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Researchers have found in a new study that elevated superficial punctate keratitis (SPK) is often the earliest sign of Acanthamoeba keratitis (AK) and can resemble contact lens-related sterile keratitis. The study, published in the Journal of Optometry, analyzed 14 eyes from 13 AK patients diagnosed via detection of Acanthamoeba cysts in corneal scrapings. Corneal scraping proved to be a valuable tool for early diagnosis, enabling timely initiation of treatment and improving patient outcomes. Early recognition is particularly important because misdiagnosis or delayed intervention can worsen the disease and increase the need for surgical management.The study showed that PHMB (polyhexamethylene biguanide) monotherapy was effective in treating early-stage AK, resulting in significant improvement in visual acuity and resolution of infection. Delayed diagnosis or prior use of steroids was associated with disease progression, including one case requiring therapeutic keratoplasty. Patients commonly presented with SPK, dot infiltrates, radial perineuritis, pseudodendrites, stromal edema, and ring infiltrates, with SPK being the most frequent early sign. These findings highlight the importance of distinguishing AK from other contact lens-related corneal conditions to ensure rapid and appropriate treatment.In conclusion, the study emphasizes that early detection and targeted management of AK are critical for preserving vision and preventing complications. Corneal scraping allows ophthalmologists to confirm diagnosis at an earlier stage, facilitating timely initiation of PHMB therapy and reducing the likelihood of surgical intervention. The research underlines the need for clinicians and contact lens users to be aware of subtle early signs such as SPK. By integrating early diagnostic techniques with prompt treatment, outcomes for patients with this sight-threatening infection can be significantly improved.Keywords: Acanthamoeba keratitis, SPK, corneal scraping, PHMB, early diagnosis, contact lens, visual outcomes, Journal of Optometry, ChangReferenceChang, W.-H., Kuo, Y.-W., & Hou, Y.-C. (2025). Optimizing early diagnosis and treatment of acanthamoeba keratitis through corneal scraping. Journal of Optometry, 100566. https://doi.org/10.1016/j.optom.2025.100566
