'I am taking Refampin as part of a treatment for 9 months.  I am also
scheduled for cataract surgery.  I am close to the point that without
this surgery I will not be able to drvie.  I still work.  The doctor
prescribing the Refampin says that it turns a contact lens red.  He is
concerned that is may turn the oclular (?) lens implanted during
cataract surgery red, too.  I have asked three doctors.  They have all
given me their best guess, and then suggest that I ask someone else. 
Do you have a definitive answer for this?'

cjcj-
Pharmacy has always been of great interest to me, so I found this
question intriguing. Never before had I heard of this particular
effect of Rifampin! Rifampin, as you know, is a powerful
antimycobacterial and antibiotic, commonly prescribed for tuberculosis
or haemophilus influenzae infections.

Your question does cause me to ask my own questions however. Is it
possible for the doctor to delay the lens implant surgery until your 9
month course of Rifampin is finished? How long have you already been
taking Rifampin?

Even though you have already asked three doctors about the potential
effect of Rifampin on the intraocular lens implant, have you asked the
ophthalmologist who will be performing the surgery? A family practice
doctor or an optometrist may not be familiar with intraocular
implants. It is possible that the brand of lens may have some bearing
on the answer, as some materials may be more prone to absorbing the
Rifampin color than others.Today’s implants are made of 
polymethylmethacrylate (PMMA), silicone, or acrylic but I have found
no information specifically about these materials  and Rifampin color
uptake. If your ophthalmologist does not know for sure, surely she/he
could contact the lens manufacturer. The manufacturer of the lens
should be able supply this information. Near the end of this answer, I
have included contact information for one of the larger inplant lens
manufacturers.

Did you know that each year, over 1.4 million people in the US have
intraocular lenses implanted?
http://insight.med.utah.edu/patient_care/ophthalmic_pathology/intermountain_ocular_research.htm

And that 20.5 million Americans over 40 will have cataracts?
http://www.lighthouse.org/vision_impairment_causes.htm#cat

Some good information about cataract surgery:
http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZSOONFSWC&sub_cat=119

And
http://www.pendletoneye.com/howiscat.htm


About the intraocular lens implants themselves: the answers I have
found online are varied…some sites claim Rifampin “MAY” discolor
lenses, other sites are more definitive.

I have found that Rifampin does indeed discolor soft contact lens. Do
you use soft lenses now, or are you worried about the lens implant
only?

Visit this site, and look in the left hand column, under “Comments”
http://www.medsch.wisc.edu/cgi-clinsci/amcg.pl?drug=Rifampin

Here also:
http://www.hopkins-aids.edu/publications/book/ch6_rifampin.html


This site briefly mentions that Rifampin “may” discolor lens implants
http://www.childrensvaccine.org/files/Pink_Book_hib.pdf

(Scroll down to the bottom of 116 and the top of 117). This is in PDF
format, and you may need Adobe Acrobat reader, if you don’t have it
installed. If you need to download it, it can be downloaded for free
at this site : http://www.adobe.com/products/acrobat/
 
This site states that Rifampin will NOT discolor hard contact lenses,
and that the reddish-orange discoloration of soft lenses will fade
upon discontinuing the medication. (Scroll down to “Precautions”)
http://www.nlm.nih.gov/medlineplus/druginfo/rifampinsystemic202511.html

This site from the Oklahoma Health Department says the discoloration
of soft lenses ‘MAY” occur, but is not harmful.
http://www.cchdoc.com/Epi%20Fact%20Sheets/Rifampin%20Prophylaxis%20Fact%20Sheet.pdf

Another  “may discolor” site: (Near the bottom of the page—look for
Rifampin in the right hand column)
http://www.crha-health.ab.ca/clin/sac/sideeffe.htm

A “Will discolor” site: (Under “Antimycobacterials”)
http://medix.marshall.edu/~lewis42/word%20antimicrobials.rtf

A “Will discolor” site:
http://www.metrokc.gov/health/prevcont/rifampin.htm

This site is a “Will discolor” site, in Spanish. I can tell you it
states that Rifampin “Will permanently discolor” lenses.I have
included it simply as an added reference.
http://www.gmhc.org/espanol/tb_esp.html

A “May discolor” “May be permanent” site:
http://my.webmd.com/content/article/4046.2159#sideeffects


This site, from the National Eye Institute offers some tips on talking
to your eye doctor about eye surgery:
http://www.nei.nih.gov/health/talktodoc.htm

Here, a major manufacturer of intraocular lens implants:
I have dropped them an e-mail asking your specific question, and will
post it if and when I get a response.
http://www.mdriol.com/
EyeKon Medical 
2451 Enterprise Road 
Clearwater, FL 33763
Main Number: 727-793-0170 
Main Fax: 727-799-2212 
Customer Service: 800-633-9248 
Customer Service Fax: 800-275-2694 

Beware: Rifampin can decrease the efficacy of both birth control pills
AND Viagra!
http://www.metrokc.gov/health/prevcont/rifampin.htm

If this has not adequately answered your question, please ask for an
answer clarification.

Wishing you the best with your eye surgery!
-crabcakes-ga

---

Request for Answer Clarification by cjcj-ga on 22 Aug 2002 05:59 PDT

This is really not a clarification, but rather some comments.  I
appreciate your research but am still left in the dark.  To answer
some of your comments:
Yes, I could postpone the surgery, as long as it doesn't bother me to
start begging whoever I can find to drive me 75 miles to work each
day. As I stated in my original original question without the surgery
I will very shortly not be able to drive.  Without the Rifampin I will
not be allowed to work.
I have asked my opthamologist...she's not concerned, it's not her eye.
 She just wants to do the surgery.  I'm sure you think with that
response I should try another doctor.  True.  But she has an excellent
reputation for performing this surgery, and where I live you can't say
that about many other doctors.
My next move WAS to contact the lens manufacturer, which I will now
do.  I thought contacting Google research might be easlier and save me
time.  That's why I was willing to pay.
I will read all your links when I come home from work tonite.   Thank
You.

---

Clarification of Answer by crabcakes-ga on 22 Aug 2002 07:49 PDT

cjcj-
Thank you for answering the clarification. I am glad you have a
surgeon with a good reputation! At times I have had what seemd to be
an uncaring or even gruff doctor myself.Before changing doctors, I did
what you are doing....weighing the important aspects (surgical skills
and expertise) versus a pleasant personality. Of course, I chose the
skills and remained with the crabby doctor. (I still think medical
personnel should practice good manners) I do aim to answer your
question to your satisfaction. When I asked if you had asked your
<surgeon>, not the <optometrist> it was because generalists may not ne
familiar with the manufacturers, as an ophthomologist would be. Since
you state you did ask an ophthomologist, she should have had the
information easily available, even if she is unconcered over your fear
of discoloring your lens. I do not want you to delay your surgery, but
 asked how long you had taken the Rifampin already for this reason: to
see if perhaps you were close to the end of the drug regimen. I was
thinking it MAY be in your best interest to wait a short time, if you
were nearly finished the course of Rifampin.
As I indicated in my answer, I fired off an e-mail to A lens
manufacturer while I was in the midst of answering your question. As
of now, I have had no response. As I answered your question around 10
PM (My time), I would not expect an answer untill today (If they DO
answer).  Again, there is more than one kind of lens implant, more
than one manufacturer, and at least three types of materials from
which they are made. The definitive answer will depend on knowing the
exact model, the exact manufacturer, and the exact material used to
make the lens. I am more than happy to call the manufacturer myself,
but I don't know which manufaturer, lens, or material of lens your
surgeon is planning to utilize for you. IF you could supply me with
the information, I would be glad to call them myself.

When I started working on your question, I myself was unaware that the
information would be so vague. I tried to come up with an analogy to
explain not only MY answer, but why I could find no precise answer
online. Suppose I asked "Will food stain an article of clothing ?".
Well, immediately one thinks, yes, some food stains clothing. Tomato
sauce will definitely stain a white cotton blouse. Milk will not stain
the same white cotton blouse, but will stain a navy blue silk blose.
Bacon grease will stain polyester jogging shorts, yet bacon grease
will wipe off and not stain my plastic coated rain parka. Therefore,
Rifampin COULD stain a lens made of silicone, but perhaps it may not
stain an acrylic one.

I will search further today, and will post the response from the lens
manufacturer upon arrival in my mailbox!

Thank you,
-crabcakes

---

Request for Answer Clarification by cjcj-ga on 22 Aug 2002 17:56 PDT

Grabcakes...your answers do remain vague but I can tell you have done
a great deal of research on my part.  Before I used Google research of
course I tried to do this myself.  You have provided me with links
that I never found.  I thank you. I just started Rifampin and knew
before I started it that I was scheduled for cataract surgery.  The
rifampin prescribing doctor is the one who brought this possibily to
my attention and told me to check it out.  The rifampin is not
optional for me, there is legality issue involved.  I am a teacher,
had TB, fortunately am no longer active, but to assured the health
department that I would never become active again, and hence very
possibly contagious, I need rifampin and one other drug for 9 months
(approximately).
I will certainly take you up on your offer and try to provide you with
manufacturer, model, and material.  But I am sure it will be next week
before I am able to get any of this information to you.  I assume you
are researching numerous other cases and will allow the wait.  Hope
I'm right.  I loved how the manufacturing rep that you communicated
with used words such as maybe, possibly, I think so, I don't think so.
 The truth is that there has possibly been so little research done in
this area that noone knows.  Just think about it.  How many people
that have had TB even have insurance to be able to afford cataract
surgery?  Thanks again, Carbcakes, for your time. Connie

---

Clarification of Answer by crabcakes-ga on 23 Aug 2002 10:16 PDT

cjcj-
Silly me...I posted my clarification under comments. Please see the
comments. I am still waiting for THE phone call. If I don't hear soon,
I will call them again. (I don't want to pester the good man, as he
sounded so earnest, and is doing research for us).
Later, crabcakes

---

Clarification of Answer by crabcakes-ga on 26 Aug 2002 09:19 PDT

cjcj- 

I finally have a very informative and interesting 2 part answer!

1) Sam, the production manager at EyeKon called me this morning, with
a more definitive answer! He said he did quite a bit of research, and
spoke to several other people in the industry. The consensus amongt
Sam and his colleagues is that rifampin will NOT stain the hard PMMA
lenses, as they are hydrophobic. (hydro = water, phobic = repels, fear
of ---therefore hydrophobic lenses repel water). By the way, Sam says
he did e-mail me over the weekend, and even though I did not receive
the mail, I feel sure he sent it, somewhere! Actually, Sam sounds like
a dedicated EyeKon employee with a strong work ethic, and a wonderful
soft, smooth Southern accent. He did his homework! He did tell me no
one he has spoken with has ever heard of any reaction between rifampin
and lenses.

2)Sam did give me an excellent lead as well this morning. He suggested
I call Alcon, a much larger lens manufacturer.

http://www.alconlabs.com/us/aj/
1 (800) 757-9195 


Everyone at Alcon was extremely courteous, even the receptionist who
asked me if Alcon made rifampin! I was connected to several very
helpful people who all gave me bits and pieces to this puzzle. Rafael
in surgical products connected me to Jennifer, who connected me to
Terry who gave us the most scientific answer! Drum roll.....on to THE
ANSWER:

Terry said that rifampin will NOT stain any intraocular lenses as they
are located in a part of the eye that is not affected by bodily
fluids. Inside your eye, under the cornea, of which there are several
layers, is your iris. Below that is a sort of empty space, and then a
capsular bag. This "bag" is a membranous clear sac, which contains
your lens. When the intraocular lens is inserted, this sac is cut to
allow removal of your old lens, and insertion of the intraocular lens.
The small cut then heals, and seals. No bodily fluids such as tears
even enter the sac with the lens. Since no fluids enter, there is no
chance of rifampin-containing tears staining the lens. The protective
barrier of the capsular bag protects the lens!

I am pleased to finally give you the complete answer! Good luck with
the surgery...when my mother had the same surgery, she was able to
quit wearing her glasses altogether! Made ME want to get intraocular
implants as well! I am hoping all goes well for you and that you enjoy
your improved vision! Please wear sunglasses at all times when
outdoors!

While I was looking up Alcon's number, I came across this interesting
little article on the history of cataract surgery, which may interest
you!
http://www.alconlabs.com/us/eo/surgery/b4_cat_surgery/b41_historyofcataract.jhtml


-crabcakes

---

Clarification of Answer by crabcakes-ga on 26 Aug 2002 11:45 PDT

cjcj-
I wanted to let you know...don't be concerned with anyone thinking you
are silly. We all make typographical errors when typing online,
especially myself! You were obviously concerned with your impending
surgery and your health.

I have written to Google and asked them to remove the comments where
you mention information of a somehwat personal nature. To me, it does
not appear to be too revealing, but if Google can remove it, it may
worry you less.

I did not know Johnny Carson was from your area. My husband had an
aunt there once, and currently has a sister, and several nieces and
nephews in the horse business in your area. I've been there once, but
saw relatively little of the area, as it was a family affair.

Again, I wish you the best in seeking a cure for your vision problems.

-crabcakes

Great researcher.  Provided huge amounts of info. Cares more than my doctor!!!!

cjcj- 
I just spoke to a production manager at EyeCon Medical, in Clearwater,
Florida, who told me he had never heard of Rifampin interaction with
lens implants. When I described your question, he also guessed that
the silicone and acrylic lenses would be more prone to absorbing
stain. HE also guessed the PMMA lenses MIGHT be more resistant to
stain. He said he would research the question and get back to me
within a day or two.
Meanwhile, my search continues to return vague, non-precise
information.

This site gives a modicum of information, saying silicone lenses are
prone to staining (in general)
http://www.med.unibo.it/reparti_servizi/oculistica/icbo/abs/galand.htm

This site describes  some of the materials used in lens manufacturer,
but avoids mentioning lens discoloration.
http://www2.borism.net/~akight/iol_project/lens_materials.html

From all I have read (and now heard) on the topic, I am going to
venture a  non-precise guess:  Rifampin will stain ANY lens. All the
lenses are described as being either very soft + foldable  and/or
containing a large amount of water. One could easily conclude that
soft, aquaeous material would retain stain, as in Rifampin
discoloration.

As soon as I hear from EyeKon Medical, I will give you the
information.
-crabcakes

cjcj,
Thanks for your comments. It is nice to know more about your
situation. I feel sorry for your troubles.Are you in the US? I am no
expert in TB or it's treatment, but I find it strange that you need to
take Rifampin since you don't have an active case of TB. After having
worked in hospitals for over 25 years, I test positive for TB as
well.(I also got Hepatitis B from a dirty needlestick!) In fact, I am
no longer required to be TB tested, as furthur testing could feasably
activate a dormant microbe! I was only required to have  chest x-ray.
End of story.

The question you pose is very interesting thought, and I have never
heard of it before. I have yet to hear from the lens manufacturer,
though when I got home from work tonight, there were two calls on my
caller ID from Florida. The caller left no message however. Perhaps
tomorrow.

If I hear from EyeKon tomorrow, I will post, post haste!
-crabcakes

cjcj-I wanted to let you know that no one from EyeKon Medical ever
returned my call today, not have they answered my e-mail from two and
a half days ago. When I got home from work, it was too late for me to
call them, as there is a three hour time difference. For what it's
worth, I sent them another e-mail, asking about the lenses, again, and
letting them know that no one returned my call. Please give me untill
Monday afternoon to see if I can get a response. I intend to do all I
can to get the answer to your question, and will get back to you.
Thanks for your patience,
crabcakes

Carbcakes, as you can tell, I'm not very bright.  It wasn't until this
moment that I realized that this is public knowledge to all.  I hope
noone in Bakersfield decides to read this.  If they were truly curious
they could easily trace this to who I am.  That's life. I like the
idea that I learn at least one new thing each day.   cjcj

Crabcakes...if you haven't noticed, please note that I have posted a
comment as a request for clarification (to make up for what you did)
and two more comments. Until you said it I didn't even notice there
were two different areas.  Mid Monday is very reasonable to me.  Not
that I want to break your enthusiasm for my question, but I would be
thrilled with Wednesday.  It will likely be at least then before I get
the info to you that I promised.  So call us even. Everyone is always
concerned most about their own little world.  Maybe we don't like
that, but that is reality.   cjcj

Ok, Carbcakes, we'll do trite things first.  I didn't mean to infer
that Johnny Carson was from here.  I doubt he ever stepped foot on our
soil.  You're too young to remember, but on his late nite show he used
to badmouth Bakersfield.  Prior to that most people never heard of the
place.
I hope your horse friends are not named Hagen, that would be too
coincidential.
I have been told that I will always need to wear glasses, but quite
frankly, if I can ever see again near 20/20 wearing glasses won't even
be an issue for me.  I have worn them for so long I would probably
feel naked without them.
If Google doesn't remove the personal stuff don't be concerned.  I
spend my life on the paranoid side, I know it, and it's really no big
deal. I actually don't card who knows, it's my doctor and the health
dept saying that if my school knows they'll become hysterical.  I
actually don't like keeping silent or secret about things so I would
really feel more comfortable if I could tell anybody that I work with.
So I've been advised to keep quiet.
I have always worn sunglasses and will continue to do so.  But I have
been told if I had worn them even more I may have never had this
problem.  Who knows? I'll be posting one more comment right after this
that will be of a more serious nature.

OK, Crabcakes, now for the serious stuff.  I think I should pay you my
surgeons salary and give my surgeon the 20 bucks.  You've put in a
great deal more effort on this.  In addition, you've never met me and
show a great deal more interest in my issue than my surgeon does. 
Your comments from EyeKon and Alcon were definitely most
interesting...and encouraging.  However, I do not know if I am having
a PMMA lens.  And it appears from what Alcon says it really does not
matter.
My surgeon has said...thru a source...she does not choose to waste her
time talking to me (I know, I should look for another surgeon) that
she maybe, probably, might possibly order a lens from Allergan
Surgical, AR -40, Sensar.
The Allergan website was of little value to me.  But your great Google
search engine led me to Advanced Medical Optics, AMD, an Allergan
spinoff.  And that led me to a Sensarlens site.  I don't have a clue
what the AR -40 means, and since I haven't read all the material on
Sensarlens to know what kind of material this lens is.  Anyway, I
dropped them a brief (ha) e-mail and we'll see if they respond.  I'll
let you know either way.
By the way, I printed off all your links this weekend, it's the size
of a book.  I'll have to postpone my impending surgery if I expect to
read all of this material prior to my surgery.
Once again, I'm extremely pleased with your efforts on my behalf.  You
have to be a really nice, decent, kind person.
Now the big question...down the road I have another question I'd like
researched...not as important to me but of interest to me.  I have
found little information myself on-line on this particular topic. 
Could I request you?  Or maybe your tired of going broke on this case.
   cjcj

cjcj-
Thanks for your kind remarks. I hope you get a response from the other
places you have contacted. My experience is that an e-mail response
from most companies/businesses is a rare thing. I like to do plenty of
research in anticipation of a purchase, be it a product, a trip, or a
surgical procedure. The fact that you are doing yours will be of great
benefit. Knowledge is power! My husband had cancer surgery 2 years
ago. About a year later, his surgeon wanted to do more restorative
surgery, which my husband also wanted. Ourinsurance company denied it.
I spent about two weeks researching it online, typed it all up and
presented it to the insurance company. My husband got the operation!
Knowing all you can about your surgery can only lessen your
apprehensions, and improve your success! By the way, if you are happy
with your answer, would you consider giving it a rating? (Even if you
are unhappy with your answer, you can rate it!)
I have seen people request certain researchers before,it is allowed,
and I'd feel honored to research your next question. I want to say
however, there are numerous excellent researchers here!
-Thank you, crabcakes

PS- Did you notice that Google did indeed remove the information you
posted which you later felt too personal to be seen by the public?

Carbcakes...nothing noteworthy today. As you said, I have not yet
received a rapid e-mail response from that last company.  If I don't,
I will beg you to try.  Yes, I did notice that Google removed my
personal response.
I feel very sorry to hear that your husband has had to suffer thru
cancer surgery, and the following aggravations.  At least he is
blessed to have you on his side, and help him follow thru and take
care of these issues. I lost a dear friend to cancer about 12 years
ago.  She worked at and had her surgery done at on of the best known
university/hospital facilities in our country. Her boss, who was a
doctor in a different area, hooked her up with one of the most highly
regarded specialists for her particular case.  She also had ready
access to some of the best research facilities in the country.  She
had so much confidence in her doctor she did absolutely no research. 
Three weeks before she died she told me that if she had done just a
minimal amount of her own research, she would have found that almost
every other well known specialist in our country disagreed with her
doctor on just this one particular area.  If she had known this
sooner, against her doctor's advice, she would have insisted on one
additional treatment that would have likely saved her life.  Your
husband will never have to be concerned about a lack of research in
his household.  Happy researching.  cjcj

cjcj-I forgot to answer...the name of the horse people yo mentioned
are unknown to me!

Good luck with your surgery! I will be hoping for an excellent
outcome!
-crabcakes

Hi Crabcakes...will not bore you with more details.  Just to say, as
you thought the lens manufacturer never responded...still wonder why
they provide an e-mail link.  My opthamologist couldn't be less
concerned than she is.  The optometrist in her office called me, I
have been seeing him for 23 years, and he actually is a partner/owner
of the office where the opthamologist works.  I know, that sounds
backwards.  He said he would pursue the issue and investigate with the
lens manufacturer...turns out there are two. He has never called back.
 Today I had my required pre-op surgery physical with my GP...he said
if it was his surgery he would forget it.  If nobody is answering
these questions it's obvious.  These people really do not care...or
the manufacturer really does not know.  Either situation is not good. 
So my GP called yet another opthomologist, who even though he was in
the middle of surgery, returned his call in ten minutes.  He likes all
the referrals my GP sends his way.  This opthomologist didn't think
there would be a problem, but readily admitted that he had never had
the question posed to him, nor had he read of it in any literature. 
He said he'd get back to my GP in two days.  And so it goes.  I told
my GP that my Google researcher, namely you, who has never met me, has
provided me with immensely more information and is more concerned with
my eye than anyone else in the picture.  I told him that I had said
that you should get the surgeon's salary, and the surgeon should get
the 20 bucks.  He thought that was a good idea.   cjcj

cjcj- You are finally going to have the surgery! I wish you all the
best, with the operation, and the Rifampin regimen. Thank you as well
for the 5 stars-we do love those stars!  Being cataract-free and
having vison restored will be a blessing for you! This Arizona
crabcakes will be thinking of my California neighbor!
-Best wishes, crabcakes