CONTACT LENSES TODAY

August 27, 2006

Contact Lenses Today® is edited by Dr. Joseph T. Barr and the staff of Contact Lens Spectrum. This week CLToday® reaches more than 12,000 readers in 74 countries.


Sports Eye Health and Safety Awareness Month
Prevent Blindness America has declared September Sports Eye Health and Safety Awareness month to educate the public on how to make sure their eyes are safe while playing sports. According to the American Academy of Ophthalmology, there are 40,000 sports-related eye injuries every year. And the Consumer Product Safety Commission estimates that there were more than 2,400 eye injuries from swimming alone in 2005.
    Severe injuries can result in vision loss and in some cases, blindness. Wearing proper eye protection can prevent up to 90% of all sports-related eye injuries. Prevent Blindness says lenses should be made of polycarbonate material and have an American Society of Testing Materials (ASTM) label indicating they meet the standards for that specific sport.
    Radiation injuries can also occur from extended exposure to sunlight, making proper protection from UV radiation important as well. Prevent Blindness suggests goggles with UV protection be worn during skiing, snow boarding, water skiing and other water sports.

B&L Comments on Fusarium Publications
Bausch & Lomb issued a statement this week commenting on the article on Fusarium keratitis that appears in the August 23, 2006 issue of the Journal of the American Medical Association (JAMA). (See abstract below.)
    “We think the report confirms that Bausch & Lomb took the right action in the interests of consumer health and safety by recalling the MoistureLoc product …” the statement says.
    The statement further reads, “This report, the accompanying commentary and the June 28, 2006, JAMA article, ‘An Outbreak of Fusarium Keratitis Associated with Contact Lens Wear in Singapore,’ note widespread noncompliance with recommended contact lens care and cleaning practices. As always, we remain committed to continuing to providing health care professionals and contact lens wearers with information about the importance of following proper lens care and wear regimens to ensure safe and healthy contact lens wear.”

Patients Report Comfort, Crisp Vision with ACUVUE® OASYS™
What are contact lens wearers saying about the ACUVUE® OASYS™ Brand Contact Lenses with HYDRACLEAR™ Plus? In a recent study, 92% of patients reported the ACUVUE® OASYS™ Brand Contact Lenses felt fresh and maintained natural moisture in adverse environments. 74% reported comfort while on the computer and 83% said they forgot they were wearing contact lenses when wearing the ACUVUE® OASYS™ Brand. And, 80% reported that ACUVUE® OASYS™ felt as natural as their own eyes. Also, 90% of patients reported crisp, clear vision at every moment.
--ADVERTISING

Global Keratoconus Congress – DEADLINE FOR PAPERS AND POSTERS APPROACHING
The Educational Program Committee of the Global Keratoconus Congress invites the submission of abstracts for the Free Papers and Scientific Posters Competition to be held January 26-28, 2007 in Las Vegas. Papers and Posters related to keratoconus, corneal topography, post penetrating keratoplasty or related irregular corneal surface, gas permeable lens and lens care topics are welcome. Please visit http://www.gkc2007.com for information.
--ADVERTISING


Abstract: Multistate Outbreak of Fusarium Keratitis
Researchers at the Centers for Disease Control and Prevention (CDC) recently investigated an outbreak of Fusarium keratitis. Beginning in March 2006, the CDC received multiple reports of Fusarium keratitis among contact lens wearers. They attempted to define the specific activities, contact lens hygiene practices or products associated with the outbreak. They identified confirmed cases as keratitis with illness onset after June 1, 2005 with no history of recent ocular trauma and a corneal culture growing Fusarium species. They genotyped available Fusarium isolates from patient’s clinical and environmental specimens by multilocus sequence typing. They also conducted environmental sampling for Fusarium at a contact lens solution-manufacturing plant.
    As of June 30, 2006, the researchers identified 164 confirmed case patients in 33 states and one U.S. territory. Of those, 154 (94%) wore soft contact lenses. The median patient age was 41 years-old. Corneal transplantation was required or planned in 55 patients (34%). The case-control study included 45 case patients and 78 controls. Case patients were significantly more likely than controls (69% vs. 15%) to report using a specific contact lens solution, ReNu with MoistureLoc. The prevalence of reported use of the solution was similar between case patients and controls (18% vs. 20%).
    The authors did not recover Fusarium from the factory, warehouse, solution filtrate or unopened solution bottles; production of implicated lots was not clustered in time. Among the 39 isolates tested, they identified at least 10 different Fusarium species, comprising 19 unique multilocus genotypes. They conclude that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution and caution that contact lens wearers should not use it.
Chang DC, Grant GB, O’Donnell K, Wannemuehler KA, et al. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA. 2006 Aug 23;296(8):953-63.


Editor's Commentary: Infection and Contact Lenses
What’s more important to you? Contact lens infections or contact lens prescriptions and whether you can sell contact lenses in the future? I'm afraid of the real answer. Not long ago, an important industry employee said to me, "Nobody wants to hear about fungus." Since then we've heard a lot about fungus. And the recent JAMA article brings this into crisp focus. (See our abstract above for details.)
    I would suggest we all pay attention to some hints from this study. Don't let your patients top-off their solutions. I don't care how good the solution is, don't let them do it. Watch wearers who are older and have worn contact lenses longer carefully. We don’t have any definitive guidelines on how often to replace a contact lens case, but the more frequent the better. Teach proper lens care over and over. Beyond fungus, we see infections all-too-often with the best new lenses, and we all need to be vigilant to protect our patients no matter how they acquire their lenses.
    By the way, it is my understanding that the Fusarium strains identified in the investigation were not new strains, but rather the same old fungus you have in your sinks.


Fitting Tip: Prescription Verification Calls
I have heard so many people complain about verification calls and faxes from contact lens distributors. I have recently come in to a practice where the now-retired former doctor told the staff to put the phone call on hold until the message finished and to ignore the faxes. I had to explain to staff that I am legally responsible for any orders that are in error. They continued to consider these calls a nuisance until I decided to keep track of how many patients our response brought in. I was also sure to keep staff informed of any errors I caught in prescriptions that I was to verify.
    In a month’s time, at least two exams a week have been scheduled for patients who tried to order replacements on expired prescriptions from a distributor and were informed by the company that the prescription was expired. Two exams a week may not seem like much, but these are patients who have not returned to the practice, despite recall letters. Staff members now tell me when they schedule a patient who they had previous taken a verification call for. The time staff spends taking those pesky calls and getting the files, and the time I spend answering the verification requests are well worth the approximately eight exams per month that it generates. Sure we have people order from the Internet or phone after those exams, but most order at the office at the end of the exam. I guess they are embarrassed to get the exam and just leave with the prescription. Whatever the case, our office has found that it’s worth the time spent answering those verification requests for the increased exam revenue and occasional contact lens revenue it brings.
Diane G. Fires, O.D.,
Pottstown, Pa.


This month at http://www.siliconehydrogels.org, get an update of silicone hydrogels at ARVO 2006 and review ‘oxygen flux‚’ as well as the cornea’s response to different levels of oxygen transmissibility.

Report adverse contact lens reactions here: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.

Access a reporting form for complications you've seen that were a result of contact lenses dispensed without a valid prescription at the Association of Regulatory Boards of Optometry's (ARBO's) Web site: http://www.arbo.org/arbo.asp?dt=R&doc=Complications. Complete and send the form online or print it out and fax it to (866) 886-6164.

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