Prostate Cancer Trials Show No Link between Androgen-Deprivation Therapy and Cardiac Deaths

Several studies have suggested that men who receive androgen-deprivation therapy (ADT) to treat prostate cancer may face an increased risk of dying from cardiovascular causes. But a new analysis of clinical trial results has found no evidence that ADT increases cardiovascular deaths among men with high-risk, nonmetastatic prostate cancer.

The findings, from a meta-analysis of eight randomized clinical trials, appeared in the December 7 issue of JAMA. Androgen-deprivation therapy, which suppresses the production of male hormones, is a mainstay of prostate cancer care. A form of ADT known as gonadotropin-releasing hormone agonist therapy has been linked to heart disease in some, but not all, studies.

Citing these studies, the Food and Drug Administration last year issued a safety warning for this class of drugs. Several medical societies have also issued a science advisory stating that there may be a relationship between ADT and cardiovascular events and death.

To explore this question further, Dr. Paul Nguyen of Dana-Farber Cancer Institute and his colleagues analyzed data on more than 4,000 participants in ADT trials. Among 2,200 men treated with ADT, there were 255 cardiovascular deaths (an overall incidence rate of 11.0 percent); among 1,941 men in the control groups, there were 252 deaths (11.2 percent).

The study also showed a benefit: Men who received ADT had a lower risk of dying from prostate cancer and other causes of death than men who did not. “Our study should be reassuring to most men with high-risk prostate cancer considering ADT,” noted Dr. Nguyen.

The main caveat of the study is that the researchers could not assess the risk of cardiac death for specific subgroups of patients, including those at highest risk for cardiovascular disease. Therefore, Dr. Nguyen said, “our study could not rule out the possibility that men with a history of cardiac disease could still be harmed by ADT.”

For men with significant underlying cardiac disease, the study authors recommend a careful examination by a cardiologist and a discussion of the risks and benefits of ADT.

Although ADT is not new, doctors are still learning about its risks and benefits, noted the authors of an accompanying editorial. Some research, for example, has suggested that ADT may shorten the time before a cardiovascular event occurs. (The current study could not address this question.)

To answer such questions, future prospective trials involving ADT should classify patients according to cardiovascular risk factors at the beginning of a study, noted the study’s senior author, Dr. Toni Choueiri of Dana-Farber Cancer Institute.

“While it is important to raise awareness of the possible cardiac side effects of ADT, it may be the case that the pendulum had swung too far away from the use of ADT, even for men with high-risk disease in whom ADT has been shown to save lives,” Dr. Choueiri wrote in an e-mail.


Two Drugs that Hit One Target Show Efficacy against Metastastic Breast Cancer

Combining two drugs that target the HER2 protein, trastuzumab (Herceptin) and the investigational agent pertuzumab, with chemotherapy may be a new treatment option for women with HER2-positive metastatic breast cancer, according to results from a large clinical trial.

The phase III CLEOPATRA trial showed that combining both of the HER2-targeting agents with the chemotherapy drug docetaxel as an initial treatment led to a 6-month improvement in progression-free survival compared to treatment with docetaxel and trastuzumab alone. The results were presented at the San Antonio Breast Cancer Symposium and published in the New England Journal of Medicine last week.

Targeting HER2 with two different drugs has shown promise in multiple trials, said the trial’s lead investigator, Dr. José Baselga of Harvard Medical School and the Massachusetts General Hospital, during a press briefing. “I think dual HER2 blockade is coming soon, and it will be in our daily practices.”

Although both drugs target the HER2 protein on the surface of cancer cells, they do so in different ways. Laboratory studies have indicated that the drugs may have a synergistic effect on HER2-positive tumors, which Dr. Baselga explained, are “addicted” to HER2 signaling.

More than 800 women were enrolled in the randomized trial; half received all three drugs and half received trastuzumab and docetaxel, a standard first-line treatment for women with metastatic HER2-positive breast cancer, plus a placebo. Progression-free survival was 18.5 months in the three-drug arm and 12.4 months in the two-drug plus placebo arm. More women who received the three-drug combination experienced significant shrinkage of their tumors than women who received trastuzumab, docetaxel, and the placebo, Dr. Baselga reported.

Although there is a trend toward better overall survival in women treated with pertuzumab, the trial hasn’t been running long enough to clearly determine whether the three-drug combination helps women live longer, Dr. Baselga said.

Trastuzumab has been associated with significant cardiac side effects in some women, but no  increase in such side effects was seen in women in the trial who received both HER2-targeted drugs.

Genentech, which manufactures pertuzumab and trastuzumab and funded the trial, has submitted an application to the Food and Drug Administration for approval of pertuzumab for use as an initial treatment in women with HER2-positive metastatic breast cancer.



Most Common Adult Muscular Dystrophy Linked to Increased Cancer Risk

Adults with myotonic muscular dystrophy (MMD), an inherited disorder marked by progressive muscle wasting and weakness, may be at increased risk of developing cancer, a new study suggests. A research team led by Dr. Mark H. Greene and Dr. Shahinaz M. Gadalla, both of the Clinical Genetics Branch in NCI’s Division of Cancer Epidemiology and Genetics, found that patients with MMD from two independent cohorts had a twofold higher overall risk of cancer compared with people in the general population, with the increased risk mainly accounted for by cancers of the colon, brain, endometrium, and ovary. The results were reported in the December 14 issue of JAMA.

MMD is the most common form of muscular dystrophy that begins in adulthood. There are two types of MMD, type 1 and type 2, which affect multiple body systems and are caused by mutations in different genes. The signs and symptoms of the two types overlap, although type 1 is more severe.

“The impetus for this work came from [coauthor] Dr. Richard Moxley’s clinical impression that the cancer occurrence among his MMD patients was greater than expected,” Dr. Greene noted. The question then was whether those cancers were part of the MMD syndrome or just a coincidental finding.

To address this question, the researchers linked the health records of 1,658 MMD patients from two nationwide patient registries, one in Sweden and one in Denmark, to the corresponding national cancer registry in each country. They found the same patterns of increased cancer risk in both the Swedish and Danish MMD cohorts, which “provides substantial reassurance that our observations are genuine,” the study authors wrote.

“This study is the first formal quantitative assessment of cancer risk in MMD, which previously has not been considered a cancer susceptibility disorder,” Dr. Greene said.

“We don’t yet know for sure why MMD patients are at increased risk of cancer,” added Dr. Gadalla. “It may be that some of the genetic changes that cause MMD symptoms are also responsible for the increase in cancer risk.” Further research to explore the possible mechanisms involved may provide new insights into mechanisms of carcinogenesis, she noted.

In addition to pursuing that avenue of research, Dr. Greene and his colleagues are investigating whether the cancer risk differs between patients with type 1 versus type 2 MMD, and whether the excess risk can be explained by known risk factors for cancer—questions that this study could not answer.

In the meantime, Dr. Greene said, “It’s important that clinicians be aware of this possible increased risk of cancer in MMD patients.”

Source:NCI bulletin


Combination Therapy Shows Promise for Treating Advanced Breast Cancer

Adding the drug everolimus (Afinitor) to exemestane helped postmenopausal women whose advanced breast cancer had stopped responding to hormonal therapy live about 4 months longer without the disease progressing than women who received exemestane alone. Findings from the trial, called BOLERO 2, were presented last week at the San Antonio Breast Cancer Symposium.

For women who received the combination therapy, the median progression-free survival was 7.4 months compared with 3.2 months for those who received exemestane alone, Dr. Gabriel Hortobagyi of the University of Texas M. D. Anderson Cancer Center reported at the symposium. These were the latest available data, updated from preliminary results presented at the European Multidisciplinary Cancer Congress in September and results published online December 7 in the New England Journal of Medicine (NEJM).

The researchers do not yet have data on whether the combination therapy improves overall survival, but they expect to have it in late 2012. In July, the randomized phase of BOLERO 2 was stopped early after an interim analysis showed an improvement in progression-free survival. The study, which was supported by Novartis, the manufacturer of Afinitor, included many participants who had previously received multiple therapies.

Everolimus inhibits a protein called mTOR, which plays a role in a signaling pathway that promotes cell growth and proliferation. Exemestane, an aromatase inhibitor, is used to treat metastatic breast cancer.

“For postmenopausal patients with hormone receptor-positive metastatic breast cancer, the addition of everolimus to exemestane markedly improves the duration of disease control,” Dr. Hortobagyi said in a statement. This benefit should be weighed against the side effects associated with everolimus, such as fatigue and oral mucositis, the study authors noted in the NEJM article.

source:NCI bulletin

Late Effects May Not Warrant Using Radiation to Treat Early-Stage Hodgkin Lymphoma

Patients with early-stage Hodgkin lymphoma who were treated with multidrug chemotherapy alone were more likely to be alive 12 years later than patients who received treatment that included radiation therapy, according to findings from a phase III clinical trial. More patients who received radiation therapy died of second cancers or other toxic late effects of their treatment, such as heart disease, than those who received chemotherapy alone, researchers reported Monday at the American Society of Hematology (ASH) annual scientific meeting in San Diego. The findings, which are the first long-term results from a randomized trial involving patients with early-stage Hodgkin lymphoma, also appeared online December 11 in the New England Journal of Medicine.

The overall survival rate was 94 percent for patients treated with the drugs doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD regimen), compared with 87 percent for patients who received either radiation therapy alone or ABVD plus radiation therapy. Of 405 patients enrolled in the trial, 12 in the ABVD-alone group died during the follow-up period (six of Hodgkin lymphoma, four of second cancers, and two of other causes). In contrast, 24 patients in the group receiving radiation therapy died (4 of Hodgkin lymphoma, 10 of second cancers, and 10 of other causes).

All of the trial’s participants had stage IA or IIA Hodgkin lymphoma, with tumors smaller than 4 inches in diameter. Hodgkin lymphoma occurs most often in younger people, and the median age of the participants in the trial was about 36 when the study began. Among the roughly two-thirds of participants with high-risk disease, 92 percent of those treated with ABVD alone were alive at 12 years, compared with 81 percent of those who received radiation therapy.

The rate of freedom from disease progression was lower in the group of patients treated with chemotherapy alone (87 percent) than in the group receiving radiation (92 percent), principal investigator Dr. Ralph M. Meyer, of the National Cancer Institute of Canada (NCIC) Clinical Trials Group, acknowledged at a press briefing on Sunday.

“What we have shown is that … chemotherapy [alone] improves overall survival, and it does so because there are fewer late effects than with a treatment strategy that includes radiation,” Dr. Meyer said. “We have also shown that the standard paradigm of keeping the disease away being a proxy measure for living longer doesn’t apply in this situation because of the late effects.”

Most trials involving patients with stage IA or IIA Hodgkin lymphoma have followed the participants for 4 to 6 years and have used disease recurrence as the primary outcome measure, Dr. Meyer noted. However, late effects associated with radiation therapy do not become apparent for 10 years or more, he continued.

“The treatment of Hodgkin lymphoma today is a real balance between achieving control of the disease and cure while limiting long-term side effects,” commented Dr. Jane N. Winter, who moderated the press briefing and is a past co-chair of the lymphoma committee of the Eastern Cooperative Oncology Group, which participated in the study. “This [study speaks] to that balance and [to] the importance of long-term follow-up in evaluating our new therapies.”

The type of radiation therapy used in the study, known as subtotal nodal radiation therapy, is now considered outdated, added Dr. Meyer. “The treatment that the patients in the control arm received would today be considered excessive and likely contributed to the additional second cancers and cardiovascular events,” he said. Although the risks of late effects associated with radiation therapy “are likely reduced with modern strategies, we don’t know the magnitude by which they are reduced,” he continued.

The NCIC trial results “confirm the known long-term detrimental effects of large-field radiation therapy, an approach that has long been abandoned given the large body of literature on the late effects of such treatment, and the similar efficacy of more limited radiation treatment fields as part of combined modality therapy,” Drs. Peter Mauch and Andrea Ng, radiation oncologists at Harvard Medical School, wrote in an e-mail. Today, radiation doses are a fraction of those used in this trial, and treatment is limited to the area of the body affected by lymphoma, they explained.

“Clinical trials have shown that higher rates of recurrence are associated with increased mortality from Hodgkin lymphoma,” Drs. Mauch and Ng continued. “The challenge is how to minimize recurrence while limiting the late mortality associated with treatment. Much has been achieved towards this goal with the use of reduced number of courses of chemotherapy and limiting the dose and field size of radiation.”

Radiation oncologists have been divided over the role of radiation therapy in patients with stage IA or IIA Hodgkin lymphoma, said Dr. Richard Little of NCI’s Cancer Therapy Evaluation Program. “Data from this study, which is the first published randomized trial with longer-term follow-up, will be taken by many to mean [that] omission of radiation therapy should be the standard of care in early-stage Hodgkin lymphoma,” he said. “However, some patients and physicians will be so averse to the slight increase in early disease progression if radiotherapy is omitted that it will not be omitted in all cases.”


The novel JAK inhibitor CYT387 suppresses multiple signalling pathways, prevents proliferation and induces apoptosis in phenotypically diverse myeloma cells

Janus kinases (JAKs) are involved in various signalling pathways exploited by malignant cells. In multiple myeloma (MM), the interleukin-6/JAK/signal transducers and activators of transcription (IL-6/JAK/STAT) pathway has been the focus of research for a number of years and IL-6 has an established role in MM drug resistance. JAKs therefore make a rational drug target for anti-MM therapy. CYT387 is a novel, orally bioavailable JAK1/2 inhibitor, which has recently been described. This preclinical evaluation of CYT387 for treatment of MM demonstrated that CYT387 was able to prevent IL-6-induced phosphorylation of STAT3 and greatly decrease IL-6- and insulin-like growth factor-1-induced phosphorylation of AKT and extracellular signal-regulated kinase in human myeloma cell lines (HMCL). CYT387 inhibited MM proliferation in a time- and dose-dependent manner in 6/8 HMCL, and this was not abrogated by the addition of exogenous IL-6 (3/3 HMCL). Cell cycling was inhibited with a G2/M accumulation of cells, and apoptosis was induced by CYT387 in all HMCL tested (3/3). CYT387 synergised in killing HMCL when used in combination with the conventional anti-MM therapies melphalan and bortezomib. Importantly, apoptosis was also induced in primary patient MM cells (n=6) with CYT387 as a single agent, and again synergy was seen when combined with conventional therapies.


High-Altitude Nuclear Explosions Dangerous, but not for Reasons Gingrich Cites

Newt Gingrich has been warning the nation of the danger of an electromagnetic pulse (EMP)—a burst of radiation created by a high-altitude nuclear explosion. This pulse would take down electrical systems over hundreds or thousands of miles, the argument goes, knocking the U.S. back to the 19th Century. “In theory, a relatively small device over Omaha would knock out about half the electricity generated in the United States,” he was quoted as saying by the New York Times. In Gingrich’s view, the threat of an EMP attack justifies actions such as pre-emptive strikes on the missile instillations of nations such as Iran and North Korea.

The threat of an EMP attack is real—assuming, of course, that a nation or organization develops not only nuclear weapons but intercontinental ballistic missiles and the will to deploy them. Yet the primary target of an EMP wouldn’t be ground-based power systems. It would be satellites.

In the June 2004 issue of Scientific American, the national security journalist Daniel G. Dupont wrote “Nuclear Explosions in Orbit” a story that details the sequence of events that would follow a nuclear detonation just above the atmosphere.

The initial blast of high-energy gamma rays would strike air molecules and create a shower of high-energy electrons, he writes. These electrons, once they reached ground, would indeed disrupt sensitive electronic equipment. But only that equipment within direct line-of-sight of the blast—taking out a city, perhaps, not a continent.

More fearsome would be the effects of radiation on orbiting satellites. After the initial nanoseconds-long blast of gamma rays, a nuclear bomb releases about 70 percent of its total energy in the form of x-rays. Dupont writes:

“Soft,” or low-energy, x-rays produced by a HANE would not penetrate deeply into any spacecraft they encountered. Instead they would generate extreme heat at the outer surfaces, which itself could harm the sophisticated electronics inside. Soft x-rays would also degrade solar cells, impairing a satellite’s ability to generate power, as well as damaging sensor or telescope apertures. When high-energy x-rays strike a satellite or other system components, however, they create strong internal electron fluxes that produce strong currents and high voltages that can fry sensitive electronic circuitry.

He quotes K. Dennis Papadopoulos, a plasma physicist at the University of Maryland who studies the effects of high-altitude nuclear explosions for the U.S. government, who concludes that “a 10-kiloton nuclear device set off at the right height would lead to the loss of 90 percent of all low-earth-orbit satellites within a month.” The exception would be U.S. military satellites, many of which have been hardened against exactly this kind of threat.

Source:Scientific American.

Some of World’s Tiniest Preemies Are Growing Up Healthy

Two of the Smallest Surviving Infants Develop Normally, but Height and Weight Lag a Bit
adult hand holding tiny foot

World's tiniest preemie at birth and at 22

Against heavy odds, the world’s tiniest and the fourth-smallest surviving infants have had normal childhood development, a new study shows, although the girls’ heights and weights still lag behind other kids the same age.

Little information is available to doctors and parents on how extremely low-birth-weight babies develop and grow as toddlers, school-age children, or into young adulthood. So a report like this offers a rare glimpse at the long-term health and growth of two of the world’s teeniest premature babies as they get older.

Rumaisa Rahman, a girl who holds the Guinness Book of World Records title of “World’s Smallest Surviving Baby,” is at her five-year follow-up doctor’s visit.

Born at just 26 weeks after her mother had severe preeclampsia, a serious condition involving high blood pressure and other abnormalities during pregnancy, Rumaisa was a twin. She weighed 9.2 ounces. She was roughly 9 inches long. Rumaisa spent 142 days in the hospital’s neonatal intensive care unit.

Madeline Mann is now a 22-year-old college senior. She was born at nearly 27 weeks into the pregnancy, also to a mother who had preeclampsia. She weighed roughly 9.9 ounces and was also about 9 inches long. Madeline was hospitalized for 122 days as a newborn before going home.

Her case is the first 20-year follow-up for one of the world’s smallest surviving infants reported in the medical literature.

Few babies born at birth weights of less than 14 ounces survive, so cases such as these are very rare. But the numbers of these “micro-preemies” who survive are on the rise.

The research appears in the Dec. 12 issue of Pediatrics.

Not Typical Outcomes

Both girls, who were born at the same Illinois hospital, showed normal language skills and hit normal milestones for walking and toilet training. Rumaisa’s movement skills — writing, grasping for toys, and getting dressed — are mildly delayed, while Madeline’s are described as normal.

Both girls remain small for their age for weight and height. Rumaisa is in first grade with an individualized education plan.

At 20, Madeline stood 4 feet, 7 inches and weighed about 65 pounds. Her growth has been consistently far below other girls her age.

“We tell parents of babies born this small not to expect their children to be super tall,” says researcher Jonathan Muraskas, MD.

Even so, he credits three main reasons for the girls’ relatively normal development. The first, says Muraskas, is that number of weeks of the pregnancy is much more important than birth weight for a child’s growth and brain development.

A second is that female preemies do better than males. “But we don’t know why,” says Muraskas, a professor of neonatal and perinatal medicine at Loyola University Medical Center in Maywood, Ill.

And a third reason is that both mothers were given steroids before birth. These medications help the baby’s lungs and brains mature faster and lower the risk of bleeding in the brain.

Muraskas points out that the two girls’ outcomes are not typical. Many micro-preemies either do not survive or grow up with disabilities from conditions such as cerebral palsy, mental retardation, and blindness.

While the researchers caution against considering their results as an expected outcome, it’s important for parents of these babies to recognize that there’s some hope.

“Good outcomes are possible even for the smallest babies,” says Edward Bell, MD, a neonatologist at the University of Iowa Children’s Hospital in Iowa City. He also says that for these tiny infants, the number of weeks spent inside the mother’s uterus affects their chances of survival more than their birth weight.

In 2000, Bell started a Tiniest Babies Registry when he realized he didn’t have good answers for parents’ questions about these babies who were born very premature.

Although information remains scarce, the registry has more than 100 babies who have survived weighing less than 14 ounces at birth.

“Most of them are doing pretty well,” Bell tells WebMD.

But this case report is not the norm, says Leslie Kerzner, MD, a neonatologist at MassGeneral Hospital for Children in Boston. “[Rumaisa and Madeline] are two remarkable, isolated cases of survival of very low-birth-weight babies.”

It’s much more common for babies of this size to not survive or to have medical problems. “While these two girls may be the lucky ones, so many more suffer from hearing loss, vision, and movement problems, and [mental] delays,” Kerzner tells WebMD.

She says we still don’t know the long-term effects of the preemies’ long hospital stays. Nor do we know how much the babies’ discomfort and pain from their early-in-life medical care affects them later on.

Also, Kerzner says the report was not clear about how much special education or tutoring the girls need in school.



Raw Cookie Dough Ready to Bake, Not Ready to Eat


2009 E. Coli Outbreak Serves as a Reminder of Risks of Eating Raw Cookie Dough


break and bake cookies

Raw cookie dough, whether it’s homemade or store-bought, should be destined for your oven, not your mouth.

That’s one of the CDC’s top lessons from the 2009 E. coli  O157:H7 outbreak in refrigerated Nestle Toll House cookie dough products.

During the outbreak, 77 people in 30 states became ill after eating the dough before baking it. Of these, 35 people were hospitalized. The outbreak prompted a recall of 3.6 million packages of cookie dough and some changes in the way that Nestle and other companies manufacture their cookie dough.

That was the first time an E. coli outbreak was traced to ready-to-bake commercial prepackaged cookie dough. The details of the outbreak and the steps taken to control it appear in the journal Clinical Infectious Diseases.

How the Cookie Crumbles

The issue is much larger than one brand, says the CDC’s Karen Neil, MD, MSPH. “You shouldn’t eat raw cookie dough, regardless of who makes it,” she says.

The same goes for any product that is supposed to be cooked or baked, including cake and biscuit batter. “Raw cookie dough is not ready to eat, it is ready to bake,” Neil says.

Other cookie dough products, such as cookie dough-flavored ice cream and cookie dough bites, are likely treated in a way that makes them safe to eat, Neil says.

As part of their investigation into the 2009 E. coli outbreak, researchers searched for the source of the contamination but were unable to pinpoint the culprit.

“We do think that one of the more likely ways is through a contaminated ingredient,” Neil says. “We suspect flour, because flour doesn’t go through specific processes to kill pathogens.”

That has changed at Nestle and some other companies.

The days, weeks, and months after the outbreak were “very intense,” says Nestle spokeswoman Roz O’Hearn. “We worked very closely with the CDC and FDA. We made a responsive decision to switch to heat-treated flour in January 2010, and continue it use it.” Several other cookie dough makers have told the FDA that they have also switched to heat-treated flour.

In the past, raw eggs have caused many salmonella outbreaks linked to cookie dough. But in the 2009 cookie outbreak, the culprit “wasn’t salmonella, it was E. coli,” Neil says. Previous E. coli-related food-borne illnesses have been linked to ground beef, leafy green vegetables, sprouts, melons, salami, and unpasteurized apple cider.

Symptoms of E.coli  O157:H7 infection include:

  • Bloody diarrhea
  • Stomach cramps
  • Nausea and vomiting

Most people recover within a week. Severe complications are more likely in young children and older adults.

“As tempting as it is to sample cookie dough, do not veer from the recommendations on the package,” says David Hirschwerk, MD, an infectious disease doctor at North Shore University Long Island Jewish Hospital in Manhasset, N.Y. “If the package says you should cook it, then you should cook it.”


Most Contact Lens Wearers Don’t Follow Safety Steps

Study: Less Than 1% Fully Compliant With Recommended Care
woman inserting contact lens

Most people who wear contact lenses say they know about the wear and care recommendations, but almost none actually comply with them, a new study shows.

More than 80% of contact lens wearers surveyed prior to an eye exam believed they followed good lens wear and care practices, but just 2% actually complied with most recommended lens hygiene steps.

And less than 1% were found to be fully compliant with recommendations such as washing their hands before handling lenses, using fresh lens solution every time instead of topping off old solution, and replacing lens cases frequently.

Contact Lens Awareness

The new survey included patients undergoing eye exams in private practice or university-affiliated optometry settings.

Overall, 85% of the patients perceived themselves as compliant with all lens-wearing practices, but only 0.4% was considered fully compliant.

The study also showed that while most of the contact wearers knew what they needed to do to avoid complications, few actually followed all the recommendations. The researchers concluded that patient awareness was not the problem.

The most frequent complications reported by the surveyed contact lens wearers were discomfort (72%) and infection (47%).

In their analysis published in the December issue of the journal Optometry and Vision Science, researchers Danielle M. Robertson, OD, PhD, and H. Dwight Cavanagh, MD, PhD, of the University of Texas Southwestern Medical Center called for new strategies to improve compliance with safe contact lens use.

Dos and Don’ts of Contact Lens Wear

American Optometric Association (AOA) spokesman Randall Fuerst, OD, says one of the most common causes of contact lens-related complications is failure to replace contacts as recommended.

“This is particularly common with lenses approved for two-week use,” he tells WebMD. “People often use them for three weeks or even a month, which can cause problems.”

When wearers use lenses longer than recommended or don’t follow proper handling and storage practices, there is a greater likelihood of deposit buildup that can lead to chronic eye redness or infection.

Wash Hands, Replace Case, Don’t Top Off

Among the other AOA recommendations:

  • Always wash and dry your hands before handling contact lenses.
  • Clean lenses often, as recommended by your eye doctor. Rub the lenses with your fingers and rinse thoroughly before soaking lenses overnight in sufficient multi-purpose solution to completely cover the lenses.
  • Use only fresh solution every time to clean and store contacts. Never top off old solution with new because the active ingredient in some solutions can break down over time. This is also why contact lens solutions should never be used after the discard date on the bottle has passed.
  • Never use tap water in any area of lens care, including rinsing the lens and lens case. Tap water may contain microorganisms that can cause eye infection.
  • Store lenses in the proper lens storage case and replace your case at least every three months. Clean the case after each use and keep it open and dry between cleaning.
  • Never swim in lenses or wear them in a hot tub.

Extended Wearers Need to ‘Listen to Their Eyes’

Fuerst also recommends that people who choose to sleep in their contact lenses use a wetting drop made for contact wearers before going to bed at night and upon waking in the morning.

Most lenses sold today are approved for a seven-day continuous use, but some newer lenses have been approved for 30-day use.

Fuerst says people who do not take their contacts out for extended periods need to be especially vigilant about “listening to their eyes.”

“If your eyes are feeling gritty, sandy, or irritated, or if they are more red than normal, take your contacts out and don’t wear them when you sleep for a while,” he says.