Refractive Surgery Blog

On May 25, 2007, Advanced Medical Optics (AMO) decided to voluntarily recall Complete MoisturePlus contact lens solution. The decision was made in response to information received from the Center for Disease Control (CDC) regarding eye infections from the microorganism Acanthamoeba. The report was based upon interviews with 46 patients who had developed Acanthamoeba keratitis (AK) since January 2005. A total of 39 of these patients were wearing soft contact lenses and 21 of them were using the solution in question.

AMO is working closely with the CDC and has recalled the contact lens solution acting out of caution. There has been no evidence of contamination of the product and none of the other AMO products have been implicated in this inquiry.

Acanthamoeba is a naturally occurring organism that can cause a serious eye infection known as Acanthamoeba Keratitis (AK). The organism can be found in water, soil, sewage systems, cooling towers and heating/ventilation/air conditioning (HVAC) systems. The incidence of AK has been estimated to be one to two cases per million contact lens users. It is usually associated with contact lens wearers who improperly store/handle/disinfect their contact lenses. For example, many patients use tap water to clean their lenses. It is also found in those who swim, use hot tubs, or those who over-use their disposable contact lenses without properly disinfecting them while trying to extend their life and save money.

Please contact us if you experience any of the following symptoms: eye pain, eye redness, blurred vision, sensitivity to light, a foreign body sensation in the eye and/or excessive tearing. Symptoms can last for weeks to months and are not uniform in their presentation. Early infections with Acanthamoeba can be similar to other eye infections but advanced AK causes severe pain with possible loss of vision that could require corneal transplant.

Please discontinue the use of this product immediately and call 1-888-899-9183 for more information. You can report adverse reactions related to this product to the FDA at 1-FDA-1088.

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Labels: Contact Lenses

Labels: Cataract Surgery in Animals

Now that corneal refractive surgery is well established and has been deemed safe and effective by the FDA, more and more patients are feeling comfortable enough to consider one of the available refractive surgical options. In particular, baby boomers in their 40s, 50s and even 60s are having LASIK performed on themselves in greater numbers in an attempt to safely, simplify their lives. But, a percentage of these patients will develop cataracts over the next ten years and will need to have them removed. These patients will expect the same excellent post-operative visual result they experienced with their refractive surgery years before. The question is: How will the refractive surgery done in years past impact your cataract surgery result?

The truth of the matter is that the calculation for the intraocular lens (IOL) that is placed in the eye after removing the cataract is trickier than was originally expected. And therefore, achieving the predicted result is not routine in patients who have had LASIK or PRK or other procedures as compared to those who have not had prior corneal refractive procedures. This is because the true power of the cornea after refractive surgery is actually less than measured by conventional instruments. Unless this is understood, post-LASIK cataract patients will end up under-corrected and farsighted following their surgery.

I have been studying this problem for several years and have performed hundreds of cataract procedures on post- LASIK, PRK, and RK patients. There are a few important features to obtaining consistent results. First, it is critical that accurate measurements of the length of the eye are obtained. We use the newest version of the IOLMaster. This device measures the length of the eye by having the patient fixate on a target and then bouncing a beam of light off of the center of the retina (macula). This is different and more accurate than measuring the length of the eye with the traditional method of using ultrasound. Secondly, the calculations become more predictable if both the pre and post LASIK corneal curvatures are known. The latter can be easily measured but the former need to be obtained from old medical records. Finally, it is important that the correct formula is used in the calculation.

What you should do now is obtain your old records before they get lost or are destroyed. Keep them in a safe place or have them copied and give them to your present ophthalmologist for safe keeping in his/her records. That way you will allow yourself the best chance for accurate calculations prior to future procedures.

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Stuart Lewis, M.D.

Labels: Cataract Surgery after LASIK