Download Use of Tap Water on Gas Permeable Lenses

Use of Tap Water on Gas
Permeable Lenses
The International Society of Contact Lens Specialists 2015
Mindy Toabe, OD, FAAO, FSLS
MetroHealth Medical Center/
Senior Clinical Instruction, Case Western Reserve University
School of Medicine
Corneal Gas Permeable Risk of
Microbial Keratitis
 Stapleton, F., Keat, L., et al. The incidence of contact
lens –related microbial keratitis in Australia.
Ophthalmology. 2008 Oct;115(10):1655-62.
 Centers for Disease Control and Prevention(CDC) Study:
Collier SA, Gronostaj, MP, et al. “Estimated burden of
keratitis—United States, 2010.” Morb Mortal Wkly Rep.
2014 Nov;63(45):1027-30.
 Wu, Y., Wilcox, M., Stapleton, F. Contact lens hygiene
compliance and lens case contamination: a review. Cont
Lens & Ant Eye. 2015 British Contact Lens Association
Corneal Gas Permeable Wearers and
Microbial Keratitis Risk Factors
 1.2 daily wear RGP
wearers out of 10,000
developed CL related
microbial keratitis
 Relationship between
bacterial contamination
and age of contact lens
case
Kuzman, T., Kutija, MB., et al. Lens wearers non-compliance-is there an association with lens case contamination? Cont Lens
Anterior Eye. 2014 Apr;37(2):99-105.
Scleral Lens Risk of Microbial
Keratitis
 Zimmerman, Aaron B (01/2014). "Microbial keratitis secondary to
unintended poor compliance with scleral gas-permeable contact
lenses". Eye & contact lens (1542-2321), 40 (1), p. e1
 Bruce, Adrian S (03/2013). "Acute red eye (non-ulcerative
keratitis) associated with mini-scleral contact lens wear for
keratoconus". Clinical and experimental optometry (0816-4622),
96 (2), p. 245.
 Fernandes, Merle (04/2013). "Polymicrobial and microsporidial
keratitis in a patient using Boston scleral contact lens for
Sjogren's syndrome and ocular cicatricial pemphigoid". Contact
lens & anterior eye (1367-0484), 36 (2), p. 95.
Primary Reason for Tap Water Use
Change in routine
“I went camping and lost my
solutions so had to use water.
It was really uncomfortable,
but my fault.”
Dumbleton, K., Spafford, M., et al. Exploring Compliance: A Mixed- Methods Study of Contact Lens Wearers Perspectives Optometry and
Vision Science. 2013 Aug;90(8):898-908.
Tap Water Risks
“Do not expose your contact
lenses to any water: tap, bottled,
distilled, lake or ocean water.
Never use non-sterile water
(distilled water, tap water or any
homemade saline solution).
Exposure of contact lenses to
water has been associated with
Acanthamoeba keratitis, a corneal
infection that is resistant to
treatment and cure.”
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerPro
ducts/ContactLenses/ucm062584.htm 2014
Pseudomonus
 Found in natural bodies of
water, human body,
distilled water, sewerage
systems, and whirlpools
 Not found in drinking
water but biofilms
colonize in plumbing
fixtures
Mena K., Gerba, C. Risk assessment of Pseudomonas aeruginosa in water. Rev Environ Contam Toxicol.
2009;201:71-115.
Tap Water and Storage Case Samples
Tap Water Samples
 Bacteria (TAMB) - 68%
 Gram Negative Bacteria - 0%
 Pseudomonus - 0%
 Amoebae - 30%
 Fungi - 30%
Storage Case Samples (soft and rigid)
 Bacteria (TAMB) - 90%
 Gram Negative Bacteria - 40%
 Pseudomonus - 4%
 Amoebae - 30%
 Fungi - 36%
Üstüntürk, M., Zeybek, Z. Microbial contamination of contact lens storage cases and domestic tap water of
contact lens wearers. The Central European Journal of Medicine. 2012 Oct 24:251.
Microbial Keratitis Process
Water
touches
contact
lens
Lens is
inserted
in the
eye
Mechanical
effects of
the lid
increase
adhesion of
bacteria
Bacteria
binds to
shedding
epithelium
and then
to the lens
deposits
(lipids and
proteins)
Corneal
epithelial
integrity
is
comprom
ised by a
scratch
Microbial
keratitis
occurs
Case Contamination
Gram–positive bacteria, gramnegative bacteria and fungal
increases with tap water use,
especially gram-negative bacteria
levels
Tap water rinses off the
disinfecting solution in the case
increasing the risk of biofilm
formation
Tilia, D., Lazon de la Jara, P., et al. The Effect of Compliance on Contact Lens Case Contamination.
Optometry and Vision Science. 2014 Mar; 91(3): 262-271.
Acanthamoeba
Biology
Causal Agents:
Acanthamoeba spp. , are commonly found in lakes, swimming pools, tap water, and heating and air
conditioning units. Several species of Acanthamoeba, including A. culbertsoni, A. polyphaga, A.
castellanii, A. astronyxis, A. hatchetti, A. rhysodes, A. divionensis, A. lugdunensis, and A. lenticulata
are implicated in human disease.
Life Cycle:
Acanthamoeba spp. have been found in soil; fresh, brackish, and sea water; sewage; swimming pools;
contact lens equipment; medicinal pools; dental treatment units; dialysis machines; heating,
ventilating, and air conditioning systems; mammalian cell cultures; vegetables; human nostrils and
Parasites
- Granulomatous
Amebic
Encephalitis
(GAE); Acanthamoeba has
throats;
and- Acanthamoeba
human and animal
brain, skin, and lung
tissues.
Unlike N. fowleri,
only
two stages,
cysts and trophozoites , in its life cycle. No flagellated stage exists as part of the
Keratitis,
http://www.cdc.gov/parasites/acanthamoeba/biology.html
life cycle. The trophozoites replicate by mitosis (nuclear membrane does not remain intact) . The
Exposure to Acanthamoeba
Swimming, hot
tub, natural
spring
Non-sterile
wetting
solutions, saliva,
or chlorine
disinfectants
Tap, bottled or
distilled water as
wetting /storage
solution
contact
lens
wear
CDC
Acanthamoeba pathogenesis
Minor trauma to corneal epithelium
Contaminated
water
• contact lens
Amebae
adhere to
contact lens
•Biofilm on
contact lens
Keratitis
•Biofilm protects
ameba from lid
action and tears
Moore. M. Acanthamomeba Keratitis and Contact Lens Wear: The Patient Is at Fault. Cornea. 1990;9 Suppl
1:S33-S35;discussion S39-S40.
Worldwide: Acanthamoeba
 Japan Watanabe, R., Ishibashi, Y., Acanthamoeba isolation from contact lens
solution of contact lens wearers without keratitis. Nihon kanka Gakkai Zasshi.
1994 May;98(5):477-80.
 Seal, D., Kirkness, C. Acanthamoeba keratitis in Scotland: Risk factors for contact
lens wear. Cont Lens Anterior Eye 1999;22:58-68.
 Radford, C., Minassian, D., et al. Acanthamoeba keratitis in England and Wales:
Incidence, outcome, and risk factors. Br J Ophthalmol 2002;86:536-542.
 Jeong, H., Yu, H. The role of domestic tap water in Acanthamoeba contamination
in contact lens storage cases in Korea. The Korean Journal of Parasitology. 2005
June;43(2):47-50.
 USA Shoff, M., Rogerson, A., et al. prevalence of Acanthamoeba and other naked
amoeba in South Florida domestic water. J Water Health. 2008 Mar;6(1):99-104.
 Bonilla-Lemus P, Ramerirez-Bautista GA, Zamora-Munoz C, et al. Acanthamoeba
spp. In domestic tap water in houses of contact lens wearers in the metropolitan
area of Mexico City. Exp Parasitol. 2010 Sep;126(1):54-8.
Elimination of Tap Water Use
 Cleaning lenses and cases
with tap water leads to an
increased risk of
acanthamoeba keratitis
 NO tap water-no
acanthamoeba and low
risk of biofilm
Seal DV, Dalton A, Doris D. Disinfection of contact lenses without tap water
rinsing: is it effective? Eye(London) 1999 Apr;13 (Pt 2):226-30.
Confusion with Tap
Confusion exists between package inserts and
doctor’s recommendations
Legarreta JE, Nau AC, Dhaliwal, AC. Acanthamoeba keratitis associated with tap water use during contact lens cleaning: manufacturer guidelines
need to change. Eye Contact Lens 2013 Mar;39(2):158-61.
Confusion with Tap Water
Patient education is the key
to increasing compliance.
Seal, D., Stapleton, F., et al. Possible environmental sources
of Acanthamoeba spp in contact lens wearers. Br J
Ophthalmol. 1992 Jul;76(7): 424-7.
Effective Disinfectants
3% Hydrogen peroxide
Chlorhexidine
Benzalkonium chloride
with edetate
Moore, M. Acanthamoeba keratitis and contact lens wear: the patient is at fault. Cornea. 1990;9
Suppl 1:S33-5; discussion S39-40.
Noncompliance Issues
Ky W., Scherick, K., et al. Clinical survey of lens care in contact lens patients. CLAO J. 1998 Oct;24(4):216-9.
Kuzman, T., Kutija, M., et al. Lens wearers non-compliance-is there an association with lens case contamination? Cont Lens Anterior Eye. 2014
April;37(2):96-105.
Lens Care: Hand washing
 Wash hands with soap
and water, not water only
 Dry hands completely
 Replace case every 30-90
days
Lens Care Steps
 Clean
 Rinse
 Disinfect
Store
Seal DV, Dalton A, Doris D. Disinfection of contact lenses without tap water rinsing: is it effective?
Eye(London) 1999 Apr;13 (Pt 2):226-30.
Thakur DV, Gaikwad, UN. Microbial contamination of soft contact lenses and accessories in asymptomatic
contact lens users. Indian J Med Res.2014 Aug;140(2):307-309.
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