The Times They Are A-Changin?.
So said Bob Dylan in the late sixties.
I was lucky enough to hear him tell us the same again, some three decades later, in a rare concert on Auckland?s North Shore. At least the somewhat dishevelled and ageing Bob can be sure that those words will always be pertinent, as one thing you can always be sure of - everything changes.
This is especially relevant to the disposable lens market, as recently we've had a number of changes here in New Zealand. Firstly the Aspect Frequency 55 lens is now no longer available through Hirstlens, but directly from Aspect Australia. There have also been a number of people asking questions as to how the OSI based Provue lens can be listed as non-ionic when the Aspect based Frequency 55 is listed as ionic? While both local supplier?s ?fact sheets? listed the lenses as ?ocufilcon D? material, the Provue lens was listed as ?non-ionic? while the F55 was listed as ionic. ?Impossible?, we said, ocufilcon D is a group 4 lens and therefore ionic. No way could the same polymer be ionic in one lens and non-ionic in another!
Finally I enlisted the help of Paul Rose who checked back with the UK manufacturer [Optical Sciences, Inc.] who confirmed that the lens was indeed derived from ionic Ocufilcon D!. Apparently a ?gremlin? had slipped into the fact sheet. Problem solved.
Although the Provue and F55 are made from the same material, and similar manufacturing technology they are not identical lenses. Case closed.
The OSI lens is however cropping up around the world in different guises and under different brand names. One of these versions is now also being locally marketed, and no doubt with parallel importing we will soon be faced with even more brand names and more confusion.
Even more interesting is the fact that the F55 lens is marketed locally as an 8.6/14.2 while the lens is marketed as an 8.7/14.2 on the US market! Is it the same lens repackaged? Does the US market have a special base curve manufactured for that market?
I?ll keep you posted if I ever get to the bottom of it.
Hirstlens have just lined up the Encore range of disposable lenses, through a local marketing agreement with the Australian based Capricornia group. John Shennan is pleased as the people at Capricornia are in his words ?real contact lens people? with a well established reputation in the custom making of soft and RGP lenses. Initially Hirstlens will be supplying the Encore disposable - a non-ionic, moulded, mid water lens - in both spherical and toric options, with a wide range of parameters and competitive pricing. It's certainly useful to have another toric disposable choice.
I'm also informed that B&L will soon be will be launching their Soflens One Day disposable on the NZ market. It's an 8.6/14.2/73% water, cast moulded lens. Sounds pretty good, but relatively thick at 0.14mm @ -3.00D. Let?s see how it works and what impact it has on pricing. It's arriving a lot earlier than expected and it would be nice if the other one day lens and the eagerly awaited multifocal disposables and silicone hydrogels also arrived soon.
Whew! How many different disposable fitting sets and stocking systems do you plan to have? Do you have the space for all of them? we're already wall to wall with lenses in our lab, and managing all the options is already a headache. Sooner or later the market is going to be saturated and suppliers will start finding a reluctance from practitioners who will really want to know the ?value added? reasons for yet another option - apart from pricing that is.
don't get me wrong, the more options the better - from both a ?fitters? and a wearers point of view - as each lens has its pro?s and con?s. Additionally if we're to believe all the proactive, paradigm shifting, MBA, ?consumer is king? types [and assorted politicians], then competition is good for pricing??
All the more reason to get behind fee based practice!
New Toric Options.
As briefly mentioned last month I had some news on some new soft toric options.
I can now report on one option that I've been trialing - through the development stages over the past few months - with some promising results. The lens, CLC?s Benz G 5x toric has been helping me solve some fairly tricky fittings.
In the March ?98 - In Contact, I mentioned a case of a HEMA soft toric wearer who had developed severe SEALs when I switched her to 58% and 67% water content toric lenses. Additionally she was suffering from a thyroid imbalance.
After fitting the ?low evaporation? G 5x lenses she responded very positively and reported them to be ?the best lenses ever?. To the lens? credit her corneae were absolutely clear.
I also refitted a rather tricky high myope [CL Rx: -10.00/-1.00 x 180] who had been steadily increasing in myopia and astigmatism, over the past few years. A colleague had tried numerous HEMA torics but the patient did not obtain good comfort or vision and her astigmatism kept climbing, to over two dioptres. I stabilised her myopia and astigmatism to that reported above, through the use of Actifresh 400 diposables. As she still craved the clarity of a fully corrected sphero-cylindrical Rx I refitted her with the G 5x toric.
She also reported ?these are the best lenses ever!? Both patients reported better comfort and wearing times, good vision, less fluctuation and reduced dry eye symptoms.
So full credit to the G 5x for solving problems where numerous other lenses had failed, not a bad start!
I had, in both cases, strongly suggested RGP lenses, and I'm confident the results would have been good, but both had flatly refused to even try them.
Subsequently I have had eight out of ten good results, all the more so due to the fact that some had been very complex and difficult cases [and people!] who had literally ?been through the mill?. As with many soft toric fittings there were still some fitting changes involved, mostly for lens rotation problems, as the G 5x does need to be fitted steeper than ?normal?. As the lens was ?under development? this ?remake rate? was acceptable and no worse than for many established soft torics.
I'm sure the results will be even more promising when fitting ?common garden variety? patients.
The lens seems to be well made and nice and thin, especially so for a soft toric, as many lenses of this form have a reputation for being ?as thick as bricks?! On the negative side some ?visible? location marks would be a great help and the lenses are prone to breakage, as the Benz G 5x material is known to be brittle and the thin design doesn?t help!
You can?t have everything though and my philosophy is that lenses can be replaced. Corneas can?t.
Well not easily at any rate!
Father Of Soft Lenses Passes Away.
The contact lens world was recently saddened by the passing of Dr. Otto Wichterle the Prague based Czechoslovakian inventor of the HEMA polymer. It's thus fitting that this years B&L European Symposium on Contact Lenses is to be held in Prague, during October. No doubt he will be honoured at this meeting.
After developing HEMA in the early 1950?s - originally for artificial blood vessels - Prof. Wichterle tried moulding soft lenses in the mid ?50?s. He abandoned this avenue as the available technology led to poor edges and torn lenses during moulding. With the help of his son?s Meccano set he developed the spin casting technique - the basis for much of B&L?s lens manufacturing since the 1970?s.
My father saw some of the original drawings and diagrams of his ?erector set? technology and admits it was indeed very much a ?Heath Robinson? affair. He was fortunate to see and learn more about this ?futuristic stuff? while staying with an optometric colleague, Dr. Robert J. Morrison in the States.
Bob Morrison, a real entrepreneur, of Harrisburg, Pennsylvania, is apparently quite a character. He had - at the time of my dad?s visit - flown in a full orchestra from New York, for a party held in honour of one of his patients, none other than Princess Beatrice of Holland, and currently provides optometric services to fourteen royal families and assorted Hollywood stars. He is known to fly around the world providing optometric specialities to royalty and providing charity clinics to the underprivileged. Bob apparently proudly displayed a massive collection of keys to many of the world?s best Hotels!
While researching this column I tracked him down through the internet and was amazed at his recall of names, facts and figures.
Dr. Morrison had heard of Otto Wichterle?s invention after a French colleague, Pierre Rochet had read of the HEMA polymer in the Nature journal. Knowing Bob?s fascination with ?things new? he advised him to look into it. He immediately recognised its potential and shared Dr. Wichterle?s vision that this technology could be a major development in contact lenses.
So right they were!
Bob told me that Otto was a brilliant chemist and if ever someone was deserving of the accolade ?genius?, he was. After seven visits to Prague and many late nights drawing on table cloths, he bought the patents from Dr. Wichterle. Due to the complexities of dealing with the then ?communist block? he enlisted the help of two American patent attorneys. They were awarded the patent rights for the Western hemisphere as well as for Israel and South Africa, as Czechoslovakia did not even recognise the existence of these two states! At this point things became legally complicated and somehow the two patent attorneys ended up as fifty percent partners in the company thus formed. It was listed as the National Patent Development Corporation, also known as Hydron!
Legal issues escalated and in order to meet their obligations the two attorneys sold to B&L!
that's part of the story of how B&L and Hydron became the leading manufacturers of soft lenses at the time!
Interestingly the first buttons of HEMA [necessary in order to lathe cut soft lenses] came from a rod formed in a test-tube! Dr. Morrison was also instrumental in the development of oil based soft lens polish, as the water based polishes of the day didn't do much good to the hydrophillic HEMA polymer. Additionally, although HEMA was not pH sensitive, the higher water, vinyl pyrolidene/HEMA copolymers were, and thus became unstable in the 5.5 pH vaculiter [hospital drip] saline of the day. He thus developed the basis for the forms of buffered saline we use today. At one stage in the development of the soft lens, he was the only person in the US fitting them!
True pioneering stuff!
Prof. Wichterle was the first director of the Institute of Macromolecular Chemistry at the Czechoslovak Academy of Sciences, Prague, an institution for which his HEMA patents earned nearly a million dollars over a nine year period of payments and royalties. Serious numbers in those days, and valuable foreign exchange in a communist country. The capitalism of the United States however, dictated that some rather more serious dollars were at stake, and indeed changed hands.
Read more on Dr. Wichterle at http://www.imc.cas.cz/imc/history.html and http://www.pathfinder.com/money/latest/press/BU/1998Aug20/991.html
He was indeed a man of vision and brilliance, who proved to be a ray of light to millions of soft lens wearers the world over.
For more information or any comments email Alan at alan@optom.co.nz.