Rare eye infection puts new focus on contact-lens care

The recent withdrawal from the market of a popular contact-lens solution under investigation in an outbreak of a rare eye infection has left many contact-lens users confused and concerned. Eye doctors report a surge in calls from users of Bausch & Lomb's ReNu with MoistureLoc MultiPurpose Solution, which the company has asked retailers to stop selling.

Last month, the Food and Drug Administration recommended that those who use the product immediately stop and throw it away.

"We've gotten a lot of calls from people" worried about fusarium keratitis — a fungal eye infection that can cause corneal scarring and permanent blindness, said Roy Rubinfeld, a spokesman for the American Academy of Ophthalmology.

"People are calling my office off the hook saying, 'My eyes itch. Is that the fungus?' " According to the federal Centers for Disease Control and Prevention (CDC), 176 cases of fusarium keratitis are suspected or confirmed in 27 states. The infection is linked to fusarium, a fungus found in plants, tap water and soil. Risk factors include trauma, immunodeficiency, chronic ocular surface diseases and, on rare occasions, contact-lens use, according to the FDA.

The FDA says that in a population of 10,000 people, four to 21 cases of severe eye infection — called microbial keratitis, which includes fusarium — will occur annually. Fusarium infection is so rare that many eye doctors say they've never seen a case. Symptoms include redness, blurry vision, discharge, swelling, tearing, pain and increased sensitivity to light.

Eye itchiness, said Rubinfeld, is more likely due to allergies and not a cause for alarm.

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Rubinfeld advises contact wearers who experience irritation to switch to glasses. If symptoms persist beyond a few hours, experts recommend seeing a doctor — or going to the emergency room if symptoms are severe.

A fusarium keratitis infection can be confirmed through a culture taken at a doctor's office. Treatment usually begins with medications; if that's not effective, surgery — including a cornea transplant — may be necessary.

Experts said the outbreak should remind contact-lens users — about 30 million of them in the U.S. — that contacts carry risks.

"I think this is a real wake-up call for both patients and the medical community," said Arthur Epstein, chair of the American Optometric Association's contact-lens and cornea section. Eye-care professionals are advising lens wearers to follow basic precautions (see accompanying information).

Bausch & Lomb voluntarily pulled ReNu with MoistureLoc from U.S. stores on April 13; other ReNu products are still available. Of the 30 cases of fusarium keratitis that the CDC and the FDA had fully investigated by mid-April, 28 involved contact-lens wearers. Of these, 26 "reported using a Bausch & Lomb ReNu brand contact-lens solution or a generic brand manufactured by the same company" during the previous month, according to an FDA statement.

Five patients reported using other contact-lens solutions, including solutions made by Alcon and Advanced Medical Optics Inc. Nine reported wearing their contacts overnight, which is a known risk factor for severe corneal infection. Eight people needed cornea transplants.

How to get a refund

So far, no evidence has directly linked MoistureLoc solution to the fungal infections, reports the FDA. Bausch & Lomb says it is testing its products and has thoroughly inspected the U.S. plant that makes the solution.

Consumers with supplies of MoistureLoc can receive a refund or a coupon to purchase other products by completing a form at Bausch & Lomb's Web site (www.bausch.com/renu). Epstein recommends sticking to major name brands when looking for a replacement.

Maureen Thomas, 52, of Vista, Calif., scheduled an appointment with her eye doctor after news of the infections. Thomas used MoistureLoc for months and says she's experienced discharge, pain and blurriness ever since. Suspecting an infection, her primary-care doctor prescribed antibiotic drops twice — to no avail.

"I've stopped wearing my contacts and have gone to glasses," said Thomas, who said she'd always taken proper care of her contact lenses.

Not all patients are so diligent. Jay Klessman, a Washington optometrist, said, "An awful lot of people have been lazy ... reusing the same solution over and over." He endorsed a step that the FDA has suggested in the wake of the infections — that patients rub their lenses even if the solution container says it's not necessary.

"I've always told patients that I don't believe in the no-rub concept," Klessman said. "There are just some things that will get on lenses that just won't come off" without rubbing, he said.