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Stress proper lens wear, care schedules to patients
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![Michael D. DePaolis, OD, FAAO [photo]](/~/media/shared-images/michael-d-depaolis-od-faao.jpg)
As you read this editorial, I can only hope we have more answers than we have right now. It’s April 10, 2006, and the eye care community has just learned of a Centers for Disease Control and Prevention investigation into 109 suspected cases of contact lens-associated fungal keratitis. All we really know is that we don’t know much for certain.
There seems to be no geographic predilection, with reported cases ranging from Southeast Asia to North America. The infections aren’t isolated to warm, moist climates as so often occurs in fungal infections, but have been documented as far north as Michigan – in the winter, no less. While preliminary investigations suggest an association with ReNu with Moisture Loc (Bausch & Lomb), microbiology studies have failed to reveal a definitive link.
Convenience may lead to noncompliance
Perhaps the missing piece to this puzzle lies in the hands of our patients. Literally. The industry has spent the better part of a decade striving for convenience in contact lens care: a product that cleans, disinfects and promotes longer daily wear times, all while being easy to use. To a large degree, the development of “all-in-one” multipurpose solutions has made this quest a reality. While “no-rub” formulas are undoubtedly even more patient friendly, they may very well lead to noncompliance.
Let’s face it, when using a product that’s convenient and reliable, it is human nature to become somewhat complacent. Habits such as poor hand washing, inadequate lens rinsing, “topping off” existing solutions and improper lens case care become commonplace. Add in environmental issues, such as tsunami- or hurricane-induced water contamination, and you have the formula for a “perfect storm.”
In the final analysis, it might very well be that certain lens care products withstand breaches in compliance, while others don’t offer as much of a safety net. As this relates to our current fungal keratitis outbreak, we just don’t know for sure.
Take lens care “back to the basics”
Amidst all of the speculation, we’ve learned one thing for certain. Contact lenses are indeed medical devices and need to be treated as such. Until we sort out this fungal keratitis ordeal, our mandate is simple: prevent any additional cases. And prevention means returning to the basics.
We need to be vigilant in ensuring that contact lenses are not obtained through an unauthorized or expired prescription. We must remind patients to wear and replace their lenses as prescribed. We need to be sure patients follow good lens hygiene habits. While this sounds like pretty basic stuff, it does require time. Time to examine, educate and impress upon patients just how important all of this is.
In conjunction with our colleagues at the CDC, at the Food and Drug Administration and in industry, I’m confident we’ll ultimately have the answers we need. In the interim, we must provide meticulous care, offer conservative advice and be factual in communicating with our patients. Anything less will only further confuse an already complex issue.