2001: A Contact Lens Odyssey
In just over a week after this edition hits the streets, 2001: A Contact Lens Odyssey, will be blasting off in Blenheim. Around 200 delegates will be attending what we hope will be a great mix of education and entertainment. Looking forward to seeing you there!
It seems that the organisers of the forthcoming Asia Pacific Optometric Conference in Queensland, Australia were so impressed with the name of our meeting that they have decided to name their's 2001 A Vision Odyssey! They say that imitation is the sincerest form of flattery!
Thanks guys.
You still have a few days to make that last minute registration for the Blenheim meeting. http://www.nzoptics.co.nz/blenheim/rego.htm
NZ Rules.
In the recent 1999-2000 Annual Report from the American Academy of Optometry, I noted that thirteen percent of fellows are 'outside' the US, with these members situated in thirty seven countries. Of these, New Zealanders are in the top five in terms of numbers after Canada, the UK, Australia and tie with the Netherlands in fourth place. Not bad for a small group of islands in the middle of nowhere, with only a few hundred registered optometrists.
Why not consider attaining your fellowship of the AAO? Surf to http://www.aaopt.org/Membership/felOverview.html for an overview of the process and links to other relevant pages. As the Academy website is undergoing a rebuild this link may change and I have also found some difficulty getting onto the site, but it will be worth taking a look at their new site design, once it goes live, sometime in the future.
While you're at it you may also want to consider attaining fellowship of the NZSCLP. See http://www.contactlens.org.nz/ click the insider link, enter your password and look under fellowship.
Attaining fellowship has many benefits and the process itself is a worthwhile form of CE and serves as a good refresher course and provides professional stimulation.
Efron modifies his 'Demise of RGPs' statement.
In a recent guest editorial in Clinical and Experimental Optometry [Vol. 83 #5, September-October 2000] Nathan Efron claims he was misquoted and that what he actually said was that he predicts the virtual demise of rigid lenses by the year 2010.
See the online version in pdf from at http://www.optometrists.asn.au/ceo/vol83/5/ceo83-5-a.pdf. It makes interesting reading.
I have written quite a bit on the subject in past editions and overseas journals.
[See http://www.nzoptics.co.nz/backissues/mar00.htm and http://www.nzoptics.co.nz/backissues/feb01.htm ]
It's interesting to note that a number of 'coal face' practitioners in Australia apparently do not agree with his views and I'm told we can expect to see some responses in the letters page of future editions of Clinical and Experimental Optometry, and elsewhere.
It is worth pointing out that although many of Nathan's points are valid, and backed up by references, he does make a number of rather controversial statements. Nathan talks about 'intractable' rigid lens problems such as ptosis, 3&9 staining, corneal warpage and lens binding. I agree that these problems do occasionally crop up, but certainly not in the majority of patients. As I've pointed out there are many RGP wearers that show excellent pathophysiological response [or should I say lack thereof?], often with eyes in far better condition than those who have worn soft lenses for similar times over two or three decades.
Nathan also quotes research by Tomlinson and Ridder and mentions the 'general visual dissatisfaction that many rigid lens wearers report'. I don't know where these guys get these reports but anecdotally I'd have to say that many soft lens wearers also complain of general visual dissatisfaction! Nathan and some of the quoted researchers I must add, are not at the coal face of contact lens practice and do not deal with patients that they fit and manage over many years. Indeed they do have research subjects, but who knows how often they actually fit and manage these subjects?
Certainly in my experience - both past and current - one of the first things that soft lenses wearers mention when you refit them with RGPs is the notably better vision they get! RGP lens use may well be in decline, but I believe that this is partially as a result of a lack of proper student training, which Nathan claims is due to the fact that "These clinics mimic the real world, in which patients are demanding and expecting soft lenses". He goes on to say that a graduating student may only have fitted one or two RGP patients.
Shock, horror, but unfortunately true!
When researchers investigate a given contact lens in the typical controlled manner of double blind, randomised studies what they often must do is fit a standardised RGP design. For example a 30Dk, 9.2mm lens from a specific manufacturer, with a specific design is used. Real RGP fitters all know that there is no way a single design will fit everyone equally well and many a lens supplied may have poor edge design and optical and fitting compromises.
So what these studies really tell us is that patients are merely reporting on their individual experience with a given lens, and this may indeed cause discomfort or poor vision.
Likewise the researchers may well observe pathophysiological complications for that given design for that specific subject.
I've spoken to researchers who candidly acknowledge the limitations imposed by research in obtaining real world clinical results. There have been many cases where I've managed patients who report poor comfort with a lens fitted by another practitioner where simply re-edging and creating a decent edge, or blending the back surface, has made all the difference. This is something that a controlled study would not allow. Believe me it's true, I've been involved in a few protocol studies, where we were specifically not allowed to modify a lens.
Just to prove a point, when we did indeed modify a lens or two, they worked better!
The problems with proper clinical training in Optometry schools have been around since I was a student, and indeed always have when it comes to contact lenses. Specialist contact lens practitioners gain their skills by working with, observing and learning from specialist practitioners in specialist practices. Many students that qualify today move straight into the commercial world of optometric practice and chain store operations with little time and financial restraints that limit their ability to spend the time [or indeed their employers money] gaining the skills that are needed. They often have major loans to pay off as well.
In my two decades of practice there have been very few newly qualified optometrists that I've come across that have had the desire, motivation or aptitude to become great contact lens fitters. I have also, in the past, resigned from a teaching institution where I felt that students were being allowed to qualify without the necessary clinical experience in contact lenses, contrary to the requirements of the curriculum.
There's a lot to this emotive topic and I would value input from our readers.
At Last!
In a recent article in Joe Barr's Contact Lenses Today e-mail newsletter [February 11th 2001] he mentions recent legal action against a company 'illegally' tampering with Ocular Sciences disposable lenses. The article follows;
"Ocular Sciences announced it has filed suit against Weblens.net, an Internet seller of contact lenses. The suit alleges that Weblens.net obtained Ocular Sciences' contact lenses in an unauthorized fashion, removed the barcoding and other identifying information from the company's contact lens packaging and unsealed the boxes to remove labels from individual lenses."
In another press release from the OptiStock e-mail newsletter the following point was also made;
"Ocular said the labels also included information necessary to patients, such as lens type, power, and expiration date."
That's exactly what I've been going on about these past few years! It's good to see that at last someone is taking this sort of thing seriously.
You can subscribe to these online e-mail newsletters by following these links:
CL TODAY http://www.cltoday.com OPTISTOCK http://www.optistock.com
When I surfed to Weblens [ http://www.weblens.net/ ] the website defaulted to a page that said they would be 'closed' until February 13th. One wonders if this had anything to do with the legal action? It is however now functional and still has OSI lenses on display, for sale.
One wonders if this sort of thing is still going on in NZ - as it appeared to be - after the select committee stupidly 'deregulated' contact lens supply a few years back?
If so, will anyone do anything about it?
Field 'Defects'?
In another recent edition of CL Today, [February 4th 2001] Cynthia Green, O.D., Columbus Ohio mentioned visual field anomalies with contact lens wearers. Indeed I have noted similar problems with decentred RGPs as well as other field 'defects' that have arisen from optic zones of RGP and soft toric lenses. I will discuss this in more details in a future edition, and if all goes well may have a few fields to demonstrate this.
These 'defects' disappeared after removing the offending CLs and re-doing the fields.
See you in Blenheim.
For more information or any comments email Alan at alan@optom.co.nz.