Acanthamoeba Keratitis Associated With Tap Water Use During Contact Lens Cleaning

Legarreta, John E.; Nau, Amy; Dhaliwal, Deepinder K.

doi:10.1097/icl.0b013e31827a79ee

Cited by 31 publications

(27 citation statements)

References 23 publications

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“…31 Based on instructions that state to rinse with tap water, RGP wearers might assume that storage in tap water is acceptable as well. To avoid mixed public health messaging, it might be preferable to advise RGP wearers to avoid tap water in all steps of the cleaning process and storage of their lenses.…”

Section: Discussionmentioning

confidence: 99%

Acanthamoeba Keratitis among Rigid Gas Permeable Contact Lens Wearers in the United States, 2005 through 2011

et al. 2016

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Objective To describe the clinical presentation and outcomes of Acanthamoeba keratitis (AK) in rigid gas permeable (RGP) contact lens wearers and identify modifiable risk factors. Design A case-control investigation. Participants Case-patients were RGP contact lens-wearing U.S. residents with a diagnosis of AK during 2005–2011. Controls were RGP contact lens wearers with no history of AK and at least 12 years of age. Methods Case-patients were identified during two multi-state AK outbreak investigations. Controls from the first investigation in 2007 were identified using a reverse address directory. In the second investigation, controls were recruited from participating ophthalmology and optometry practices. Case-patients and controls were interviewed by phone using a standardized questionnaire. Odds ratios (ORs) and Fisher’s exact P-values were calculated to assess risk factors associated with infection. Main Outcome Measures AK, a rare eye disease primarily affecting contact lens wearers, is caused by free-living amebae, Acanthamoeba spp. Results We identified 37 case-patients in the two investigations, 10 (27%) from the 2007 investigation and 27 (73%) from 2011. There were 17 healthy controls, 9 (53%) from 2007 and 8 (47%) from 2011. Among case-patients, 9 (24%) wore RGP lenses for orthokeratology or therapeutic indication; no controls wore RGP lenses for these indications. Significant risk factors for AK were wearing lenses for orthokeratology (OR undefined, P=0.02), sleeping while wearing lenses (OR 8.00, P=0.04), storing lenses in tap water (OR 16.00, P=0.001), and topping off contact lens solution in the case (OR 4.80, P=0.01). After stratifying by use of RGP lenses for orthokeratology, storing lenses in tap water and topping off remained significant exposures. Conclusions Nearly a quarter of case-patients were orthokeratology wearers. Using tap water to store RGP lenses and topping off solution in the lens case were modifiable risk behaviors identified in RGP wearers who wore lenses for both orthokeratology and non-orthokeratology indications. RGP wearers should avoid exposing their lenses to tap water and should empty their cases and use fresh lens solution each time they take out their lenses.

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Section: Discussionmentioning

confidence: 99%

Acanthamoeba Keratitis among Rigid Gas Permeable Contact Lens Wearers in the United States, 2005 through 2011

et al. 2016

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“…A recent case report draws attention to an AK case where a patient complied with manufacturer GP care solution guidelines, which included a tap water rinsing step, and an infection developed. 13 Those authors emphatically called for changes in industry labeling and in practice to eliminate the use of tap water for cleaning GP lenses or any storage cases. They also sought better warnings for patients on the danger of using tap or distilled water for lens care.…”

Section: Introductionmentioning

confidence: 99%

Water Exposure is a Common Risk Behavior Among Soft and Gas-Permeable Contact Lens Wearers

Zimmerman

Richdale

Mitchell

et al. 2017

Cornea

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Purpose To understand soft contact lens (SCL) and gas permeable lens (GP) wearers’ behaviors and knowledge regarding exposure of lenses to water. Methods The Contact Lens Risk Survey (CLRS) and health behavior questions were completed online by a convenience sample of 1,056 SCL and 85 GP wearers age 20–76 years. Participants were asked about exposing their lenses to water and their understanding of risks associated with these behaviors. Chi-square analyses examined relationships between patient behaviors and perceptions. Results GP wearers were more likely than SCL wearers to ever rinse or store lenses in water (rinsing: 91% GP, 31% SCL, p<0.001; storing: 33% GP, 15% SCL p<0.001). Among SCL wearers, males were more likely to store (24% vs 13%, p=0.003) or rinse (41% vs 29%, p=0.012) their lenses in water. Showering while wearing lenses was more common in SCL wearers (86%) than GP wearers (67%) (p<0.0001). Swimming while wearing lenses was reported by 62% of SCL wearers and 48% of GP wearers (p=0.027). Wearers who rinsed (SCL; p<0.0001, GP; p=0.11) or stored lenses in water (SCL; p<0.0001, GP p=0.007) reported this behavior had little or no effect on their infection risk, compared with those that did not. Both SCL (p<0.0001) and GP wearers (p<0.0001) perceived that distilled water was safer than tap water for storing or rinsing lenses. Conclusion Despite previously published evidence of Acanthamoeba keratitis’ association with water exposure, most SCL, and nearly all GP wearers regularly expose their lenses to water, with many unaware of the risk.

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“…This painful, often unilateral eye disease may eventually progress to blindness and is associated with contact lens use but can also be diagnosed in non-contact lens wearers. Acanthamoeba species can be found in a variety of different environments including recreational and drinking water, soil and air (Gianinazzi et al, 2009;Legarreta et al, 2013;Rivera et al, 1991). Trophozoites and highly robust cysts can persist for years and are often resistant to drug treatments.…”

Section: Introductionmentioning

confidence: 99%

Acanthamoeba keratitis: improving the Scottish diagnostic service for the rapid molecular detection of Acanthamoeba species

Alexander

Coyne

Jones

et al. 2015

Journal of Medical Microbiology

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Acanthamoeba species are responsible for causing the potentially sight-threatening condition, Acanthamoeba keratitis, which is commonly associated with contact lens use. In this report, we highlight the challenges faced using conventional laboratory identification methods to identify this often under-reported pathogen, and discuss the reasons for introducing the first national service in Scotland for the rapid and sensitive molecular identification of Acanthamoeba species. By comparing culture and molecular testing data from a total of 63 patients (n580 samples) throughout Scotland presenting with ocular eye disease, we describe the improvement in detection rates where an additional four positive cases were identified using a molecular assay versus culture. The testing of a further ten patients by confocal imaging is also presented. This report emphasizes the importance of continuing to improve clinical laboratory services to ensure a prompt, correct diagnosis and better prognosis, in addition to raising awareness of this potentially debilitating opportunistic pathogen. INTRODUCTIONAcanthamoeba keratitis is an uncommon but sightthreatening disease of the cornea caused by free-living protozoan amoebae belonging to the genus Acanthamoeba (Lorenzo- Morales et al., 2013). This painful, often unilateral eye disease may eventually progress to blindness and is associated with contact lens use but can also be diagnosed in non-contact lens wearers. Acanthamoeba species can be found in a variety of different environments including recreational and drinking water, soil and air (Gianinazzi et al., 2009;Legarreta et al., 2013;Rivera et al., 1991). Trophozoites and highly robust cysts can persist for years and are often resistant to drug treatments.Global increases of Acanthamoeba keratitis occurred during the 1970s and 1980s with links to contact lens use in over 85% of cases, which is consistent with recent data from America and Canada (Stehr-Green et al., 1989;Fraser et al., 2012;Page & Mathers, 2013). In addition, noncommercial saline solutions have been implicated as potential risk factors (Newton et al., 1986). The UK experienced an increase in cases during the 1990s which coincided with increased use of soft contact lenses (Illingworth et al., 1995).There is a lack of recent robust data on the prevalence of Acanthamoeba keratitis in Scotland, but based on a study by Seal et al. (1999), the incidence was 149 per million soft contact lens wearers compared with much lower incidence rates of around 18 to 21 per million in the rest of the UK (Radford et al., 2002). Presently, there are approximately 3.7 million contact lens wearers in the UK (British Contact Lens Association, http://www.bcla.org.uk/).An early, accurate diagnosis is crucial for achieving a better prognosis. However, conventional techniques to detect Acanthamoeba species may lack sensitivity, which is likely to result in the true prevalence being underestimated. The challenges of an early diagnosis are compounded by the ability of Acanthamoeba to mimic non-...

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Acanthamoeba Keratitis Associated With Tap Water Use During Contact Lens Cleaning

Cited by 31 publications

References 23 publications

Acanthamoeba Keratitis among Rigid Gas Permeable Contact Lens Wearers in the United States, 2005 through 2011

Acanthamoeba Keratitis among Rigid Gas Permeable Contact Lens Wearers in the United States, 2005 through 2011

Water Exposure is a Common Risk Behavior Among Soft and Gas-Permeable Contact Lens Wearers

Acanthamoeba keratitis: improving the Scottish diagnostic service for the rapid molecular detection of Acanthamoeba species

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