Pool of knowledge: Educate patients on swimming and eye safety

With Memorial Day around the corner, many local public pools and swimming parks will reopen this weekend. For doctors of optometry, the holiday provides the perfect opportunity to talk swimming and eye safety.

This week also marks Healthy and Safe Swimming Week (May 21-27), sponsored by the Centers for Disease Control and Prevention (CDC).

"We know the Memorial Day holiday means water activities, and this is where the danger comes into play if proper precautions aren't taken," says Amber Dunn, O.D., who practices in King City, Oregon.

"About this time, we do start seeing more patients—more children—who have irritated eyes from swimming and the chemicals in the pools," says Cyndie Baker, O.D., who practices in Denham Springs, Louisiana.

Whether they are complaining of red, irritated eyes from pool chemicals or seeking advice on whether they should wear their contact lenses in the water, patients turn to their doctors of optometry to preserve their fun in the sun.

What to fear with swimming?

Parasitic bacteria.

According to a CDC Morbidity and Mortality Weekly Report published May 18, about 500 disease outbreaks in treated recreational water were reported between 2001 and 2014. Those outbreaks caused more than 27,200 cases of infection and eight deaths in 46 states and Puerto Rico. Pathogens (disease-causing microorganisms) accounted for most of the outbreaks (94%), while chemicals in the water were linked to the remaining outbreaks.

Most outbreaks occurred in hotels (32%) followed by community/municipality/public park (23%), club/recreational facility (14%) and water parks (11%). The leading parasitic infection was Cryptosporidium (58%).

"I tell patients that even though good disinfection systems are in place for pools and hot tubs, there are still bacteria in the water that can adhere to their contact lens and cause eye infections," says Julie Toon, O.D., who practices in Wichita, Kansas. "I remind them that lakes and rivers have no disinfection systems to kill microbes."

Edward Bennett, O.D., M.S. Ed., is chair of the AOA's Contact Lens and Cornea Section (CLCS) and assistant dean at the University of Missouri-St. Louis College of Optometry.

Dr. Bennett noted that the U.S. Food and Drug Administration (FDA) has recommended that contact lenses not be exposed to any form of water, whether it's from a swimming pool, wells, showers or the kitchen tap.

"There are many types of bacteria and other microorganisms in pool water and, if the eye is already irritated, these organisms can cause a serious sight-threatening infection, often called a corneal ulcer," Dr. Bennett says. "Although rare, the most devastating such infection is 'Acanthamoeba keratitis,' which often results in the need for a corneal transplant (in the most severe cases). These organisms can become attached to the contact lenses, which increases the risk for infection. 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.

"If it is impossible to avoid contact lens wear while swimming, tight-fitting goggles are strongly recommended to prevent exposure to water," he adds. "If lenses are exposed to water, they should then be removed, cleaned and then disinfected before wear. One of the benefits of daily disposable lenses is that they can be thrown away prior to swimming. In addition, another option would be wearing specially designed rigid gas permeable lenses worn at night only (overnight orthokeratology.) These lenses reshape for the cornea of front surface of the eye when worn at night; therefore, eligible patients would not need to wear any correction during the day. This is a popular option for competitive swimmers."

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.

Going with goggles

Doctors of optometry appreciate the allure of swimming—the fun and physical activity. Dr. Baker, for instance, swims, water skis and scuba dives. When she's in the water, though, she wears well-fitting goggles. She encourages her patients to do the same, as do Drs. Toon and Dunn.

"I do offer swim googles that have lens correction as the best alternative to wearing contact lenses while swimming," Dr. Toon says.

"Anyone who wears contact lenses should avoid lakes, rivers, streams, swimming pools and even showering with their lenses in," Dr. Dunn says. "If you are debilitated when not wearing your contact lenses, swimming goggles are a great alternative to being able to see and keep your eyes safe."