This is an official CDC HEALTH ADVISORY
Distributed via Health Alert Network
Friday, May 25, 2007, 21:39 EDT (09:39 PM EDT)
CDCHAN-00260-2007-05-25-ADV-N
Early Report of Serious Eye Infections Associated with Soft Contact Lens
Solution
The Centers for Disease Control and Prevention (CDC), collaborating
with the Food and Drug Administration, state and other partners, has identified
an outbreak of a serious but rare eye infection called Acanthamoeba
keratitis (AK). This infection is caused by a free-living ameba (Acanthamoeba)
a microscopic organism found everywhere in nature. Infections can result in
permanent visual impairment or blindness. AK primarily affects otherwise
healthy people, most of whom wear contact lenses. In the United States, an
estimated 85% of cases of this infection occur in contact lens users. The
incidence of the disease in the U.S. is approximately one to two cases per
million contact lens users.
CDC has received reports of 138 cases of culture-confirmed
AK in 35 states and Puerto Rico, with complete patient data available for 46
case-patients. Thirty-nine of the 46 case-patients wore soft contact
lenses. Preliminary information obtained by CDC from patient interviews
indicates that, among soft contact lens users who reported the use of any type
of solution, 21 (58%) reported having used Advanced Medical Optics (AMO)
CompleteR MoisturePlusTM Multi-Purpose Solution in the
month prior to symptom onset. Out of the 37 case-patients for whom
clinical data was available, 9 (24%) failed medical therapy and required or are
expected to undergo corneal transplantation.
Based on these findings people who wear soft contact lenses
who use Advanced Medical Optics (AMO) CompleteR MoisturePlusTM Multi-Purpose
Solution should:
· Stop using the product immediately
and discard all remaining solution including partially used or unopened
bottles. Choose an alternative contact lens solution.
· Discard current lens storage
container.
· Discard current pair of soft lenses.
· See a health care provider if
experiencing any signs of eye infection: Eye pain, eye redness, blurred vision,
sensitivity to light, sensation of something in the eye, or excessive tearing.
All contact lens users should closely follow prevention
measures to help prevent eye infections, which include
· See an eye care professional for
regular eye examinations.
· Wear and replace contact lenses
according to the schedule prescribed by an eye care professional.
· Remove contact lenses before any
activity involving contact with water, including showering, using a hot tub, or
swimming.
· Wash hands with soap and water and
dry before handling contact lenses.
· Clean contact lenses according to
the manufacturer's guidelines and instructions from an eye care professional.
· Use fresh cleaning or disinfecting
solution each time lenses are cleaned and stored. Never reuse or top off old
solution.
· Never use saline solution and
rewetting drops to disinfect lenses. Neither solution is an effective or
approved disinfectant.
· Store reusable lenses in the proper
storage case.
· Storage cases should be rinsed with
sterile contact lens solution (never use tap water) and left open to dry after
each use.
· Replace storage cases at least once
every three months
Clinicians evaluating contact lens users with symptoms of
eye pain or redness, tearing, decreased visual acuity, discharge, sensitivity
to light, or foreign body sensation should consider AK and refer the patient to
an ophthalmologist, if appropriate. Diagnosis requires a high degree of
suspicion, especially in a contact lens wearer with a recent diagnosis of
another form of keratitis, such as herpes simplex virus keratitis, who is not
responding to therapy. Diagnosis is made on the basis of clinical picture
and isolation of organisms from corneal culture or detection of trophozoites
and/or cysts on histopathology. However, a negative culture does not
necessarily rule out Acanthamoeba infection. Confocal microscopy and
polymerase chain reaction assays to detect Acanthamoeba may also assist
with diagnosis. Early diagnosis can greatly improve treatment efficacy.
Clinicians should consider obtaining clinical specimens
(e.g., corneal scrapings) for culture before initiating treatment. Clinicians
or microbiology laboratories should report cases of AK to state and local
health departments or directly to CDC at telephone, 770-488-7775. Acanthamoeba
isolates should be submitted to state laboratories according to instructions
provided by local and state public health laboratories.
For more information, see the CDC website: http://www.cdc.gov/ncidod/dpd/parasites/acanthamoeba/index.htm
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