The Association of Contact Lens Solution Use and Acanthamoeba Keratitis


      To investigate Acanthamoeba keratitis (AK) risk factors. Diagnosis of AK, a rare but serious corneal infection, has recently increased significantly at the University of Illinois at Chicago (UIC) Cornea Service.


      Retrospective case-control study.


      settings: University, tertiary care hospital. patients: Fifty-five AK cases with contact lens use were diagnosed between May 1, 2003 and September 15, 2006. Clinic-matched controls with contact lens use were recruited. Subjects completed surveys targeting lens hygiene, contact lens solution use, and water exposure. main outcome measure: Acanthamoeba keratitis.


      Thirty-nine (73.6%) cases and 113 (65.3%) controls participated; 38 cases had complete contact lens data. Thirty-five of 38 cases (92.1%) and 47 of 100 controls (47.0%) used soft lenses. Analysis was performed on 30 cases and 39 controls with matched pairs with soft lens use. Exclusive use of Advance Medical Optics (AMO) Complete MoisturePlus Multi-Purpose Solution was independently associated with AK in multivariable analysis (55.2% vs 10.5%; odds ratio [OR], 16.67; 95% confidence interval [CI] 2.11 to 162.63; P = .008). However, 38.8% of cases reported no use of AMO Complete MoisturePlus Multi-Purpose Solution either alone or in combination with other solutions. Although not statistically significant, additional hygiene-related variables (solution “reuse,” lack of “rubbing,” and showering with lenses) suggest a pattern of risk.


      AMO Complete MoisturePlus Multi-Purpose Solution use is independently associated with AK among soft contact lens users. However, it does not explain all cases, suggesting additional factors. Further research into environmental risk factors and hygiene practices is warranted, especially considering this is the second outbreak of an atypical, contact lens-related infection.
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      Charlotte Joslin, OD, is currently an Assistant Professor at the University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences. Dr Joslin received her undergraduate degree from Illinois Wesleyan University and professional degree from The Ohio State University, and completed her residency training at the VA Chicago Healthcare, West Side and Hines Divisions. Dr Joslin is currently a NEI K23 awardee and is a PhD candidate in epidemiology at the UIC School of Public Health.


      Elmer Tu, MD, is currently an Associate Professor of Clinical Ophthalmology at the University of Illinois at Chicago serving as director of the Cornea and Refractive Surgery Service. Dr Tu completed his residency at the University of Wisconsin-Madison and cornea fellowship at the Bascom Palmer Eye Institute in Miami, Miami, Florida. He was previously director of the Cornea and External Disease Service and Residency Program Director at the University of Texas Health Science Center, San Antonio, Texas.

      Linked Article

      • Parasites on the Rise: A New Epidemic of Acanthamoeba Keratitis
        American Journal of OphthalmologyVol. 144Issue 2
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          Historically, the overwhelming majority of contact lens associated with infectious corneal ulcers in the United States have been attributable to bacteria.1,2 However, over the past two years, two distinct epidemics of contact lens-associated non-bacterial infectious keratitis have been recognized. Last year the Center for Disease Control (CDC) alerted health care providers and consumers of an epidemic of Fusarium keratitis, and just last month they warned of an alarming increase in the number of reported cases of Acanthamoeba keratitis.
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