Refractive Surgery Alliance (RSA) Expresses Concerns about Details in CDC Report

by Lance Kugler, MD

2629e05aa7fe157288a773dcb6c1dce3The Refractive Surgery Alliance (RSA), a professional organization of surgeons who perform operations such as LASIK, has taken the unusual step of formally demanding that the Centers for Disease Control (CDC) retract a November 2014 report that linked nearly 1 million office visits each year to poor contact lens care.

The CDC report, titled “Estimated Burden of Keratitis—United States, 2010,” was published in Morbidity and Mortality Weekly Report (Vol. 63, No. 45, pp 1027-39) and was based on an analysis of billing data. The RSA formal demand letter to the CDC dated November 25, 2014 was addressed to the lead author, Sarah A. Collier, MPH, and states that the CDC report “has created the mistaken impression among the media and among many in the public that the cost for reimbursed medical care extending from contact lens misuse approaches $180 million” and 1 million clinical visits per year. “The data do not justify that claim.”

The RSA letter lists seven objections to the CDC’s interpretation of the billing data. A key objection – only 25.2% of the 1 million clinical visits cited list the contact lens billing code as the reason for the visit. The other clinical visits were for corneal complaints grouped under the general term “keratitis.”

“The CDC reported the direct cost of clinical visits for various forms of keratitis for 2010,” said Lance Kugler, MD, President of the RSA and CEO of Kugler Vision in Omaha, Neb., one of the physicians who wrote the letter, “and used the opportunity to highlight the need for proper contact lens use. Roughly 75% of the clinical visits studied were not attributed to contact lens use by the health care provider.” The Discussion section of the CDC report leads with these two statements: “Nearly 1 million clinical visits for keratitis occur annually. The largest single risk factor for microbial keratitis is contact lens wear.” The latter statement is supported by an obscure study of 91 patients dating back to 1991.

“Opening the Discussion with these comments makes the reader think that the 1 million clinical visits for keratitis in 2010 resulted from contact lens infections,” said Guy M. Kezirian, MD, FACS, Founder of the RSA. “Clearly the Washington Post, Fox News, NBC News, Web MD and literally dozens of other media outlets read it that way. This report should be retracted. It has created a false understanding of the risks of contact lenses.” Greg Parkhurst, MD, FACS, an RSA surgeon in San Antonio, Texas and co-signer on the RSA letter, explained why the RSA is troubled by the CDC report. “Contact lenses provide an important solution to patients who want to be glasses-free, especially for active younger patients who are not yet able to have LASIK. Contacts are a valuable visual aid. We should have the facts before we assume they are causing a million patient visits per year.”

RSA surgeon Sheri Rowen, MD, Medical Director of the Rowen Vision Center in Baltimore and former Ophthalmology Clinical Instructor at the Johns Hopkins Hospital in Baltimore, believes that while some contact lens wearers have become cavalier about the potential risks of contact lenses, “It is a lost opportunity that the CDC report was not done better, because the message about proper lens use is important,” said Dr. Rowen. “I generally avoid the issue of handling and care by recommending disposable daily lenses. I don’t recommend extended wear lenses at all.”

“It almost seems that the CDC report was designed to justify a solution before they defined the problem. All they accomplished was to show how billing data can be misinterpreted and misused by government bureaucracy,” says Dr. Parkhurst, who is also a former Army surgeon.

““We hope the CDC will respond to our letter and correct the mistaken public perception their report generated about contact lens risks. Of course, the RSA supports the CDC’s recommendations for common sense precautions that all contact lens users should follow,” says Dr. Kugler. “We want the information to be accurate. When eyes reach maturity they can be corrected with refractive surgery such as LASIK, which permanently corrects vision so contacts or glasses are not needed. So if you use contact lenses while you are waiting to have your eyes fixed, please use them safely.”

About the Refractive Surgery Alliance

The Refractive Surgery Alliance (RSA) is a professional organization of leading refractive surgeons from the U.S. and Europe. The mission of the RSA is to increase access to refractive surgery through education, research and industry leadership. It is member supported and does not accept industry or corporate funds. Membership is open to all qualified refractive surgeons. For more information, please visit


kugler vision doctor lance kugler

Lance Kugler, MD, is a specialist in LASIK and vision correction surgery and CEO of Kugler Vision. A proud Omaha native, he is passionate about improving lives through clear vision. Dr. Kugler serves on several national boards, and his practice is recognized internationally as a center of excellence. Dr. Kugler is one of the original founders of the Refractive Surgery Alliance, an international organization comprised of over 350 of the world’s leading vision correction surgeons; he also served as its first president. In 2019, Dr. Kugler was selected as a TEDx speaker, and delivered a talk in Omaha about the worldwide epidemic of nearsightedness and refractive solutions. Dr. Kugler is an Associate Professor of Refractive Surgery at the University of Nebraska Medical Center’s Truhlsen Eye Institute, has been published in many medical journals, and participates in numerous clinical studies to advance the field of vision correction surgery. Dr. Kugler and his wife are proud parents to five active kids. When he has a spare moment, he enjoys skiing, tennis, travel, and fine coffee.

Share This Article

Leave a Reply

Your email address will not be published. Required fields are marked *