Fusarium: Facts and Figures to Share with Patients
BY SUSAN J. GROMACKI, OD, MS, FAAO
By now, most eyecare practitioners and many of our patients know about the recent Fusarium keratitis outbreak. The lay media has done a thorough job of reporting this issue and then some. One advantage to this attention is that many patients are finally taking a proactive approach to their lens care. This gives us a great opportunity for proper patient education.
Here is a review of the latest Fusarium information:
Fusarium is a fungus commonly found in organic matter such as soil and plants. Fusarium keratitis is not transmittable from one person to another. People most at risk for this type of infection include the immunocompromised and those who have trauma and/or certain diseases of the eye.
Fusarium infections are rare in the United States. Fungal infections are more common in warmer climates. For example, 35 percent of corneal infections in the southeastern United States are caused by a fungus, vs. just 1 percent in New York. During this recent outbreak, however, Fusarium infections occurred all over the nation.
There are 30 million contact lens wearers in the United States. At press time, the Centers for Disease Control and Prevention (CDC) received reports of 130 confirmed cases, 125 of whom were contact lens wearers; 118 could identify which solution they used. Of those, 75 reported using ReNu with MoistureLoc (Bausch & Lomb), which is disproportionate to its market share.
B&L voluntarily and permanently recalled MoistureLoc worldwide. The CDC and the U.S. Food & Drug Administration found no evidence of product contamination, tampering, counterfeiting or sterility failure.
In a letter to the American Academy of Ophthalmology, B&L stated that MoistureLoc's preservative, alexidine, is effective, but if allowed to evaporate, if not regularly replaced in the lens case, or when the bottle is kept open between uses or the case isn't cleaned properly or replaced regularly, "the concentration of the polymers included in the formula to enhance comfort may make the solution more likely to be contaminated with Fusarium in the environment."
Other studies have shown various products to be less effective against Fusarium under sustained high temperature conditions.
Lens Care Reminders
In summary, noncompliance with contact lens care may have played a role in some of the cases in this
outbreak. To ensure healthy lens wear for your patients, urge them to follow these instructions:
Always wash your hands with soap and water before handling contact lenses.
Wear and replace lenses according to the schedule prescribed by your practitioner.
Follow the specific lens cleaning and storage guidelines from your practitioner. Don't deviate from the lens care products your practitioner recommends.
Make sure you always use fresh solution and replenish the solution daily. If you don't use the lenses daily, follow the manufacturer's recommendations for cleaning and storing the lenses.
Keep the lens case clean and replace it every three months.
Remove your lenses and consult your eye doctor immediately if you experience symptoms such as redness, pain, tearing, increased light sensitivity, blurry vision, discharge or swelling.
This would also be a good time to reinstate the "rub and rinse" rather than the "no-rub" cleaning method. Many of you never deviated from this in the first place.
To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #129.
Dr. Gromacki has a specialty contact lens and post-surgical co-management practice as part of a multi-subspecialty ophthalmology group in Ann Arbor, MI.