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Data Behind Contact Lens Wear and Care Recommendations

Wearing and caring for contact lenses properly is critical to keeping the eyes healthy and preventing eye infections; however, the majority of contact lens wearers 1 do not practice proper contact lens hygiene. Since 2006, in the US there have been three outbreaks of Acanthamoeba keratitis 2,3 and Fusarium keratitis 4—both of which are very serious and sometimes blinding types of eye infections. These outbreaks have brought attention to contact lens wearer hygiene and the need for consistent information about how to wear and care for contact lenses to help prevent such infections. 

CDC—with feedback from experts in optometry, ophthalmology, opticianry, and infectious diseases—encourages contact lens wearers to follow these recommendations, which are based on data from a number of studies. The articles listed here give information on each CDC recommendation but are not intended to be a comprehensive list of references. For additional articles related to contact lens wear and care, visit the Publications, Data, & Statistics page.

Your Habits

Wash your hands with soap and water. Dry them well with a clean cloth before touching your contact lenses every time.

Why? Not washing hands with soap and water prior to touching your contact lenses is a risk factor for complications related to contact lens wear 1,2, as germs from the hands are transferred to the contact lenses and the lens case 3,4. Because microbes that cause eye infections are found in the water 5, you should dry your hands first before touching your contact lenses . Washing hands with soap and water, and drying them with a clean, lint-free cloth, is essential each time that contact lenses are inserted and removed. Follow these tips for proper handwashing.

References
  1. Radford CF, Minassian D, Dart JK, Stapleton F, Verma S. Risk factors for nonulcerative contact lens complications in an ophthalmic accident and emergency department: a case-control study. Ophthalmology. 2009;116(3):385-92.
  2. Collins MJ, Carney LG. Patient compliance and its influence on contact lens wearing problems. Am J Optom Physiol Opt. 1986;63(12):952-6.
  3. Szczotka-Flynn LB, Pearlman E, Ghannoum M. Microbial contamination of contact lenses, lens care solutions, and their accessories: a literature review. Eye Contact Lens. 2010;36(2):116-29.
  4. Hart DE, Shih KL. Surface interactions on hydrogel extended wear contact lenses: microflora and microfauna. Am J Optom Physiol Opt. 1987;64(10):739-48.
  5. Visvesvara GS, Jones DB, Robinson NM. Isolation, identification, and biological characterization of Acanthamoeba polyphaga from a human eye. Am J Trop Med Hyg. 1975;24:784-90.

Don't sleep in your contact lenses unless prescribed by your eye doctor.

Why? Sleeping in any type of contact lens increases by 6 to 8 times the risk of getting a serious type of corneal infection called microbial keratitis 1-4. Out of every 10,000 people who sleep overnight in their contact lenses in an average year, 18-20 infections of microbial keratitis will occur 1,3,5-7. Several companies make contact lenses that are approved by the U.S. Food and Drug Administration to wear during the day and to sleep in (often called "extended wear," "continuous wear," or "overnight wear"); however, contact lens wearers who choose this type of lens should be informed that sleeping in any type of contact lenses increases the risk of serious eye infections 8.

References
  1. Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G, Holden BA. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008;115(10):1655-62.
  2. Dart JK, Radford CF, Minassian D, Verma S, Stapleton F. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology. 2008;115(10):1647-54, 1654 e1-3.
  3. Poggio EC, Glynn RJ, Schein OD, Seddon JM, Shannon MJ, Scardino VA, Kenyon KR. The incidence of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. N Engl J Med. 1989;321:779-83.
  4. Schein OD, Glynn RJ, Poggio EC, Seddon JM, Kenyon KR. The relative risk of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. A case control study. Microbial Keratitis Study Group. N Engl J Med. 1989;321:773-78.
  5. Cheng KH, Leung SL, Hoekman HW, Beekhuis WH, Mulder PG, Geerards AJ, Kijlstra A. Incidence of contact-lens-associated microbial keratitis and its related morbidity. Lancet. 1999;354(9174):181-5.
  6. Morgan PB, Efron N, Hill EA, Raynor MK, Whiting MA, Tullo AB. Incidence of keratitis of varying severity among contact lens wearers. Br J Ophthalmol. 2005;89(4):430-6.
  7. Schein OD, McNally JJ, Katz J, Chalmers RL, Tielsch JM, Alfonso E, Bullimore M, O’Day D, Shovlin J. The incidence of microbial keratitis among wearers of a 30-day silicone hydrogel extended-wear contact lens. Ophthalmology. 2005;112(12):2172-9.
  8. Hickson-Curran S, Chalmers RL, Riley C. Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases. Cont Lens Anterior Eye. 2011;34(5):207-15.

Keep water away from your contact lenses. Avoid showering in contact lenses, and remove them before using a hot tub or swimming.

Why? Contact lenses are a known risk factor for Acanthamoeba keratitis 1-5, a severe type of eye infection caused by a free-living ameba that is commonly found in water 6. Infection from Acanthamoeba is relatively rare, with 1-21 infections per million contact lens wearers, depending on the geographical location 3,7-10. It can be difficult to treat and extremely painful—in the worst cases causing blindness 11,12. Activities such as showering, using a hot tub, and swimming while wearing contact lenses may increase the risk of this infection 12-14, as well as other types of infections 15. Due to regional differences in environmental factors and water quality worldwide 9,11,16 contact lens wearers should always avoid exposure of contact lenses to water—both at home and when traveling. To learn more, visit CDC’s Acanthamoeba keratitis website.

References
  1. CDC. Acanthamoeba keratitis associated with contact lenses—United States. MMWR Morb Mortal Wkly Rep. 1986;35(25):405-8.
  2. Stehr-Green JK, Bailey TM, Brandt FH, Carr JH, Bond WW, Visvesvara GS. Acanthamoeba keratitis in soft contact lens wearers. A case-control study. JAMA. 1987;258(1):57-60.
  3. Stehr-Green JK, Bailey TM, Visvesvara GS. The epidemiology of Acanthamoeba keratitis in the United States. Am J Ophthalmol. 1989;107(4): 331-6.
  4. Verani JR, Lorick SA, Yoder JS, Beach MJ, Braden CR, Roberts JM, Conover CS, Chen S, McConnell KA, Chang DC, Park BJ, Jones DB, Visvesvara GS, Roy SL. National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States. Emerg Infect Dis. 2009; 15(8):1236-42.
  5. Yoder JS, Verani J, Heidman N, Hoppe-Bauer J, Alfonso EC, Miller D, Jones DB, Bruckner D, Langston R, Jeng BH, Joslin CE, Tu E, Colby K, Vetter E, Ritterband D, Mathers W, Kowalski RP, Acharya NR, Limaye AP, Leiter C, Roy S, Lorick S, Roberts J, Beach MJ. Acanthamoeba keratitis: the persistence of cases following a multistate outbreak. Ophthalmic Epidemiol. 2012;19(4):221-5.
  6. Visvesvara GS, Jones DB, Robinson NM. Isolation, identification, and biological characterization of Acanthamoeba polyphaga from a human eye. Am J Trop Med Hyg. 1975;24:784-90.
  7. Schaumberg DA, Snow KK, Dana MR. The epidemic of Acanthamoeba keratitis: where do we stand? Cornea. 1998;17:3-10.
  8. Radford CF, Lehmann OJ, Dart JK. Acanthamoeba keratitis: multicentre survey in England 1992-6. Microbial Keratitis Study Group. Br J Ophthalmol. 1998;82(12):1387-92.
  9. Radford CF, Minassian DC, Dart JK. Acanthamoeba keratitis in England and Wales: incidence, outcome, and risk factors. Br J Ophthalmol. 2002;86(5):536-42.
  10. Seal DV, Kirkness CM, Bennett HG, Peterson M. Acanthamoeba keratitis in Scotland: risk factors for contact lens wearers. Cont Lens Anterior Eye. 1999;22(2):58-68.
  11. Page MA, Mathers WD. Acanthamoeba keratitis: a 12-year experience covering a wide spectrum of presentations, diagnoses, and outcomes. J Ophthalmol. 2013;2013:670242.
  12. Joslin CE, Tu EY, Shoff ME, Booton GC, Fuerst PA, McMahon TT, Anderson RJ, Dworkin MS, Sugar J, Davis FG, Stayner LT. The association of contact lens solution use and Acanthamoeba keratitis. Am J Ophthalmol. 2007; 144(2):169-80.
  13. Hammersmith KM. Diagnosis and management of Acanthamoeba keratitis. Curr Opin Ophthalmol. 2006;17(4):327-31.
  14. Beattie TK, Tomlinson A, McFadyen AK, Seal DV, Grimason AM. Enhanced attachment of Acanthamoeba to extended-wear silicone hydrogel contact lenses: a new risk factor for infection? Ophthalmology. 2003;110(4):765-71.
  15. Mena KD, Gerba CP. Risk assessment of Pseudomonas aeruginosa in water. Rev Environ Contam Toxicol. 2009;201:71-115.
  16. Kilvington S, Shovlin J, Nikolic M. Identification and susceptibility to multipurpose disinfectant solutions of bacteria isolated from contact lens storage cases of patients with corneal infiltrative events. Cont Lens Anterior Eye. 2013 Mar 1.

Your Supplies

Your Contact Lenses

Rub and rinse your contact lenses with contact lens disinfecting solution—never water or saliva—to clean them each time you remove them.

Why? Improper cleaning of contact lenses raises the risk of complications among contact lens wearers 1. Rubbing contact lenses with a clean finger and rinsing them with disinfecting solution is the most effective way to remove deposits and microbes from soft contact lenses 1,2. Rinsing contact lenses with multipurpose solution and soaking them overnight without rubbing them first is not as effective at removing microbes 1,2. Regardless of the type of contact lens worn, rubbing and rinsing the lenses daily is an important step in maintaining contact lens and eye health 1-4.

References
  1. Cho P, Cheng SY, Chan WY, Yip WK. Soft contact lens cleaning: rub or no-rub? Ophthalmic Physiol Opt. 2009;29(1):49-57.
  2. Zhu H, Bandara MB, Vijay AK, Masoudi S, Wu D, Willcox MD. Importance of rub and rinse in use of multipurpose contact lens solution. Optom Vis Sci. 2011;88(8):967-72.
  3. Sweeney D, Holden B, Evans K. Ng V, Cho P. Best practice contact lens care: a review of the Asia Pacific Contact Lens Care Summit. Clin Exp Optom. 2009;92(2):78-89.
  4. Dumbleton KA, Woods CA, Jones LW, Fonn D. The relationship between compliance with lens replacement and contact lens-related problems in silicone hydrogel wearers. Cont Lens Anterior Eye. 2011;34(5):216-22.

Never store your contact lenses in water.

Why? For the same reason that showering, using a hot tub, and swimming should be avoided while wearing contact lenses, contacts should not be stored in water at any time 1-4. Exposing contact lenses to water may increase the risk of different types of eye infections. One serious type of contact lens-related eye infection, Acanthamoeba keratitis 1-4, is caused by a microscopic ameba commonly found in water 5. Even though infection from Acanthamoeba is rare, it can be difficult to treat and extremely painful—in the worst cases causing blindness 1, 6-8. To learn more, visit CDC’s Acanthamoeba keratitis website.

References
  1. Joslin CE, Tu EY, Shoff ME, Booton GC, Fuerst PA, McMahon TT, Anderson RJ, Dworkin MS, Sugar J, Davis FG, Stayner LT. The association of contact lens solution use and Acanthamoeba keratitis. Am J Ophthalmol. 2007; 144(2):169-80.
  2. Hammersmith KM. Diagnosis and management of Acanthamoeba keratitis. Curr Opin Ophthalmol. 2006;17(4):327-31.
  3. Butcko V, McMahon TT, Joslin CE, Jones L. Microbial keratitis and the role of rub and rinsing. Eye Contact Lens. 2007;33(6 Pt 2):421-3; discussion 424-5.
  4. Beattie TK, Tomlinson A, McFadyen AK, Seal DV, Grimason AM. Enhanced attachment of Acanthamoeba to extended-wear silicone hydrogel contact lenses: a new risk factor for infection? Ophthalmology. 2003;110(4):765-71.
  5. Visvesvara GS, Jones DB, Robinson NM. Isolation, identification, and biological characterization of Acanthamoeba polyphaga from a human eye. Am J Trop Med Hyg. 1975;24:784-90.
  6. Page MA, Mathers WD. Acanthamoeba keratitis: a 12-year experience covering a wide spectrum of presentations, diagnoses, and outcomes. J Ophthalmol. 2013;2013:670242.
  7. Verani JR, Lorick SA, Yoder JS, Beach MJ, Braden CR, Roberts JM, Conover CS, Chen S, McConnell KA, Chang DC, Park BJ, Jones DB, Visvesvara GS, Roy SL. National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States. Emerg Infect Dis. 2009; 15(8):1236-42.
  8. Ross J, Roy SL, Mathers WD, Ritterband DC, Yoder JS, Ayers T, Shah RD, Samper ME, Shih CY, Schmitz A, Brown AC. Clinical characteristics of Acanthamoeba keratitis infections in 28 states, 2008 to 2011. Cornea. 2014; 33(2):161-8.

Replace your contact lenses as often as recommended by your eye doctor.

Why? While the effects of not replacing contact lenses as regularly as recommended by an eye care provider have not been fully examined 1-4, studies have shown that contact lens wearers who do not follow recommended replacement schedules have more complications and self-reported discomfort than contact lens wearers who follow the replacement recommendations 2,4. Some contact lens wearers have also reported poorer vision as a result of wearing contact lenses longer than indicated by their eye care providers 2.

References
  1. Hickson-Curran S, Chalmers RL, Riley C. Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases. Cont Lens Anterior Eye. 2011;34(5):207-15.
  2. Dumbleton K, Woods C, Jones L, Richter D, Fonn D. Comfort and vision with silicone hydrogel lenses: effect of compliance. Optom Vis Sci. 2010;87(6):421-25.
  3. Dumbleton K, Richter D, Bergenske P, Jones LW. Compliance with lens replacement and the interval between eye examinations. Optom Vis Sci. 2013;90(4):351-58.
  4. Dumbleton KA, Woods CA, Jones LW, Fonn D. The relationship between compliance with lens replacement and contact lens-related problems in silicone hydrogel wearers. Cont Lens Anterior Eye. 2011;34(5):216-22.

Your Contact Lens Case

Rub and rinse your contact lens case with contact lens solution—never water—and then empty and dry with a clean tissue. Store upside down with the caps off after each use.

Why? Contaminated contact lens cases have been linked to rare but serious eye infections in contact lens wearers in recent years 1, 2 . An invisible layer in the case called a biofilm 3, 4 can become a breeding ground for microscopic germs that can cause infections 5-7. Biofilms in contact lens cases can be best removed by rubbing and rinsing the case with disinfecting solution, and wiping dry with a tissue 8-10, and then allowing to air-dry face down with the caps off 11. Fewer than half of contact lens wearers report always cleaning their contact lens cases 1, 12 , even though the number of moderate to severe contact lens-related infections could be cut in half through improved lens case cleaning procedures 1.

References
  1. Stapleton F, Edwards K, Keay L, Naduvilath T, Dart JK, Brian G, Holden B. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology. 2012;119(8):1516-1521.
  2. Radford CF, Minassian DC, Dart JK. Disposable contact lens use as a risk factor for microbial keratitis. Br J Ophthalmol. 1998;82(11):1272-5.
  3. McLaughlin-Borlace L, Stapleton F, Matheson M, Dart JK. Bacterial biofilm on contact lenses and lens storage cases in wearers with microbial keratitis. J Appl Microbiol. 1998;84(5):827-38.
  4. Wilson LA, Sawant AD, Simmons RB, Ahearn DG. Microbial contamination of contact lens storage cases and solutions. Am J Ophthalmol. 1990;110(2):193-8.
  5. Gray TB, Cursons RT, Sherwan JF, Rose PR. Acanthamoeba, bacterial, and fungal contamination of contact lens storage cases. Br J Ophthalmol. 1995;79(6):601-5.
  6. Devonshire P, Munro FA, Abernethy C, Clark BJ. Microbial contamination of contact lens cases in the west of Scotland. Br J Ophthalmol. 1993;77(1):41-5.
  7. Yung MS, Boost M, Cho P, Yap M. Microbial contamination of contact lenses and lens care accessories of soft contact lens wearers (university students) in Hong Kong. Ophthalmic Physiol Opt. 2007;27(1):11-21.
  8. Wu YT, Teng YJ, Nicholas M, Harmis N, Zhu H, Willcox MD, Stapleton F. Impact of lens case hygiene guidelines on contact lens case contamination. Optom Vis Sci. 2011;88(10):E1180-7.
  9. Wu YT, Zhu H, Willcox M, Stapleton F. The effectiveness of various cleaning regimens and current guidelines in contact lens case biofilm removal. Invest Ophthalmol Vis Sci. 2011;52(8):5287-92.
  10. Wu YT, Zhu H, Willcox M, Stapleton F. Removal of biofilm from contact lens storage cases. Invest Ophthalmol Vis Sci. 2010;51(12):6329-33.
  11. Wu YT, Zhu H, Willcox M, Stapleton F. Impact of air-drying lens cases in various locations and positions. Optom Vis Sci. 2010;87(7):465-8.
  12. Hickson-Curran S, Chalmers RL, Riley C. Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases. Cont Lens Anterior Eye. 2011;34(5):207-15.

Replace your contact lens case at least once every three months.

Why? Infrequent replacement of contact lens cases, along with poor cleaning of cases, has been linked to serious eye infections in contact lens wearers 1. A significant number of contact lens wearers report not changing their lens case on a regular basis 2, 3. Even when cleaned properly by rubbing and rinsing the case with disinfecting solution, contact lens cases can still be contaminated with microscopic germs 4 that can cause infections when they come into contact with the eye 5, 6. The ideal frequency for lens case replacement has not been scientifically established 7, but there is agreement among experts in the vision care field that cases should be replaced every three months, or when a new bottle of solution is purchased that comes with a case—whichever comes sooner 8-10.

References
  1. Stapleton F, Edwards K, Keay L, Naduvilath T, Dart JK, Brian G, Holden B. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology. 2012;119(8):1516-21.
  2. Dumbleton KA, Woods CA, Jones LW, Fonn D. The relationship between compliance with lens replacement and contact lens-related problems in silicone hydrogel wearers. Cont Lens Anterior Eye. 2011;34(5):216-22.
  3. Wu Y, Carnt N, Stapleton F. Contact lens user profile, attitudes and level of compliance to lens care. Cont Lens Anterior Eye. 2010;33(4):183-8.
  4. McLaughlin-Borlace L, Stapleton F, Matheson M, Dart JK. Bacterial biofilm on contact lenses and lens storage cases in wearers with microbial keratitis. J Appl Microbiol. 1998;84(5):827-38.
  5. Gray TB, Cursons RT, Sherwan JF, Rose PR. Acanthamoeba, bacterial, and fungal contamination of contact lens storage cases. Br J Ophthalmol. 1995;79(6):601-5.
  6. Stapleton F, Dart JK, Seal DV, Matheson M. Epidemiology of Pseudomonas aeruginosa keratitis in contact lens wearers. Epidemiol Infect. 1995;114(3):395-402.
  7. Hickson-Curran S, Chalmers RL, Riley C. Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases. Cont Lens Anterior Eye. 2011;34(5):207-15.
  8. FDA. Contact lens risks. 2014.
  9. DePaolis M, Cho P, Cunningham D, Morgan PB, Quinn TG, Saks AP, Shovlin JP. What do we do now? Implications for the clinical practice. Cont Lens Anterior Eye. 2013;36 Suppl 1:S28-33.
  10. American Optometric Association. Contact lenses. 2013.

Your Contact Lens Solution

Don’t "top off" solution. Use only fresh contact lens disinfecting solution in your case—never mix fresh solution with old or used solution.

Why? Topping off solution—or mixing fresh solution with used solution in the case for storing contact lenses—has been an important risk factor in serious outbreaks of contact lens-associated infections 1, 2. Used solution in the case can become contaminated by germs that are on contact lenses or in the contact lens case 3. An invisible layer called a biofilm can grow in the case 4. The presence of biofilms can make contact lens disinfecting solution less effective at killing germs 3 that can cause serious eye infections, and adding new solution to used solution can lower germ-killing power 5. It is important to use only fresh solution—never water—in the contact lens case when storing contact lenses overnight to help prevent infections 6, 7.

References
  1. Chang DC, Grant GB, O’Donnell K, Wannemuehler KA, Noble-Wang J, Rao CY, Jacobson LM, Crowell CS, Sneed RS, Lewis FM, Schaffzin JK, Kainer MA, Genese CA, Alfonso EC, Jones DB, Srinivasan A, Fridkin SK, Park BJ. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA. 2006;296(8):953-63.
  2. Verani JR, Lorick SA, Yoder JS, Beach MJ, Braden CR, Roberts JM, Conover CS, Chen S, McConnell KA, Chang DC, Park BJ, Jones DB, Visvesvara GS, Roy SL. National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States. Emerg Infect Dis. 2009;15(8):1236-42.
  3. Wilson LA, Sawant AD, Ahearn DG. Comparative efficacies of soft contact lens disinfectant solutions against microbial films in lens cases. Arch Ophthalmol. 1991;109(8):1155-7.
  4. McLaughlin-Borlace L, Stapleton F, Matheson M, Dart JK. Bacterial biofilm on contact lenses and lens storage cases in wearers with microbial keratitis. J Appl Microbiol. 1998;84(5):827-38.
  5. Ahearn DG, Zhang S, Stulting RD, Simmons RB, Ward MA, Pierce GE, Crow SA Jr. In vitro interactions of Fusarium and Acanthamoeba with drying residues of multipurpose contact lens solutions. Invest Ophthalmol Vis Sci. 2011;52(3):1793-9.
  6. FDA. Contact lens risks. 2014.
  7. DePaolis M, Cho P, Cunningham D, Morgan PB, Quinn TG, Saks AP, Shovlin JP. What do we do now? Implications for the clinical practice. Cont Lens Anterior Eye. 2013;36 Suppl 1:S28-33.

Use only the contact lens solution recommended by your eye doctor.

Why? It is important to use the type or brand of contact lens solution recommended by your eye care provider. An eye doctor or optician recommends a contact lens solution based on each patient’s eyes and medical history. In addition, certain types of contact lenses and solutions may interact and cause eye irritation when used together 1. An eye doctor can help determine the best solution for each type of contact lens 2. Eye doctors should be consulted before changing the type or brand of contact lens solution, and contact lens wearers should always be sure to read the package insert carefully before using any type of solution.

References
  1. Santos L, Oliveira R, Oliveira ME, Azeredo J. Lens material and formulation of multipurpose solutions affects contact lens disinfection. Cont Lens Anterior Eye. 2011;34(4):179-82.
  2. FDA. Contact lens solutions and products. 2010.

Your Eye Doctor

Visit your eye doctor yearly or as often as he or she recommends.

Why? The eye care community generally agrees that yearly eye exams are recommended for contact lens wearers in order to keep their eyes as healthy as possible while wearing contact lenses 1—particularly given that wearing contact lenses increases the risk for eye infections and complications 2. Additionally, contact lens wearers often need to have a yearly exam to confirm their prescription so that they may order new supplies of contact lenses. In some instances, eye doctors may recommend that patients return more frequently for eye exams.

References
  1. American Academy of Ophthalmology. Proper care of contact lenses. EyeSmart. 2013.
  2. Dart JK, Stapleton F, Minassian F. Contact lenses and other risk factors in microbial keratitis. Lancet. 1991;338(8768):650-3.
References
  1. Sokol JL, Mier MG, Bloom S, Asbell PA. A study of patient compliance in a contact lens-wearing population. CLAO J. 1990;16(3):209-13.
  2. Verani JR, Lorick SA, Yoder JS, Beach MJ, Braden CR, Roberts JM, Conover CS, Chen S, McConnell KA, Chang DC, Park BJ, Jones DB, Visvesvara GS, Roy SL. National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States. Emerg Infect Dis. 2009;15(8):1236-42.
  3. Ross J, Roy SL, Mathers WD, Ritterband DC, Yoder JS, Ayers T, Shah RD, Samper ME, Shih CY, Schmitz A, Brown AC. Clinical characteristics of Acanthamoeba keratitis infections in 28 states, 2008 to 2011. Cornea. 2014;33(2):161-8.
  4. Chang DC, Grant GB, O’Donnell K, Wannemuehler KA, Noble-Wang J, Rao CY, Jacobson LM, Crowell CS, Sneed RS, Lewis FM, Schaffzin JK, Kainer MA, Genese CA, Alfonso EC, Jones DB, Srinivasan A, Fridkin SK, Park BJ. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA. 2006;296(8):953-63.
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