In Contact - May 2006
Strange Days
Strange Days was one of The Doors? more interesting albums.
Although my personal favourite is LA Woman, Strange Days more aptly describes the current state of the planet. The lyrics can also be interpreted as relevant.
As far as health issues are concerned we indeed seem to be in the grip of some weird goings on. Some would argue It's just paranoia.
With that comes the potential for mass hysteria.
For the Birds?
Bird flu is a classic example. we've had ?related? epidemics a few times in the 1900s. there's no real evidence it will happen again but H5N1 could just as well mutate into a version that would spread from human to human.
If it does, we?ll all be in trouble.
I attended an NZ MoH presentation in Wellington in March. The speaker basically said ?don't even try going near a Hospital as there?ll be a few hundred thousand in the queue before you?. At best they could accommodate a few thousand people. The Singaporean MoH also takes it seriously.
The bottom line on Bird flu is: If it starts up and becomes rampant elsewhere in the world, close the doors into NZ and keep them firmly shut. Take your Tamiflu - if you get symptoms or if there is a local outbreak. It may help you survive. Stock up on the necessities of life and pay your Sky TV?
that's Bird flu sorted?
we're also reading of an outbreak of ?rat tailed maggots? - some as big as ?small mice? - in water and drains in and around Cape Town and Gauteng, South Africa.
Such episodes have occurred throughout history. We have epidemics and pandemics of various sorts, from time to time. Diseases wax and wane. Modern communication and reporting simply make us much more aware of what?s going on. In the past the excitement would have been over by the time the rest of the planet heard about it. Air travel dramatically aids the spread of disease. We all know how many times people come back from overseas with ?airline flu?.
Never mind the risk of DVT.
Even a relaxing holiday on a cruise ship carries a high risk of developing novovirus induced gastroenteritis. At times hundreds of people get seriously ill on a given cruise.
New Zealand even has its very own Meningitis cluster.
What the Hell?
I've written before on issues relating to the FDA and No Rub MPS?
Nothing new?
I first became aware of a seeming ?spike? in Fusarium Keratitis [FK] that seemed to be developing in Singapore and Hong Kong in February this year. Malaysia and the US subsequently reported similar problems.
Fungal Keratitis is nothing new and has been reported since the late 1800s. The causative agents - of which there are at least seventy different types - have probably been around for millions of years longer than us humans.
They?ll probably also be around long after we're extinct.
For reasons not yet understood, B&L?s US manufactured ReNu MoistureLoc ? not yet on the NZ market due to registration delays ? has been linked to the outbreak. No causative link has been demonstrated and testing of the solution, facility and components have apparently not shown any contamination with Fusarium.
Apparently the older formula ReNu MultiPlus is unaffected by the recall nor is MoistureLoc manufactured in Europe and elsewhere outside the US.
Read B&L Chairman Ron Zarella?s message and see their recent communiqu?s.
I don't envy solution manufacturers. Their solutions have to pass a rigorous assay of microbial challenges. They have to be able to wipe out ? or at the very least severely reduce - the numbers of ?colony forming units? [CFUs] of a range of test organisms, including bacteria and fungi. All within a practical soaking time. Ideally, solutions should be biocompatible with human cells: Free of cytotoxic and hypersensitivity reactions.
These are extremely tough calls.
It seems they also want these solutions to clean, deproteinise, lubricate, keep the eyes moist all day and at the same time fetch the beer, do the dishes, and mow the lawn.
The contact lens disinfection and solution business has been littered with casualties: In the ?old? days solution manufacturers happily included mercury-based thiomersal in solutions and we have had BAK, Chlorhexidine, Iodine and Chlorine disinfection. We had the Acanthamoeba scare a decade or two back where among other things, home-made salt tablet saline was implicated. B&L and the FDA were involved in that too.
Here?s the Rub
Many contact lens practitioners have long objected to the FDA ?supported? ?No Rub? marketing, promoted in recent years by manufacturers. No doubt with consumers in mind.
I have written much on this over the years.
One of the recommendations included in B&L?s information relating to this Fusarium scare is to actually ignore the information printed on the boxes. They now recommend that patients [consumers] actually rub and rinse the lenses and if not worn every day, that they ignore the ?30 day storage? info on the bottles and change the solution daily.
I sincerely hope that this scare is just that, a random and coincidental spike in FK and that things get back to normal soon.
I also hope that this scare will be a wake up call to all solution manufacturers and that they will banish the ?No Rub? claims to the rubbish heap of history.
There can be many possible reasons for this current scare. Firstly one must remember that among the documented FK cases are also a number of non contact lens wearers. Other solution brands are apparently also involved in a limited number of cases.
Maybe ReNu has the greatest market share in the solution business in the markets involved and hence the greatest number of cases?
Wearers were apparently only ?asked? what solution they used. If these ?consumers? are anything like some of the non-compliant ones I come across they rarely know their brand of solution and in many cases point at a bottle of Complete and say, ?that's the one?bush and limb. Even when its not. So maybe B&L are victims of their own popularity and brand awareness?
The reports are pretty scanty as to what type of lenses are being worn. Were there any cases among compliant daily disposable or AOSPET users? In some FK cases expired disposables were being used.
Others suggest maybe some of the lens wearers don't sleep long enough and maybe the required soaking times are not achieved?
Is climate change leading to more virulent strains of Fusarium [and other microbes?]
Is pollution, the overuse of antibiotics and hormones in the food chain, as well as over prescribing of medicines leading to a weakening of our immune systems?
Could agricultural phenomena have any relationship? Is genetic engineering implicated?
Conspiracy theorists also find ways to link cases of ?mould? apparently found in some of CIBA?s eye drops and dry-eye gel. Although the closure of CIBA?s Canadian plant [recently reopened] was apparently unrelated, cynics wonder?
Why do so many solutions get discontinued? Is it for purely commercial reasons?
Questions are asked. Comments made.
Stocks react.
Communiqu?s are issued
we've had a lot of time wasted by these problems. I receive dozens of emails. I have staff members regularly telling me that this, that and the next thing are unavailable, out of stock, discontinued, or may be in the coming months. We have to re-instruct users who are understandably frustrated.
There?ve been warehouse fires in Oz taking other items off the market and re-labelling issues which mean reapplication to Medsafe before we get them back to market in NZ.
We know how long that can take.
Fortunately we were prepared for some of the shortages and our AOSEPT should last until stocks are replenished. In the meantime we've run out of some cleaners and solutions. We are all finding it very frustrating.
It's the worst state I have seen the solution business in for many years.
Way back in the days of conventional lenses we would occasionally see fungal growths on and hyphae in the matrix of soft lenses. In some cases patients were storing lenses in saline. Others seemed to occur more frequently in Asian patients using a recently discontinued solution for disinfection. Many admitted to chopping up mushrooms [fungi] for their meals. I surmised that the spores thus released landed on their lenses and found the warm moist environment conducive to colonisation?
Fusarium is a very broad subject. The deeper one digs, the more complex it becomes. Those stung by ?leaky building? issues in NZ may be aware of other health effects relating to Fusarium and mould in general.
Why is only US manufactured MoistureLoc seemingly linked? Does it contain ingredients that could potentially act as a ?food source? to Fusarium?
Check out this consumer site in Singapore. It gives one an idea of what drives choices, brand awareness and compliance issues.
The current situation merely highlights what I've been saying for the past decade:
Daily Disposables Rule!
I guess this will give further impetus to the increasing swing to the healthiest contact lens modality: One Day Lenses.
They have the lowest incidence of MK [Less than 1 case per 10,000] and are best with sensitive and allergic eyes. They have less mechanical sequelae [e.g. SEALs] and a low incidence of GPC.
FK.
UC, I told you so!
Rock On
Eleven years to the day after their last trip, the Rolling Stones rocked Auckland. I thought they were one of the greatest live acts I had ever seen in 1995. Now, with the ?boys? all in their sixties they were no less entertaining. Great sound. Great act. Great songs.
I sincerely hope I can still rock like that when I reach their age and that I can still have a full on snooker night with the boys. I hear that every venue they play has to have a full size snooker table backstage ? apart from the gym and flowers for their dressing rooms.
I wonder what became of sex ?n drugs and rock and roll?
Maybe that's why they?ve lived so long?
I know, its only rock ?n roll?but I like it? like it...
Yes, I do!
For more information or any comments email Alan at incontact@optom.co.nz.