Contact lens practitioners are rather fortunate these days in that we have broad access to a large number of rather marvellous contact lenses, both RGP and soft. Physiology is no longer such a major problem, with most new lenses satisfactory for their intended use e.g. daily or extended wear.
Some of us were displeased when B&L discontinued their novel SofLens 66 sphere, which I have used over the past few years with excellent results. The SM and FM lenses were in many instances the only disposable lens that would work on some rather tricky and extreme cases. Its large diameter and unique geometry led to excellent centration and suitable coverage when many other lenses did not.
A young chap who?d been fitted with disposable lenses in Canada had come in after his return to NZ. The lenses were not fitting well and he had some signs and symptoms to confirm this. I refitted him with Soflens 66 which he's worn successfully these past few years. He came in recently for a routine aftercare with no complaints or problems. I explained his lenses were being discontinued and that we either had to supply him with the next year?s stock and then refit, or simply refit him now. We opted for the latter. The Soflens Comfort was no good as it decentred ?up & in?, with the lens edge riding on the corneal side of the limbus. As many of my SofLens 66 fits were complex cases, some have proved unsuitable for refitting with either Comfort, dailies or extended wear.
In this case I refitted with UltraVision?s Speciality Choice AB - a two to four week mid water aspheric disposable, with aberration control. With its 8.7/14.5 specifications it gave the best coverage and centration I have yet seen on this fellow and he reported great comfort and improved vision.
I received the following message a few days later, as I had asked him to confirm whether we order the new design, or the bulk stock of the 66 and hope we had a better lens in a years time.
???the trial lenses you provided last week are marvellous and could you please order???.Many thanks.?
Check out, http://www.ultravision.com.au/
This example illustrates many of the issues we are faced with today, but most importantly it shows that to really provide expert contact lens care you need immediate access to a broad range of contact lens types, options and modalities. Too often one sees practitioners putting all their eggs in one basket and thus being unable to provide the full spectrum of care that contact lens patients need and eventually demand.
Whether these one eyed, one brand, one-size-fits-all practitioners are pressured into these limited options through strategic alliances, no option bottom line commercial practices or simply through poor decision making is beside the point.
To provide full spectrum contact lens care, we need choices.
Fortunately today we have them, but we must be careful not to let commercial pressures and other issues misguide us.
In Your Eye
Another area where the hype is hard to ignore is in the multipurpose solution market, and it relates to another message I received from a patient.
I had refitted her with Soflens 66 Torics. So far these lenses had been the best she?d ever had, and I can tell you she was not an altogether straightforward case. She called after a few weeks saying her tolerance had dropped and that one lens was becoming unstable during the day. She had been using an MPS solution prior to first consulting me, and although I am no fan of most all-in-one disinfecting solutions, I will often not change a ?happy? user.
In this case I brought her in for a check, noted slightly inflamed eyes and lids, placed her on lid hygiene and meibomian therapy and supplied her with a starter kit of AOSept and LC65 unpreserved daily cleaner.
This is the message I got from my assistant a few days later; ?Maryanne phoned to say that things are heaps better since she stared using AOSept and she assured me she would implement the other suggestions you made.?
As fate would have it, the very next day our March 2001 copy of Contact Lens Spectrum arrived in the mail. On page 52 there was an article by Glenn MacDonald and William Martin, both ODs in Ohio. They discuss what some call ?multipurpose non-keratitis? ? red, sore, gritty, itchy eyes. These symptoms often resolve if one switches to other types of disinfection. In this case they recommend the ?EarthEyes Electronic Disinfection Unit? - what we used to call a ?heat unit? in the ?old days?. Unlike units of old, this one is a solid state, chip controlled unit.
On the whole I'd have to agree that for the large part most users of heat units and unpreserved sterile saline and rinse-off, ?unpreserved? cleaners would experience improved tolerance and reduced symptoms. Back in South Africa we were major users of thermal disinfection and many CL wearers have obtained decades of trouble free and economical disinfection ? and indeed still do. The authors claim 100% success in eliminating solution allergies and intolerance.
[I am sometimes questioned on my ?anecdotal? statements but would be sceptical of any claim that includes always, never, 100% or she?ll be right, mate!]
Nevertheless the point I am trying to make is that they are certainly getting major improvements, just as my AOSept case did, as do thousands of others.
MacDonald and Williams acknowledge their unit is ?not the next wave?, but that it is dependable, inexpensive and an effective addition to our contact lens disinfection arsenal.
More @ http://www.eartheyes.cc/
Again, that nicely sums up my point of needing a broad ranging armamentarium for effective, successful contact lens care.
Yet another patient wrote me a hand written letter expressing her thanks for ?discovering? her apparent hypoglycemia. Over many years of practice I have discussed with patients the possibility of hypoglycemia where they have been suffering headaches, big swings in energy levels and other ?diagnostic? symptoms ? yet with no visual cause and no joy from the doctor. Sometimes a simple diet experiment will give them answers, as in many cases GPs have not given these patients any diagnosis or treatment of this controversial condition.
This young lady, was very enthusiastic about her new found control of her own destiny. Okay, destiny may be a bit over the top but she is ecstatic with her ability to find out what works for her metabolism. She was effusive in her thanks and excited about how much better she was feeling - after many years in the doldrums. I see a number of cases like this a year.
She also gave me some references to some new books and information on the subject as she felt some of the recommended reading I'd supplied was a bit dated, and indeed she appears to be right. She told me there are strong moves in Australia to get foods labelled with the GI or Glycaemic Index. What the GI tells us is the relative time it takes for the breakdown of these foods into sugars in the body. For instance some foodstuffs immediately raise blood sugar while others take longer Just like we now have ?good? and ?bad? cholesterol we now have good and bad carbohydrates. It was interesting to see the GI clearly indicated on a wrapper for some or other Australian food I bought recently.
It should be noted that some of this data is directed toward diabetics and the mechanism of hypoglycemia in diabetics is very different to that in reactive hypoglycemia in non-diabetics. It's a complex subject with differing and controversial opinions and thus needs careful research.
Here are some links to basic information on hypoglycemia and the GI.
Symptoms of hypoglycemia http://www.fred.net/slowup/hypo.html
Definitions of hypoglycemia http://www.fred.net/slowup/hcauses.txt and http://www.niddk.nih.gov/health/diabetes/pubs/hypo/hypo.htm
A list of GI ratings for foods http://www.montignac.com/en/gindex.html
For all you athletic types and some background http://www.oztrack.com/gi.htm
Try using the search terms hypoglycemia and ?glycaemic index? in www.google.com for more information.
Just when you thought it was safe to go back into the sweet shop!
One thing all the aforementioned cases had in common was communication. All these people had consulted me as patients, sometimes travelling a long way. All had reported back using one of the three major forms of communication viz. E-mail, telephone and letter.
It really pays to build up a good rapport with patients, to communicate well and to offer value added services.
After all, anyone can fit contact lenses.
Or can?t they?
More on that in future editions [ad nauseum] and an interesting case of ?arc? eyes.
Also take a look at the latest salvo in the Virtual Efron saga. It makes interesting reading @ http://www.optometrists.asn.au/ceo/vol83/6/ceo83-6-h.pdf or see Clinical and Experimental Optometry Vol. 83 No.6 November-December 2000 pages 337-339.
For more information or any comments email Alan at firstname.lastname@example.org.