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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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 Posted: Tue May 23, 2006 12:01 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Anon E. Muss wrote:
| Quote: | Regardless, the incidence of acanthamoebal keratitis is extremely low
(less than 1 in 1.6 MILLION!)
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I think you are in need of updating your numbers, which reflect the
annual incidence in the overall population. Contact lens wearer is one
of the chief risk factors for this disease. The updated incidence is 1
in 30,000 soft contact lens wearers per year.
| Quote: |
When I educate patients, I do NOT recommend people swim in their
lenses. But I give them the REALISTIC risk of developing an
infection. After that, patients make up their mind whether they
choose to swim in their lenses or not <-- informed consent.
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Then, you should be telling them that their risk of contracting the
disease is 1 in 30,000 per year, which will go up significantly if they
swim in their lenses, rinse them with non-sterile solution, or fail to
disinfect them properly.
| Quote: | As an OD, have no undue fear about personally swimming in my silicone
hydrogel contact lenses. The risk of severe injury by car accident or
cancer is much greater. Everyone has their comfort zone.
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Cancer may not be preventable, but acanthamoeba keratitis is highly
preventable if patients avoid the major risk factors, which include
swimming in their contact lenses (34%), and failure to disinfect their
lenses (62%).
DrG
http://www.copfameye.com |
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Anon E. Muss
medicine forum Guru Wannabe
Joined: 22 May 2006
Posts: 136
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| Posted: Tue May 23, 2006 3:28 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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On 23 May 2006 05:01:21 -0700, "Dr. Leukoma" <drg@leukoma.com> wrote:
| Quote: | Anon E. Muss wrote:
Regardless, the incidence of acanthamoebal keratitis is extremely low
(less than 1 in 1.6 MILLION!)
I think you are in need of updating your numbers, which reflect the
annual incidence in the overall population. Contact lens wearer is one
of the chief risk factors for this disease. The updated incidence is 1
in 30,000 soft contact lens wearers per year.
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Correct.
| Quote: | When I educate patients, I do NOT recommend people swim in their
lenses. But I give them the REALISTIC risk of developing an
infection. After that, patients make up their mind whether they
choose to swim in their lenses or not <-- informed consent.
Then, you should be telling them that their risk of contracting the
disease is 1 in 30,000 per year, which will go up significantly if they
swim in their lenses, rinse them with non-sterile solution, or fail to
disinfect them properly.
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I go over rare things such as acanthamoebal keratitis very quickly. I
have been spending a lot more time lately answering questions about
fusarium keratitis which is also *extremely* rare.
I *emphasize* and spend more time on the more common conditions and
risk factors such as bacterial keratitis/GPC and extended wear/proper
lens care/hygiene.
| Quote: | As an OD, have no undue fear about personally swimming in my silicone
hydrogel contact lenses. The risk of severe injury by car accident or
cancer is much greater. Everyone has their comfort zone.
Cancer may not be preventable, but acanthamoeba keratitis is highly
preventable if patients avoid the major risk factors, which include
swimming in their contact lenses (34%), and failure to disinfect their
lenses (62%).
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Still, the risk is extremely low.
Contact lens wear, in and of itself, is a huge risk factor for
acanthamoebal keratitis. I am more concerned with endophthalmitis (no
more than 1 in 3,000) after cataract surgery or iatrogenic corneal
ectasia after LASIK than acanthamoebal keratitis due to swimming in
contact lenses.
Some patients are willing to accept that risk, some are not after
given the epidemiology, natural history and risk factors.
Good discussion. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Tue May 23, 2006 4:45 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Anon E. Muss wrote:
| Quote: |
Still, the risk is extremely low.
Contact lens wear, in and of itself, is a huge risk factor for
acanthamoebal keratitis. I am more concerned with endophthalmitis (no
more than 1 in 3,000) after cataract surgery or iatrogenic corneal
ectasia after LASIK than acanthamoebal keratitis due to swimming in
contact lenses.
Some patients are willing to accept that risk, some are not after
given the epidemiology, natural history and risk factors.
Good discussion.
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I agree, except that we don't really know what the risk is for people
who routinely swim in their lenses. It could be 1 in 500.
Overall, contact lens wear is the least risky form of vision correction
other than wearing spectacles.
DrG |
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William Stacy
medicine forum Guru
Joined: 01 May 2005
Posts: 1177
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| Posted: Tue May 23, 2006 6:26 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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I think it would make a huge difference WHERE they are swimming. To me,
swimming in the ocean is very safe for your eyes (only) due to the
antimicrobial effect of strong saline, more risky in private swimming
pools, riskier yet in public pools, very risky in hot tubs, and
extremely risky in freshwater ponds.
w.stacy, o.d.
Dr. Leukoma wrote:
| Quote: |
I agree, except that we don't really know what the risk is for people
who routinely swim in their lenses. It could be 1 in 500.
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Tue May 23, 2006 7:44 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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I'm not aware of any studies that would either support or contradict
your view. I know that one study of acanthamoeba claimed that the risk
was greater if the water was soft rather than hard. Then someone came
along and debunked that idea. If acanthamoeba didn't like salt water,
then they wouldn't inhabit the salty environment of contact lens
solutions.
I think that the risks need to be clearly spelled out, and that
patients who insist on swimming in contact lenses avail themselves of
daily disposables so that the lenses can be thrown away. There is also
the role of hypoxia and corneal integrity, and extended wear may also
enter the mix as a risk factor. You can only go so far to warn people.
DrG |
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William Stacy
medicine forum Guru
Joined: 01 May 2005
Posts: 1177
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| Posted: Tue May 23, 2006 10:44 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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I doubt a study is needed on the disinfecting properties of strong
saline the sea as compared to the exceedingly weak salines of tears
and/or ophthalmic solutions, or even saline swimming pools (which are
also of the "normal" saline variety). Certainly if it were not the case,
the oceans would be teeming with all kinds of bacteria, which they are
not. Normal saline is under 1%, sea water is at least 3.5% salt.
Here's a quote from:
http://141.150.157.117:8080/prokPUB/chaphtm/004/04_04.htm
"High salt concentrations represent a special case of low water
activity. Sea water (aw = 0.9 is not tolerated by the majority of
bacteria living in soil and in fresh water. Ecosystems containing salt
(sodium chloride) at saturating concentrations are inhabited by only a
few organisms."
w.stacy, o.d.
Dr. Leukoma wrote:
| Quote: | I'm not aware of any studies that would either support or contradict
your view. I know that one study of acanthamoeba claimed that the risk
was greater if the water was soft rather than hard. Then someone came
along and debunked that idea. If acanthamoeba didn't like salt water,
then they wouldn't inhabit the salty environment of contact lens
solutions.
I think that the risks need to be clearly spelled out, and that
patients who insist on swimming in contact lenses avail themselves of
daily disposables so that the lenses can be thrown away. There is also
the role of hypoxia and corneal integrity, and extended wear may also
enter the mix as a risk factor. You can only go so far to warn people.
DrG
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Tue May 23, 2006 11:04 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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I am talking about acanthamoeba, not bacteria. Just Google on the
search terms of acanthamoeba and salt water and see how many hits you
get. Quite a few (I didn't count).
DrG |
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William Stacy
medicine forum Guru
Joined: 01 May 2005
Posts: 1177
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| Posted: Tue May 23, 2006 11:45 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Of course they grow very well in NORMAL saline, and the tons of articles
are mostly about normal saline, not brine. I'm sure they can survive up
to a certain amount of salinity, but I'm just betting they don't do well
in the open ocean.
w.stacy, o.d.
Dr. Leukoma wrote:
| Quote: | I am talking about acanthamoeba, not bacteria. Just Google on the
search terms of acanthamoeba and salt water and see how many hits you
get. Quite a few (I didn't count).
DrG
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Wed May 24, 2006 3:29 am Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Then type in the search terms "acanthamoeba and ocean water." You will
get the same number of hits. The size of your corner is getting ever
smaller.
DrG |
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Dan Abel
medicine forum Guru
Joined: 28 Apr 2005
Posts: 492
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| Posted: Wed May 24, 2006 4:01 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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In article <1148441373.938412.21070@y43g2000cwc.googlegroups.com>,
"Dr. Leukoma" <drg@leukoma.com> wrote:
| Quote: | Then type in the search terms "acanthamoeba and ocean water." You will
get the same number of hits. The size of your corner is getting ever
smaller.
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Many people believe that life evolved in the ocean. Go to any large
aquarium (I've mostly been to the Monterrey Bay Aquarium, a fascinating
place) and see how many critters live in salt water. Some are filter
feeders, living on microscopic organisms. A theory is that the
concentration of salt in our blood matches that of the ocean at the time
we evolved.
--
Dan Abel
dabel@sonic.net
Petaluma, California, USA |
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LarryDoc
medicine forum Guru Wannabe
Joined: 29 Apr 2005
Posts: 262
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| Posted: Wed May 24, 2006 4:47 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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I have to make a strong case for the risks of ocean water. At least here
in Southern Cal, and especially after the rains wash tons of human and
animal excretement, dead carcasses and agricultural waste into the
ocean---well, not a good time to be getting that water in your eyes or
any body orafice. Beaches are routinely posted "avoid contact with
ocean water---may cause illness." Ear infection, eye infection, fever
and cough, cases of Hep A and even B, colitis, vomiting and "the big D".
Yeah, it's a sad state of affairs but real.
I get my arsenal of antibiotic eye drops and referral documents to MDs
ready and away we go. It does not please me that contaminated ocean
water is good for my business.
I ALWAYS make it quite clear that swimming with contact lenses on the
eye is a risk that MUST be mitigated by either not doing it, using
single-use lenses or careful disinfection following ocean water contact.
And NEVER EVER sleep in those same lenses that day and prior to
disinfection.
Yet that being said, I have had but a handful of patients who have
experienced cornea pathology as a possible result of water sports and
zero have lost any vision. Then again I routinely dismiss (eg: "go find
another doctor") patients who are non compliant with lens hygiene and
replacement protocols.
LB, O.D.
PS: Doc (apparently) Anon E Mus: feel free to be who you are. We don't
bite. |
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William Stacy
medicine forum Guru
Joined: 01 May 2005
Posts: 1177
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| Posted: Thu May 25, 2006 1:46 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Dr. Leukoma wrote:
| Quote: | Then type in the search terms "acanthamoeba and ocean water." You will
get the same number of hits. The size of your corner is getting ever
smaller.
DrG
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Using the following google searches, I get the indicated # of hits:
acanthamoeba and salt water 24700
acanthamoeba and sea water 29000
acanthamoeba and "salt water" 1340
acanthamoeba and "sea water" 864
It is very important when doing such searches to place in quotes key
word pairs. The following quote is from the first hit on the last search:
Acanthamoebae have also been isolated from salt water of low salinity,
presumably from cysts. One author (AR) has never managed to maintain
'marine strains' on full salinity media for more than a few generations.
I still say that swimming in the ocean is very safe for the eyes, except
possibly near active sewage inlets.
w.stacy, o.d. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Thu May 25, 2006 2:23 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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William Stacy wrote:
| Quote: | Dr. Leukoma wrote:
Then type in the search terms "acanthamoeba and ocean water." You will
get the same number of hits. The size of your corner is getting ever
smaller.
DrG
Using the following google searches, I get the indicated # of hits:
acanthamoeba and salt water 24700
acanthamoeba and sea water 29000
acanthamoeba and "salt water" 1340
acanthamoeba and "sea water" 864
It is very important when doing such searches to place in quotes key
word pairs. The following quote is from the first hit on the last search:
Acanthamoebae have also been isolated from salt water of low salinity,
presumably from cysts. One author (AR) has never managed to maintain
'marine strains' on full salinity media for more than a few generations.
I still say that swimming in the ocean is very safe for the eyes, except
possibly near active sewage inlets.
w.stacy, o.d.
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Who cares just so long as the fact remains that acanthamoeba are
present in the ocean, as is evident within the first page of returns.
They are also present in soil. There are also strains of bacteria that
have adapted quite well to not only the salinity of the ocean, but also
survive at great depths. In a related topic, in reading about methods
of food preservation, it is generally accepted that a minimum
concentration of 10% sodium chloride is necessary.
So, given those facts, if someone still wants to wear their contacts in
the ocean instead of wearing prescription goggles, then I am not going
to give it my blessing. They assume the risk solely and completely.
If they want to have LASIK so that they don't have to worry about any
of this, then that is another set of risks.
DrG |
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William Stacy
medicine forum Guru
Joined: 01 May 2005
Posts: 1177
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| Posted: Thu May 25, 2006 5:47 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Dr. Leukoma wrote:
| Quote: | Who cares just so long as the fact remains that acanthamoeba are
present in the ocean,
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Anyone who is interested in the science behind the professions.
They assume the risk solely and completely.
What a joke. Tell *that* to the jury.
w.stacy, o.d. |
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mb
medicine forum beginner
Joined: 10 Mar 2005
Posts: 22
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| Posted: Thu Jun 01, 2006 4:31 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Dr. Leukoma wrote:
| Quote: | I'm not aware of any studies that would either support or contradict
your view. I know that one study of acanthamoeba claimed that the risk
was greater if the water was soft rather than hard. Then someone came
along and debunked that idea. If acanthamoeba didn't like salt water,
then they wouldn't inhabit the salty environment of contact lens
solutions.
I think that the risks need to be clearly spelled out, and that
patients who insist on swimming in contact lenses avail themselves of
daily disposables so that the lenses can be thrown away. There is also
the role of hypoxia and corneal integrity, and extended wear may also
enter the mix as a risk factor. You can only go so far to warn people.
DrG |
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