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mb
medicine forum beginner
Joined: 10 Mar 2005
Posts: 22
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 Posted: Sun Jun 04, 2006 2:35 am Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Dr. Leukoma wrote:
| Quote: | mb wrote:
Well, I could certainly ask him what his motive was if I wanted to.
Given what happened to my daughter, I am glad we had the option of a
daily disposable. My son was very content in glasses until he turned 18
and met a girl who said he looked better without them. Other family
members and friends have turned to a daily disposable as well also
because of what happened to my daughter. If everyone has such poor
hygiene habits like all of you claim and what an industry wants
everyone to believe (that is debatable in my opinion), then daily
disposables remain a good choice whatever his objective. Profits
remain a key to any business and that will never change. What needs to
change is the FDA's total protection to the consumer.
Yes, but some patients still want clear vision 24/7 which means
continuous wear lenses, and not daily disposables.
There will always be risk.
I have noted that your daughter's eye doctor is fellowship trained in
LASIK.
DrG
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Yes, he is a renowned lasik surgeon. My daughter would let no one
touch her eye except him. His hands are gifted as well as his mind.
We could not have been under better care than that, facing the prospect
that she almost lost her eye battling this infection. |
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mb
medicine forum beginner
Joined: 10 Mar 2005
Posts: 22
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| Posted: Sun Jun 04, 2006 2:53 am Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Quick wrote:
| Quote: | mb wrote:
Quick wrote:
Alright. I think I'm getting a better picture of your
agenda. My feeling is there should be some
responsibility on the patient. I don't want "total"
protection by the FDA.
I DO want to be completely informed of risks and then
make
my own decision. I'm aware there is an increased risk of
eye infection by wearing contacts. I thought about it,
I'm OK with it and decided to go ahead.
-Quick
Exactly right! I want to be FULLY informed of ALL risks
and then make my own decision as well. That is all I
believe any of us want. Total protection by the FDA will
never happen, but that is supposed to be the only job of
the FDA, to protect the public, not the companies. Of
course, patients bear some responsibility, but how can
they if they are not aware of all risks, i.e., swimming
with contacts, hots tubs, lakes, pools, tap water? Where
are these disclosures on any of these products. We have
a medical profession that is not even aware of and/or
debates these risks as insignificant statistics.
Life has inherent risks. We don't and can't know all of them.
You will never know all the risks. You will never be FULLY
informed. Now or in the future.
The medical profession can't know all of them. No one and
no organization can give you total protection. Sometimes
people are injured, maimed, and die due to no fault of their
own or anyone else. It can't be totally prevented. That's life
It's an accepted practice with products to say what they
*will* do and not what they won't do.
It's well known that there is an increased risk of infection
as a result of wearing contacts.
I don't know what the B&L product says. If it states that
it will kill *all* bad organisms then I would feel they are
at fault. If the product itself actively caused some harm
without any disclosure of the risk I would feel they were
at fault. If the product was contaminated while in control
of the company I would feel they were at fault. I don't
expect any product to list all the things it *won't* do
unless one of those things is generally (statistic) expected
from like products.
-Quick
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I agree life has inherent risks. That is not what I am disputing.
They have already admitted their product was not fully tested for its
efficacies. Now they are facing damage control and liability. The
public will forget, but the people who it affected will not forget.
All I am saying is that we need prominently displayed warning labels of
ALL water related risks on all contact lens products. I don't think
that is asking too much, especially if the FDA website already states
"no swimming in contacts." We were clueless when it affected by
daughter and quite frankly, I was shocked and angry why we did not
know. Why don't most consumers know of this risk? If the industry
told you there were any water related risks, it would be difficult for
them to sell their 30 day lens. They bank on the assumption this
statistic is low and will absorb the liability when it hits them. The
problem is Acanthamoeba is a sight threatening parasite that does not
die easily. 15-20 years you just lost your eye. It is not just a
"pink eye" infection. It is devastating and as I have stated before,
every good ophthalmologist will tell you, do not go swimming in
contacts or do so at your own risk. They further would not even
recommend a 30 day lens. Now those are the good doctors. And if you
don't like that advise, then go to another doctor who will fit you.
There are plenty out there as well. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Sun Jun 04, 2006 3:29 am Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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mb wrote:
| Quote: |
Yes, he is a renowned lasik surgeon. My daughter would let no one
touch her eye except him. His hands are gifted as well as his mind.
We could not have been under better care than that, facing the prospect
that she almost lost her eye battling this infection.
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Interestingly, I know what that is like first hand. One of my most
recent patients was damaged by LASIK in 1998, performed by a very
gifted surgeon. She hasn't let anyone touch her eyes until now.
DrG |
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mb
medicine forum beginner
Joined: 10 Mar 2005
Posts: 22
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| Posted: Sun Jun 04, 2006 4:58 am Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Dr. Leukoma wrote:
| Quote: | mb wrote:
Yes, he is a renowned lasik surgeon. My daughter would let no one
touch her eye except him. His hands are gifted as well as his mind.
We could not have been under better care than that, facing the prospect
that she almost lost her eye battling this infection.
Interestingly, I know what that is like first hand. One of my most
recent patients was damaged by LASIK in 1998, performed by a very
gifted surgeon. She hasn't let anyone touch her eyes until now.
DrG
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My naivete must be showing. All of us common people put so much trust
in our doctors when they help us, but even gifted doctors make mistakes
or procedures just simply go wrong. Yes, lasik can be blindness as
well as better sight. You are right, of course, no one is protecting
the consumer on that front either. I am just not surprised anymore.
Our eyesight has been underprotected for years on all fronts.
Something needs to change.
I hope your gifted hands can restore your patient's sight. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Sun Jun 04, 2006 1:22 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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mb wrote:
| Quote: | Dr. Leukoma wrote:
mb wrote:
Yes, he is a renowned lasik surgeon. My daughter would let no one
touch her eye except him. His hands are gifted as well as his mind.
We could not have been under better care than that, facing the prospect
that she almost lost her eye battling this infection.
Interestingly, I know what that is like first hand. One of my most
recent patients was damaged by LASIK in 1998, performed by a very
gifted surgeon. She hasn't let anyone touch her eyes until now.
DrG
My naivete must be showing. All of us common people put so much trust
in our doctors when they help us, but even gifted doctors make mistakes
or procedures just simply go wrong. Yes, lasik can be blindness as
well as better sight. You are right, of course, no one is protecting
the consumer on that front either. I am just not surprised anymore.
Our eyesight has been underprotected for years on all fronts.
Something needs to change.
I hope your gifted hands can restore your patient's sight.
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She is quite happy. I just like to keep things in perspective. There
is a jungle of misinformation out there.
By the way, I have been told repeatedly by Alcon that their Optifree
kills acanthamoeba cysts after 6 hours. I know that hydrogen peroxide
kills the cysts as well after a 6 hour soak. This means a 6 hour soak
in the full 3% strength. The unfortunate thing is that the leading
hydrogen peroxide disinfection system begins to neutralize the hydrogen
peroxide as soon as the contact lenses are put into the container. I
am referring of course to the one with the grey disk at the bottom.
It might interest you that at the time of the last "acanthamoeba scare"
almost twenty years ago, there was no effective pharmaceutical agent
against it initially.
DrG |
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mb
medicine forum beginner
Joined: 10 Mar 2005
Posts: 22
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| Posted: Sun Jun 04, 2006 2:45 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Dr. Leukoma wrote:
| Quote: | mb wrote:
Dr. Leukoma wrote:
mb wrote:
Yes, he is a renowned lasik surgeon. My daughter would let no one
touch her eye except him. His hands are gifted as well as his mind.
We could not have been under better care than that, facing the prospect
that she almost lost her eye battling this infection.
Interestingly, I know what that is like first hand. One of my most
recent patients was damaged by LASIK in 1998, performed by a very
gifted surgeon. She hasn't let anyone touch her eyes until now.
DrG
My naivete must be showing. All of us common people put so much trust
in our doctors when they help us, but even gifted doctors make mistakes
or procedures just simply go wrong. Yes, lasik can be blindness as
well as better sight. You are right, of course, no one is protecting
the consumer on that front either. I am just not surprised anymore.
Our eyesight has been underprotected for years on all fronts.
Something needs to change.
I hope your gifted hands can restore your patient's sight.
She is quite happy. I just like to keep things in perspective. There
is a jungle of misinformation out there.
By the way, I have been told repeatedly by Alcon that their Optifree
kills acanthamoeba cysts after 6 hours. I know that hydrogen peroxide
kills the cysts as well after a 6 hour soak. This means a 6 hour soak
in the full 3% strength. The unfortunate thing is that the leading
hydrogen peroxide disinfection system begins to neutralize the hydrogen
peroxide as soon as the contact lenses are put into the container. I
am referring of course to the one with the grey disk at the bottom.
It might interest you that at the time of the last "acanthamoeba scare"
almost twenty years ago, there was no effective pharmaceutical agent
against it initially.
DrG
|
Yes, I need you experts to keep me in perspective as my passion on this
issue overcomes me sometimes. And I am glad there are good doctors
like you out there who truly care about their patients. We need you
and sometimes rely solely on your expertise.
Optifree Express is one of the solutions I would feel comfortable using
if I wore contacts, and they have validated that for you. Since some
solutions cannot even claim acanthamoebicidal, all the more reason for
"no swimming" and water related disclosures on all products as that
clearly puts you at risk; regardless of how low the risk, there is a
risk.
Sadly so, yes, you just lost your eye 15-20 years ago. Jackie's doctor
was involved in some of the original research during that epidemic that
was studied at the CDC while he was a Fellow at Emory University in
Atlanta, between 1984-86. He has been clearly aware and has treated
these infections for quite a long time.
Obviously, since this is such a virulent parasite as we cannot even
develop effective antibiotics to kill this parasite, let alone put
these cleaning agents in our contact lens solutions, all the more
reason for warnings. I am fearful this Acanthamoeba trend will
continue and we are entitled to find out why. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Sun Jun 04, 2006 4:18 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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mb wrote:
| Quote: |
Obviously, since this is such a virulent parasite as we cannot even
develop effective antibiotics to kill this parasite, let alone put
these cleaning agents in our contact lens solutions, all the more
reason for warnings. I am fearful this Acanthamoeba trend will
continue and we are entitled to find out why.
|
I guess I need to see some statistics supporting this "trend." Or, is
it just a "spike" caused by temporary local environmental factors such
as warmer water, less rainfall causing lakes to be lower, etc. Here at
the University of Texas Southwestern Medical Center, they are looking
at the immunological aspects, i.e. what keeps most people from
contracting the infection.
My own pet theory, for which I have no proof whatsoever, is the
changing perception of the contact lens as a consumer product rather
than a medical device caused by a number of variables, and increasing
emphasis on convenience. For some reason, it seems that more people
consider it their right not to be inconvenienced. The end result?
Less attention paid to lens hygeine.
DrG |
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mb
medicine forum beginner
Joined: 10 Mar 2005
Posts: 22
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| Posted: Sun Jun 04, 2006 5:21 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Dr. Leukoma wrote:
| Quote: | mb wrote:
Obviously, since this is such a virulent parasite as we cannot even
develop effective antibiotics to kill this parasite, let alone put
these cleaning agents in our contact lens solutions, all the more
reason for warnings. I am fearful this Acanthamoeba trend will
continue and we are entitled to find out why.
I guess I need to see some statistics supporting this "trend." Or, is
it just a "spike" caused by temporary local environmental factors such
as warmer water, less rainfall causing lakes to be lower, etc. Here at
the University of Texas Southwestern Medical Center, they are looking
at the immunological aspects, i.e. what keeps most people from
contracting the infection.
My own pet theory, for which I have no proof whatsoever, is the
changing perception of the contact lens as a consumer product rather
than a medical device caused by a number of variables, and increasing
emphasis on convenience. For some reason, it seems that more people
consider it their right not to be inconvenienced. The end result?
Less attention paid to lens hygeine.
DrG
|
We had plenty of doctors very interested in my daughter's case and one
doctor too stated it could possibly be a missing gene in their immune
system that protects others from this parasite. Allergies, possibly,
with medicines that cause the eye to be dryer, don't know. Our tears
do perform a protective barrier against most bacteria. I will email
you the Chicago and Philadelphia studies. The doctors in these two
cities are very concerned about this spike as well. I would like to
know how many cases of Acanthamoeba have occurred in Texas in the last
several years. I have read with interest about Dr. Niederkorn and his
studies on the immunity issue.
Absolutely on your pet theory. We have that proof, as the FDA 4 years
ago deregulated the plano contact lens as cosmetic, which was sold in
dollar stores, because it was a non-prescription lens. It took another
two years to get Congress to pass the Plano Contact Lens bill. I
emailed 100 senators in July 2005 about this issue and other appalling
facts that I discovered. Two days later that legislation was passed in
full and now is a law that all contact lenses are medical devices, not
to be sold without a prescription. Were they listening to me and my
anguished pleas for change? And do you believe there are now states
trying to overturn this legislation. Daniel Troy, acting
administrator, at that time, saw no problem with deregulating this
medical device. And who suffered the consequences - our youth, the
ultimate risktakers.
It is also an industry marketing their products as quick and
convenient. It is a very powerful industry regardless of what good
doctors recommend to their patients. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Sun Jun 04, 2006 6:50 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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mb wrote:
| Quote: | Dr. Leukoma wrote:
mb wrote:
Obviously, since this is such a virulent parasite as we cannot even
develop effective antibiotics to kill this parasite, let alone put
these cleaning agents in our contact lens solutions, all the more
reason for warnings. I am fearful this Acanthamoeba trend will
continue and we are entitled to find out why.
I guess I need to see some statistics supporting this "trend." Or, is
it just a "spike" caused by temporary local environmental factors such
as warmer water, less rainfall causing lakes to be lower, etc. Here at
the University of Texas Southwestern Medical Center, they are looking
at the immunological aspects, i.e. what keeps most people from
contracting the infection.
My own pet theory, for which I have no proof whatsoever, is the
changing perception of the contact lens as a consumer product rather
than a medical device caused by a number of variables, and increasing
emphasis on convenience. For some reason, it seems that more people
consider it their right not to be inconvenienced. The end result?
Less attention paid to lens hygeine.
DrG
We had plenty of doctors very interested in my daughter's case and one
doctor too stated it could possibly be a missing gene in their immune
system that protects others from this parasite. Allergies, possibly,
with medicines that cause the eye to be dryer, don't know. Our tears
do perform a protective barrier against most bacteria. I will email
you the Chicago and Philadelphia studies. The doctors in these two
cities are very concerned about this spike as well. I would like to
know how many cases of Acanthamoeba have occurred in Texas in the last
several years. I have read with interest about Dr. Niederkorn and his
studies on the immunity issue.
|
I know Dr. Niederkorn, and we're practically neighbors.
DrG |
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mb
medicine forum beginner
Joined: 10 Mar 2005
Posts: 22
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| Posted: Sun Jun 04, 2006 7:10 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Dr. Leukoma wrote:
| Quote: | mb wrote:
Dr. Leukoma wrote:
mb wrote:
Obviously, since this is such a virulent parasite as we cannot even
develop effective antibiotics to kill this parasite, let alone put
these cleaning agents in our contact lens solutions, all the more
reason for warnings. I am fearful this Acanthamoeba trend will
continue and we are entitled to find out why.
I guess I need to see some statistics supporting this "trend." Or, is
it just a "spike" caused by temporary local environmental factors such
as warmer water, less rainfall causing lakes to be lower, etc. Here at
the University of Texas Southwestern Medical Center, they are looking
at the immunological aspects, i.e. what keeps most people from
contracting the infection.
My own pet theory, for which I have no proof whatsoever, is the
changing perception of the contact lens as a consumer product rather
than a medical device caused by a number of variables, and increasing
emphasis on convenience. For some reason, it seems that more people
consider it their right not to be inconvenienced. The end result?
Less attention paid to lens hygeine.
DrG
We had plenty of doctors very interested in my daughter's case and one
doctor too stated it could possibly be a missing gene in their immune
system that protects others from this parasite. Allergies, possibly,
with medicines that cause the eye to be dryer, don't know. Our tears
do perform a protective barrier against most bacteria. I will email
you the Chicago and Philadelphia studies. The doctors in these two
cities are very concerned about this spike as well. I would like to
know how many cases of Acanthamoeba have occurred in Texas in the last
several years. I have read with interest about Dr. Niederkorn and his
studies on the immunity issue.
I know Dr. Niederkorn, and we're practically neighbors.
DrG
|
Small world. Would be interested to get his expert opinion on these
issues and to ascertain if there are increasing trends in Texas. My
guess is his expertise in this field already demonstrates there is a
heightened concern. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Mon Jun 05, 2006 12:33 am Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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mb wrote:
| Quote: | Dr. Leukoma wrote:
mb wrote:
Dr. Leukoma wrote:
mb wrote:
Obviously, since this is such a virulent parasite as we cannot even
develop effective antibiotics to kill this parasite, let alone put
these cleaning agents in our contact lens solutions, all the more
reason for warnings. I am fearful this Acanthamoeba trend will
continue and we are entitled to find out why.
I guess I need to see some statistics supporting this "trend." Or, is
it just a "spike" caused by temporary local environmental factors such
as warmer water, less rainfall causing lakes to be lower, etc. Here at
the University of Texas Southwestern Medical Center, they are looking
at the immunological aspects, i.e. what keeps most people from
contracting the infection.
My own pet theory, for which I have no proof whatsoever, is the
changing perception of the contact lens as a consumer product rather
than a medical device caused by a number of variables, and increasing
emphasis on convenience. For some reason, it seems that more people
consider it their right not to be inconvenienced. The end result?
Less attention paid to lens hygeine.
DrG
We had plenty of doctors very interested in my daughter's case and one
doctor too stated it could possibly be a missing gene in their immune
system that protects others from this parasite. Allergies, possibly,
with medicines that cause the eye to be dryer, don't know. Our tears
do perform a protective barrier against most bacteria. I will email
you the Chicago and Philadelphia studies. The doctors in these two
cities are very concerned about this spike as well. I would like to
know how many cases of Acanthamoeba have occurred in Texas in the last
several years. I have read with interest about Dr. Niederkorn and his
studies on the immunity issue.
I know Dr. Niederkorn, and we're practically neighbors.
DrG
Small world. Would be interested to get his expert opinion on these
issues and to ascertain if there are increasing trends in Texas. My
guess is his expertise in this field already demonstrates there is a
heightened concern.
|
I would guess that time frame was atypical, which explains the
interest. As I said earlier, 4 cases in 6 months, without any during
the previous 19 years, and none since. Sounds like an environmental
cause to me. Plus none of the residents got it right.
DrG |
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mb
medicine forum beginner
Joined: 10 Mar 2005
Posts: 22
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| Posted: Mon Jun 05, 2006 3:37 am Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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|
Dr. Leukoma wrote:
| Quote: | mb wrote:
Dr. Leukoma wrote:
mb wrote:
Dr. Leukoma wrote:
mb wrote:
Obviously, since this is such a virulent parasite as we cannot even
develop effective antibiotics to kill this parasite, let alone put
these cleaning agents in our contact lens solutions, all the more
reason for warnings. I am fearful this Acanthamoeba trend will
continue and we are entitled to find out why.
I guess I need to see some statistics supporting this "trend." Or, is
it just a "spike" caused by temporary local environmental factors such
as warmer water, less rainfall causing lakes to be lower, etc. Here at
the University of Texas Southwestern Medical Center, they are looking
at the immunological aspects, i.e. what keeps most people from
contracting the infection.
My own pet theory, for which I have no proof whatsoever, is the
changing perception of the contact lens as a consumer product rather
than a medical device caused by a number of variables, and increasing
emphasis on convenience. For some reason, it seems that more people
consider it their right not to be inconvenienced. The end result?
Less attention paid to lens hygeine.
DrG
We had plenty of doctors very interested in my daughter's case and one
doctor too stated it could possibly be a missing gene in their immune
system that protects others from this parasite. Allergies, possibly,
with medicines that cause the eye to be dryer, don't know. Our tears
do perform a protective barrier against most bacteria. I will email
you the Chicago and Philadelphia studies. The doctors in these two
cities are very concerned about this spike as well. I would like to
know how many cases of Acanthamoeba have occurred in Texas in the last
several years. I have read with interest about Dr. Niederkorn and his
studies on the immunity issue.
I know Dr. Niederkorn, and we're practically neighbors.
DrG
Small world. Would be interested to get his expert opinion on these
issues and to ascertain if there are increasing trends in Texas. My
guess is his expertise in this field already demonstrates there is a
heightened concern.
I would guess that time frame was atypical, which explains the
interest. As I said earlier, 4 cases in 6 months, without any during
the previous 19 years, and none since. Sounds like an environmental
cause to me. Plus none of the residents got it right.
DrG
|
I added another mother to my support group from Louisana. 16 year old
boy got the infection in Jan. 2006, a woman from Indiana in January,
and a man from Kansas city last week. they fought his as herpes for 13
months. wonder what kind of solution your patients had used. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
|
| Posted: Mon Jun 05, 2006 12:26 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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mb wrote:
| Quote: | I added another mother to my support group from Louisana. 16 year old
boy got the infection in Jan. 2006, a woman from Indiana in January,
and a man from Kansas city last week. they fought his as herpes for 13
months. wonder what kind of solution your patients had used.
|
I wish I knew. We have traditionally favored Optifree Express over
ReNu because of the broader spectrum of action.
One girl had been hit in the eye with a toy hockey puck from a game.
She mentioned that she had put an ice pack on her eye. She had been
wearing her contact lens at the time.
Another was wearing 30 day continuous wear and had been swimming in
them.
The third was wearing disposable lenses, with no known risk
factors...denied swimming, using tap water, etc.
The fourth was in continuous wear contacts and got dust in her eye out
in west Texas.
All four had atypical presentation, with small dense central
infiltrates under an intact epithelium...too dense in my opinion to be
mistaken for herpes. High magnification revealed faint tracks or
filaments, which are basically tunnels created by the organism. They
all looked septic.
All were positively diagnosed with confocal microscopy. The first
three had similar appearance, which helped with the diagnosis. The
fourth patient was highly atypical in that the infiltrate was small and
peripheral. The department head, who is also an expert on
acanthamoeba, stated that these were the earliest cases he had ever
seen. He later commended me on my early "catch," and for resisting the
urge to reach for the steroids, which causes the organism to spread
quicker. It was not that I was able to correctly diagnose the first
case, but had simply ruled out anything with which I was familiar. I
reasoned first that it was infectious, and secondly that it was
anaerobic. With a medical school nearby, it would have been foolish to
begin treatment without a positive diagnosis.
DrG |
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mb
medicine forum beginner
Joined: 10 Mar 2005
Posts: 22
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| Posted: Mon Jun 05, 2006 1:48 pm Post subject:
Re: will acuvvue oasys or advance 2 be okay for swimming?
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Dr. Leukoma wrote:
| Quote: | mb wrote:
I added another mother to my support group from Louisana. 16 year old
boy got the infection in Jan. 2006, a woman from Indiana in January,
and a man from Kansas city last week. they fought his as herpes for 13
months. wonder what kind of solution your patients had used.
I wish I knew. We have traditionally favored Optifree Express over
ReNu because of the broader spectrum of action.
One girl had been hit in the eye with a toy hockey puck from a game.
She mentioned that she had put an ice pack on her eye. She had been
wearing her contact lens at the time.
Another was wearing 30 day continuous wear and had been swimming in
them.
The third was wearing disposable lenses, with no known risk
factors...denied swimming, using tap water, etc.
The fourth was in continuous wear contacts and got dust in her eye out
in west Texas.
All four had atypical presentation, with small dense central
infiltrates under an intact epithelium...too dense in my opinion to be
mistaken for herpes. High magnification revealed faint tracks or
filaments, which are basically tunnels created by the organism. They
all looked septic.
All were positively diagnosed with confocal microscopy. The first
three had similar appearance, which helped with the diagnosis. The
fourth patient was highly atypical in that the infiltrate was small and
peripheral. The department head, who is also an expert on
acanthamoeba, stated that these were the earliest cases he had ever
seen. He later commended me on my early "catch," and for resisting the
urge to reach for the steroids, which causes the organism to spread
quicker. It was not that I was able to correctly diagnose the first
case, but had simply ruled out anything with which I was familiar. I
reasoned first that it was infectious, and secondly that it was
anaerobic. With a medical school nearby, it would have been foolish to
begin treatment without a positive diagnosis.
DrG
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hmmm.... water and swimming culprits.....
Your brilliant analysis at the onset saved these patients from further
destruction of their eye. If we could clone you excellent doctors, it
would be a great benefit to us all. More continuing education in the
eye health medical field on this infection is a must. There continues
to be a mindset that this infection is so "rare" that doctors are not
inclined to even suspect it. That needs to change, but if that won't
happen, then prominently displayed warning labels of all water related
risks on all contact lens products would reduce this risk as well.
Another change on my list is mandatory reporting mechanisms to the CDC
on these infections as no one has any clue about increasing or
decreasing trends without current or previous statistics. Another
stat. that should be in place is lasik gone bad. Thus, my continuing
support for passage of the Vision Preservation Act. This legislation
is critical...... |
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