Help patients’ summers go swimmingly

Bacteria, viruses and parasites—oh my. With the impending summer swimming season comes a microscopic threat lurking just beneath the waves that swimmers, and particularly contact lens wearers, should heed.

As many of the nation's recreational water venues reopen Memorial Day weekend, the Centers for Disease Control and Prevention (CDC) has designated the preceding week, May 20-26, as Healthy and Safe Swimming Week. The health observance reminds Americans how to play it safe around water, especially as it relates to harmful recreational water illnesses (RWIs) and waterborne diseases that can come from swimming in contaminated water sources.

Last year, the CDC's CDC's Morbidity and Mortality Weekly Report described nearly 500 disease outbreaks in treated recreational water between 2001 and 2014 with outbreaks causing more than 27,200 cases of infection and eight deaths. Of those cases, pathogens as opposed to chemicals were most responsible (94%).

These RWIs are caused by ingesting, breathing or coming in contact with germs or chemicals that cause gastrointestinal, respiratory, neurological, skin, ear or eye infections. As for the latter, contact lens-wearing swimmers may be at highest risk.

Edward Bennett, O.D., AOA Contact Lens and Cornea Section (CLCS) past chair and assistant dean at the University of Missouri-St. Louis College of Optometry, said there are many types of bacteria and other microorganisms found in pool water and, if the eye is already irritated, these organisms can cause a serious, sight-threatening infection.

"These organisms can become attached to contact lenses, which increases the risk for infection," Dr. Bennett said. "In these cases, the eyes will be red and painful, and vision will be blurred. Therefore, you should immediately contact your eye care doctor for treatment."

The case of Iowa's eyes

Acanthamoeba keratitis (AK), a rare but severe corneal infection that can result in painful blindness, stems from one such organism present in all forms of water. While AK's incidence in the United States is only one or two new cases per 1 million contact lens wearers annually, evidence in at least one Midwest state suggests it could be on the rise.

Published in CDC's Morbidity and Mortality Weekly Report on May 17, 2019, an analysis reported the average number of new AK cases among Iowans doubled between 2002 and 2014, from 2.9 to 6.5 cases. Importantly, the analysis determined most AK cases were among contact lens wearers (84%) while fewer were among eyes exposed to organic material, such as algae.

Among AK-affected contact lens wearers, the analysis found nearly 86% reported inadequate contact lens hygiene. Moreover, the majority reported recent water exposure, such as swimming in lakes or rivers while wearing contacts (22%), showering while wearing lenses (18%) or cleaning lenses with tap water (13%).

The data illustrates why it's vitally important for contact lens wearers to receive and understand lens-fitting, safety and hygiene education from their eye care providers. When it comes to swimming, doctors of optometry recommend:

• Removing contact lenses before swimming, showering or using a hot tub.
• Using watertight goggles, if contact lenses must be worn in water.
• Disposing of contact lenses immediately if they are exposed to water.
• Practicing good contact lens hygiene, including washing and drying hands prior to handling lenses.

"One of the many important reasons why the eye care professional is so vital to healthy and successful contact lens wear is educating every contact lens patient about what constitutes proper lens care and compliance, including appropriate hand hygiene," Dr. Bennett said.

Use AOA member resources to promote safe contact lens wear

Swimming in lenses is one of the top-three most frequently reported contact lens hygiene risk behaviors, the CDC notes, just behind failing to visit an eye doctor annually and sleeping or napping in lenses. As patients start preparing for their summer fun, help get out the message about eye health and swimming. Here's how:

• Find AOA Marketplace products, such as the Healthy Vision and Contact Lenses Information Sheet (AOA members only) or Fact Sheet, and the Contact Lens Wear & Care pamphlet.
• Access the CDC's Healthy and Safe Swimming Week materials and resources.

Swimming isn't the only summertime concern for healthy eyes. Learn more about another culprit that can harm your eyes.