Often referred to as the “voice of the CDC,” the Morbidity and Mortality Weekly Report
(MMWR) is the agency’s vehicle for providing objective and useful information and recommendations. Readership is primarily comprised of physicians and other health care providers, epidemiologists and scientists.1
CLs in the News
Recently, contact lens-related adverse events—specifically contact lens-associated corneal infection—have received much attention in these reports. Two memorable reports related to unexpected non-bacterial clusters prompted voluntary manufacturer recalls. The first highlighted concerns with a resurgence of Fusarium infections associated with the use of Bausch + Lomb’s ReNu with MoistureLoc. The second discussed an unusually high geographical uptick in Acanthamoeba keratitis in patients using Advanced Medical Optics’ Complete Moisture Plus.
Fusarium infections received focused attention when the CDC received multistate cluster reports in 2005-2006.2 A similar report surfaced in 2007 when Chicago eye care providers relayed fears of a resurgence of Acanthamoeba keratitis in lens wearers using a specific multipurpose disinfection solution.3 In both cases, MMWR dispatches provided helpful lens care tips for the public to help minimize risk. Further, the reports included management updates for clinicians suspecting possible infection. Commonality between the Fusarium and Acanthamoeba concerns showed concurrent outbreaks in contact lens users from two different non-bacterial sources using two separate multipurpose solutions. Research showed the solutions had insufficient antimicrobial efficacy against specific organisms, resulting in safety concerns.2,3 Although the attack rate was low, getting the message out quickly was crucial due to significant morbidity rates—especially in cases of delayed diagnosis.
The most recent MMWR dispatch, based on a decade of national lens wear data, includes a policy statement for prevention and treatment following an epidemiologic report on contact lens-related corneal infections. Researchers tracked data from 2005-2015, looking at trends and impacts to public health. The authors analyzed 1,075 medical device reports (MDRs) containing the terms ulcer or keratitis received by the FDA.4 Contact lens manufacturers were responsible for 86% of the reports, while 14% were submitted by eye care providers. The MDRs contain device-related safety information to help develop benefit/risk assessments. The FDA uses these reports to monitor device performance in a post-approval surveillance fashion.4
Notably, 3.1% of cases reported were associated with decorative or cosmetic contact lens use, and 1.5% involve lenses obtained from unapproved sources without a valid prescription (i.e., flea market or costume shop). Twenty-five patients (2.3%) required hospitalization. The majority of reports reflected recurrent (often daily) office visits, frequent administration of topical eye drops and missed work or school during the acute phase of infection.4 The reports further identify several modifiable risks, including overnight wear (11.3%), over-wear beyond prescribed periods (7.0%), storing lenses in tap water (0.8%), using expired lenses or products (0.7%) and swimming in contact lenses (0.9%).4 Tragically, approximately 20% of the MDRs describe patients who suffered permanent eye damage, reduced acuity or both. At least 25% had a modifiable risk that could have been prevented.4
Stay Up-to-date1. Centers for Disease Control and Prevention. About the Morbidity and Mortality Weekly Report (MMWR) Series. Available at www.cdc.gov/mmwr/about.html. Accessed September 20, 2016.
MMWRs alert health care providers to pertinent public health issues and are often successful in minimizing ongoing risks. They are vital tools that help protect the public. Kudos to the entire CDC team for an admirable program, which also includes Contact Lens Health Week each year. I encourage you to visit the CDC’s site, www.cdc.gov/contactlenses, for more information on this worthy initiative. Practitioners should continue to monitor and report any significant adverse event to the FDA through its Safety Information and Adverse Reporting program at www.fda.gov/medwatch.
2. Centers for Disease Control and Prevention. MMWR, Fusarium keratitis-multiple states, 2006. MMWR Morb Mortal Wkly Rep. 2006;55(14):400-1.
3. Centers for Disease Control and Prevention. Acanthamoeba keratitis multiple states, 2005–2007. MMWR Morb Mortal Wkly Rep. 2007;56:532–4.
4. Centers for Disease Control and Prevention. Contact lens related corneal infections-United States, 2005-2015. MMWR Morb Mortal Wkly Rep. 2016;65(32);817-20.