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Volume 16, Number 9—September 2010

Contact Lens Solution–associated Acanthamoeba and Fusarium Keratitis

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To the Editor: Verani et al. (1) detailed the 2004–2007 outbreak of Acanthamoeba keratitis (AK) in persons wearing soft contact lenses who used Complete MoisturePlus (CMP) multipurpose contact lens solution (Advanced Medical Optics, Santa Ana, CA, USA). They noted similarities between the AK outbreak and the Fusarium keratitis (FK) outbreak of 2004–2006, including the concomitant time frame and association with a particular solution, ReNu with MoistureLoc (Bausch & Lomb, Rochester, NY, USA). Both solutions were new products introduced within 1 year before the respective outbreaks.

In neither outbreak was the solution contaminated; in both outbreaks, implicated bottles were from multiple lots, suggesting that each outbreak resulted from insufficient antimicrobial activity. However, in the FK outbreak, all reported cases involved bottles produced at 1 (Greenville, SC, USA) of 4 multinational Bausch & Lomb manufacturing plants (2). After a Food and Drug Administration inspection of the Greenville facility, Bausch & Lomb was cited for inadequacies in temperature control during production, storage, and transport of its products in and beyond the plant (3).

We experimentally demonstrated that, when exposed to prolonged temperature elevation, ReNu with MoistureLoc loses more in vitro fungistatic activity than do other contact lens solutions. We concluded that improper temperature control of ReNu with MoistureLoc may have contributed to the FK outbreak (4). We are aware of no other theory that adequately explains why only ReNu with MoistureLoc from only 1 plant was implicated.

CMP was manufactured and used internationally; AK has a much higher incidence in Europe and Hong Kong than in the United States (5), and CMP–associated AK has been reported internationally (6). Therefore, it would seem critical to know, and we would like the authors to comment on, whether the geographic pattern of the AK coincided with distribution of CMP solution from >1 Advanced Medical Optics manufacturing plants and, if so, the relevance of that information.


John D. Bullock and Ronald E. Warwar

Author affiliations: Author affiliations: Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA



  1. Verani  JR, Lorick  SA, Yoder  JS, Beach  MJ, Braden  CR, Roberts  JM, National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States. Emerg Infect Dis. 2009;15:123642. DOIPubMed
  2. Levy  B, Heiler  D, Norton  S. Report on testing from an investigation of Fusarium keratitis in contact lens wearers. Eye Contact Lens. 2006;32:25661. DOIPubMed
  3. US Food and Drug Administration. FDA Form-483 [cited 2007 Jul 28].
  4. Bullock  JD, Warwar  RE, Elder  BL, Northern  WI. Temperature instability of ReNu with MoistureLoc: a new theory to explain the worldwide Fusarium keratitis epidemic of 2004–2006. Arch Ophthalmol. 2008;126:14938. DOIPubMed
  5. Lam  DS, Houang  E, Fan  DS, Lyon  D, Seal  D, Wong  E, Incidence and risk factors for microbial keratitis in Hong Kong: comparison with Europe and North America. Eye (Lond). 2002;16:60818. DOIPubMed
  6. Por  YM, Mehta  JS, Chua  JL, Koh  TH, Khor  WB, Fong  AC, Acanthamoeba keratitis associated with contact lens wear in Singapore. Am J Ophthalmol. 2009;148:7–12.e2.


Cite This Article

DOI: 10.3201/eid1609.091381

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Table of Contents – Volume 16, Number 9—September 2010

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