Lens cleaning and disinfection should be carefully explained to patients, since improper care may be associated with complications of lens wear. 7,8 Patients should be instructed to use only sterile products that are commercially prepared specifically for contact lens care and to replace these at the intervals recommended by the manufacturers.9 Patients should also be instructed to clean and replace contact lens cases frequently, since they can be a source of lens contamination.8,10 Damaged or cracked lens cases should be discarded. Directions for use of a no-rub solution require that a steady stream of the product be directed at the lens for a specific length of time. In general, however, rubbing the lenses during cleaning is considered to be a superior method of cleaning.

Patients should be instructed to replace the solution in contact lens cases each time the lenses are disinfected (i.e., old solution should not be topped off). The U.S. Food and Drug Administration has made the following recommendations for contact lens wearers regarding proper lens care practices: 11

• Wash hands with soap and water, and dry (lint-free method) before handling lenses.
• Wear and replace lenses according to the schedule prescribed by the doctor.
• Follow the specific lens cleaning and storage guidelines from the doctor and the solution manufacturer.
• Keep the contact lens case clean and replace every 3 to 6 months.
• Remove the lenses and consult your doctor immediately if you experience symptoms such as redness, pain, tearing, increased light sensitivity, blurry vision, discharge, or swelling.

REFERENCES

1. Centers for Disease Control and Prevention (CDC). Acanthamoeba Keratitis--Multiple States, 2005-2007. Morbidity Mortality Weekly Report, vol 56. Atlanta: US DHHS, PHS Publ No. RR-6; May 26, 2007.

2. Bernal MD, Acharya NR, Lietman TM, et al. Outbreak of Fusarium keratitis in soft contact lens wearers in San Francisco. Arch Ophthalmol 2006;124:1051-3.

3. Alfonso EC, Cantu-Dibildox J, Munir WM, et al. Insurgence of Fusarium keratitis associated with contact lens wear. Arch Ophthalmol 2006;124:941-7.

4. Chang DC, Grant GB, O'Donnell K, et al. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA 2006;296:953-63.

5. Khor WB, Aung T, Saw SM, et al. An outbreak of Fusarium keratitis associated with contact lens wear in Singapore. JAMA 2006;295:2867-73.

6. Margolis TP, Whitcher JP. Fusarium--A new culprit in the contact lens case. JAMA 2006;296:985-7.

7. Nilsson SE, Montan PG. The annualized incidence of contact lens induced keratitis in Sweden and its relation to lens type and wear schedule: results of a 3-month prospective study. CLAO J 1994;20:225-30.

8. Bowden FW, 3rd, Cohen EJ, Arentsen JJ, Laibson PR. Patterns of lens care practices and lens product contamination in contact lens associated microbial keratitis. CLAO J 1989;15:49-54.

9. Acanthamoeba keratitis associated with contact lenses--United States. MMWR Morb Mortal Wkly Rep 1986;35:405-8.

10. Wilson LA, Sawant AD, Ahearn DG. Comparative efficacies of soft contact lens disinfectant solutions against microbial films in lens cases. Arch Ophthalmol 1991;109:1155-7.

11. U.S. Food and Drug Administration. Advice for patients with soft contact lenses: New information on risk of serious fungal infection. Available at: www.fda.gov/cdrh/medicaldevicesafety/atp/041006-keratitis.html. Accessed May 29, 2007.

Prepared by the American Academy of Ophthalmology Preferred Practice Patterns Refractive Management/Intervention PanelRefractive Management/Intervention Panel Members

Stephen D. McLeod, MD, ChairRoy S. Chuck, MD, PhDD. , Rex Hamilton, MD, James A. Katz, MD, Srilata S. Naidu, MD, Allan R. Rutzen, MD, FACS, John A. Vukich, MD, Susan Vitale, PhD, MHS

MethodologistPreferred Practice Patterns Committee Members

Sid Mandelbaum, MD, ChairEmily Y. Chew, MD, Linda M. Christmann, MD, Douglas E. Gaasterland, MD, Samuel Masket, MD, Stephen D. McLeod, MD, Christopher J. Rapuano, MD, Donald S. Fong, MD, MPH, Methodologist

Labels: Contact Lens, Contact Lens Care