I have recently been hearing from multiple sources that there is a feeling that Acanthamoeba keratitis (AK) is on the rise in contact lens wearers. The abstract this week shows that in Auckland, New Zealand, the incidence of AK has more than doubled in recent years, and it is primarily observed in contact lens wearers.
Given the severity of this condition and the likelihood for vision loss, it is important that we continue to emphasize proper contact lens replacement, care, and the avoidance of tap water exposure with all contact lenses.
Jason J. Nichols, OD, MPH, PhD
Love Your Lenses Week Wraps Up
Love Your Lenses Week, which is orchestrated by the General Optic Council with involvement and support from industry partners, manufacturers, and opticians around the United Kingdom, was held this past week.
The campaign, which ran from March 24 to 30, was aimed at raising awareness among patients of how best to look after their lenses, care for them, and get the best out of them. This year, the campaign focused on the importance of thorough hand-washing for safe contact lens care.
A full campaign toolkit is available for all practitioners to download from loveyourlenses.com, including a press release template to help you raise your profile in your local community.
April Is Women’s Eye Health and Safety Awareness Month
In addition to the many differences between men and women, more women than men have eye disease. Eye diseases include age-related macular degeneration, cataracts, glaucoma, and dry eye. Women also may have vision issues related to pregnancy and menopause. According to a Prevent Blindness study, The Future of Vision: Forecasting the Prevalence and Costs of Vision Problems, currently 63% of those who are blind and 62% of those who are visually impaired are women.
Prevent Blindness has designated April as Women’s Eye Health and Safety Awareness Month in an effort to educate women about these issues as well as to provide recommendations on the best ways to take care of vision.
For more information on women’s eye health, including fact sheets on eye diseases, and eye protection, visit www.preventblindness.org, or call (800) 331-2020.
Have you observed increases in any of the following categories of infectious keratitis in your contact lens-wearing patients?
Your Interesting Case Photo Here in the Next Issue
Have you seen an interesting case lately? Would you like to share it with your colleagues? An image from that case could appear in Contact Lenses Today in the coming weeks!
We welcome photo submissions from our other readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit http://www.cltoday.com/upload/upload.aspx to upload your image. Please include a detailed explanation of the photo and your full name, degree or title, and city/state/country.
CARE SOLUTION CORNER
Andrew D. Pucker, OD, PhD
Safety of Cosmetically Tinted Contact Lenses
Cosmetically tinted contact lenses (CLs) are worn by up to 39% of CL wearers in some Asian countries, yet tinted CLs represent only about 1% of the U.S. CL market.1 While the stark difference in tinted CL use around the world is likely attributable to multiple factors, at least one of the reasons why these CLs are underutilized in the United States is because many practitioners associate tinted CLs with an increased risk of ocular complications.2 While there certainly are case report examples of tinted CL-associated complications,1 are tinted CLs truly associated with an increased risk of ocular complications when they are prescribed by eyecare professionals?
A study by Rah et al attempted to answer this question by combining six tinted CL studies and analyzing the subsequent 871 subjects (2,456 visits by eye/1,228 visits by patient) in aggregate.1 Interestingly, Rah et al’s study failed to detect cases of severe adverse ocular events.1 With that said, there were five eyes that presented with grade 3 (out of 4) corneal staining; however, none of these cases required treatment.1
Therefore, Rah et al’s study suggests that when tinted CLs are prescribed by an eyecare professional, they are relatively safe, likely because the wearers are oriented properly to wearing CLs and are clinically monitored.1 Furthermore, prescribing tinted CLs may help practitioners meet their patients’ needs better and potentially prevent them from obtaining unauthorized CLs, which may also decease their risk for developing an adverse event.1
1. Rah MJ, Schafer J, Zhang L, Chan O, Roy L, Barr JT. A meta-analysis of studies on cosmetically tinted soft contact lenses. Clin Ophthalmol. 2013;7:2037-2042.
2. Halloween eye safety. Optometry. 2007 Oct;78:560-561.
MATERIALS & DESIGNS
David L. Kading, OD
Colored Lenses/Colored World
Steve presented in my office for a contact lens consultation. Without further notes, this generally means that the patient is a keratoconus patient who either found me online or was referred from another practitioner in our referral network. At the visit, he was very discouraged.
Five years ago, he had an eye injury that was pretty traumatic. While hiking in the Pacific Northwest, a branch swung out and struck him in the face. A small laceration through his cornea punctured his iris. Steve was lucky that his lens remained intact and that he was left with only a small corneal scar.
With spectacle lenses, he is able to achieve 20/20 -2 vision. Steve has been to eight practitioners over the last four years in an attempt to find someone who could help him with his vision. However, all of the practitioners (except his referring doctor) told him the same thing—that he had a small iris abnormality, that his cornea remains only minorly altered, and that he has 20/20 vision.
Not satisfied, Steve explained that he gets extreme aberrations (my word, not his) and intense glare. One practitioner tried to fit him with a GP trial lens and was able to improve his vision by two letters. Steve did not wish to proceed with ordering the lens.
Upon our initial meeting, Steve said: “Doc, you’re my last hope. I’m ready to poke this eye out or have someone sew my eye shut. The glare is killing me.”
Agreeing with all of my colleagues, I realized that Steve is likely not bothered by the small irregular corneal shape or the abnormality of the small refractive prescription that he has.
Having tinted lenses in the office before, the staff has access to a small stockpile of lenses for moments just like this. Steve was fit with a black iris tinted lens with a 4mm clear pupil. Within 60 seconds, he exhibited epiphora. At first, I suspected that the base lens fit wasn’t ideal or that he was exhibiting some sort of toxic reaction. But then, this 280-pound, 6’9” patient stood up and gave me a giant bear hug.
Patients like Steve may be rare, but there are thousands of patients who have problems similar to his. In these cases, the saying “You don't know what you don't know” rings true. Neither the patient nor I had a clear idea of what he really needed.
When you see a traumatic or surgically altered cornea that has a clear and smooth central pupil region, don't forget to consider a tinted lens to block out abnormalities. Additionally, when patients have any type of iris abnormalities, probe into their vision complaints. A tinted lens may be just what they need to give them a new life.
The Rising Tide of Acanthamoeba Keratitis in Auckland, New Zealand: a 7-year Review of Presentation, Diagnosis And Outcomes (2009-2016)
The purpose of this study was to assess the incidence, clinical presentation, diagnosis, and outcomes of patients who had Acanthamoeba keratitis (AK) in Auckland, New Zealand over a seven-year period. This retrospective, observational, consecutive case series featured 58 eyes of 52 patients diagnosed with AK. All cases of AK were identified using a cross-referenced search of clinical, laboratory, and pharmacy records from March 2009 to May 2016.
The researchers collected demographic and clinical data including age, gender, risk factors, clinical manifestations, initial diagnosis, diagnostic investigations, treatment, presenting and final visual acuity, and surgical interventions.
Contact lens (CL) use was noted in 96% of unilateral and 100% of bilateral cases. The mean duration of symptoms at presentation was 21 days, and the mean duration from presentation to definitive diagnosis was 14 days. Initial diagnosis was recorded as CL-related keratitis in 70.6%, viral keratitis in 15.5%, and AK in 12.0%. The diagnosis was confirmed with in vivo confocal microscopy (IVCM) in 67.2%, corneal scrape in 22.4%, corneal biopsy in 1.7%, and clinically in 8.6%. IVCM sensitivity was 83.0%. Surgical intervention was required in four patients, all with delayed diagnosis (range 63 to 125 days). Additionally, the incidence of AK has more than doubled when compared with the preceding seven-year period.
The study authors concluded that AK is a rare vision-threatening protozoal infection with rapidly-increasing incidence in New Zealand, predominantly affecting CL users. Diagnosis is often challenging and, when delayed, it is associated with worse outcomes. IVCM offers rapid diagnosis with high sensitivity.
McKelvie J, Alshiakhi M, Ziaei M, Patel DV, McGhee CN. The rising tide of Acanthamoeba keratitis in Auckland, New Zealand: a 7-year review of presentation, diagnosis and outcomes (2009-2016). Clin Exp Ophthalmol. 2018 Feb 7. [Epub ahead of print]