In Contact - June 2006
Mr Grumpy?
I've really had it with the current solution problems?
If only it was something new?
After twenty five years, one would think you get used to it but this year It's a case of ?enough already!?
2006 is but five months old yet we seem to have had a record year for relative disasters when it comes to solution issues and infection dramas.
We have a constant stream of disgruntled patients complaining about CIBA?s Canadian supply issues, AMO re-branding and solution changes, B&L?s problems, Boston?s Sydney-warehouse fires and so on. It leads to problems when self-selection or untrained assistants in pharmacies provide alternative products, that don't always work out.
Need I continue?
Too many businesses and politicians especially are so focussed on self gratification and short-term gain, they forget the long term.
They ignore the past.
Ego?
Ergo.
Have any of you done a low-tech ?viscosity test? on some of the RGP solutions?
Place a few drops each of old and new versions on a glossy magazine and compare to other brands. Agitate lightly and see how the drops ?wobble?.
Next, tilt the magazine: See how they run!
Some patients are not happy. One recently seen said his lenses felt like ?glass in his eyes?. He was quite happy with the old, now discontinued formula. Of course others don't notice a difference?
Manufacturers should understand we spend quite some time, over many years, finding the best combination of solutions for our patients. They all differ. Dumping a successful solution for an ?all in one version? doesn?t solve problems. It creates them. We?ll be switching the majority of these to other brands.
We also note silly instructions on packaging that imply saline is okay for 30-day lens storage, among other things.
In the current market?
I suggest you read the packaging and labels of what you recommend to patients.
It may alter your prescribing habits!
Some patients, understandably, take things at face value. They don't give a rat?s, or a CFU for that matter.
The bottom line is patients and practitioners vote with their feet.
Maybe the solution manufacturers will start listening to practitioners instead of finance, marketing and ?research?. Some know, or indeed care very little about solutions.
Shareholders. Profit. FDA. Trials. Unknown issues. Lawyers. Non-compliant users.
From time to time these issues arise. VIOXX was another biggie.
Much more serious than Fusarium.
People died.
On the Fusarium issue, MoistureLoc has now undergone a world-wide recall and manufacture has been permanently terminated.
Disinfection of soft lenses has been an issue for as long as they?ve been around?
we've had the salt pill and homemade saline dramas. There?ve been thermal, chlorine, iodine, ozone, peroxide, UV and chlorine disinfection systems. Microwaves are occasionally advocated. Add Thimerosal, BAK, Chlorhexidine, polyaminopropyl biguanide, EDTA, Polyquaternium-1, Alexidine?
Numerous other tongue twisters and acronyms abound.
I recently stumbled upon an In Contact column from 1996. It made for interesting reading.
A historical perspective. Retro vision. Retroversion. Getting back to basics.
Learning from the past?
Wow! A whole decade ago?
Reprinted for your interest as follows;
A NEW AGE [1996 Heading]
Well I'm sure It's with a great deal of relief that the sensitive new age types among you, will now be able to get on with your lives without being inundated with rugby, rugby and more rugby - here, there and everywhere! It was though, a great series and as ?Fitzy? might say, ?Full credit to the boys, rugby was the winner!? So with the series going to the AB?s and the ?Boks? at least saving some face in the final test, we can now look forward to ?97 with the long term tally of games standing at 22 all, proof indeed of how evenly matched these two great sides really are.
So, for those of you with a leaning to more cultural pleasures, you have it from me that I?ll pander to your desires and strike all reference to rugby from these pages,...at least until next time!
[Perfect timing for the Super Rugby Finals: 2006!]
IN OFFICE STERILITY
This month?s scientific report has nothing to do with the fertility of office staff! It deals rather with the clinically relevant issue pertaining to in office trial lenses.
The sterility of non disposable trial lenses, especially regarding hydrophilic (soft) lenses, has been an issue for practitioners since the early ?70?s, when they were first introduced. Today these issues continue to be the subject of research and debate, especially so with the risks associated with HIV transmission, acanthamoeba, hepatitis and with the ever increasing resistance of a myriad of micro-organisms to the currently available antibiotics. It is thus our duty as practitioners to make sure that a trial lens is completely sterile, while in storage and prior to placement on the eye. With the plethora of chemical disinfection systems now available, and with their increasing popularity, how are we to be sure that they do in fact disinfect, sterilise and maintain sterility of our in office trial lenses?
A recent study published in ICLC 1996;23:94-97, titled ?The Efficacy of Disinfection Systems for In-Office Storage of Hydrogel Contact Lenses? deals very well with this issue and leaves one in no doubt as to the preferred (only?) system that satisfactorily disinfects trial lenses. The authors, Simmons et al, of Southern California College of Optometry compared CIBA?s AOSEPT, B&L?s ReNu (Multi Purpose Solution) and thermally disinfected lenses (in unpreserved saline). They also used lenses stored in unpreserved saline with no disinfection as comparative controls. Lenses were cultured for microbial contamination at 1 week, 1, 2 and 3 months. All lenses were digitally cleaned for 20 seconds each side and then disinfected according to the solution manufacturers recommendations. It should be noted that thermally disinfected lenses were disinfected in a B&L SofLens Aseptor-Professional unit which disinfects at 95.6?C for 35 minutes.
The following abstract illustrates the incidence of contamination and the study clearly shows that thermal (heat) disinfection is the only system (tested) that gives total (acceptable) disinfection!
[The results were tabulated in the original print version. Now we simply hyperlink.]
To my mind what?s even more significant is that lenses that are thermally disinfected are sealed in vials and then disinfected, whereas in some chemical systems the lenses are disinfected and then transferred to vials and sealed which opens up the possibility of various forms of (re)contamination, especially so in the in-office situation! What?s more the lenses from the thermally disinfected vials, having been disinfected in unpreserved saline, are free of preservatives, and added chemicals thus minimising reactions in trial patients, helping to settle sometimes sensitive patients a little more quickly and less traumatically.
Makes you think, doesn?t it?
[Gee don't I just keep repeating myself?]
What is also interesting is that SOFTWEAR saline - that showed zero contamination in conjunction with thermal disinfection in another study in 1992 - has just been discontinued by CIBA.
Although we rarely re-use diagnostic soft lenses these days [I can?t recall when last I did] the historical background and disinfection variability is as relevant now as it was then. Today disposables cover most bases and when they don't an empirical ?per case? order is the best starting point.
When I joined Barry & Beale in 1996 they had long been one of the few NZ practices that used an autoclave for lens disinfection. Thermal disinfection and particularly autoclaving was very effective but the switch to Ionic, Group IV high-water materials was an issue as they couldn?t stand the heat.
Stay out of the kitchen?
The rest of the column dealt with the CONTACT ?97 - CITY OF SAILS NZSCLP conference at which leading speakers Dick Hill, Brien Holden and Karla Zadnik were due to present.
A decade later Brien, Carla and Dick are still at the forefront and legends in the own time. They continue to be recognised as greats and recipients of significant awards and honours.
Down the Track
Diarise the 8th to 11th March 2007 and book those locums for the 50th Anniversary Conference of the Cornea & Contact Lens Society of New Zealand.
We hope to have similarly spectacular speakers and cover many aspects of the cornea and contact lenses.
Some world leaders have already confirmed for Queenstown and I think our line up of top speakers will match or exceed the quality you are likely to find, all in one place, anywhere on the planet!
More on that in July.
Rugby?s the Winner.
Full credit to the Kiwi teams for an all NZ Super 14 final. I expect the Crusaders will take it again?
Just finishing off at the SRC with a record of almost 1000 registrations. My presentation went well - in a more personal seminar series - with around 120 delegates.
We head off to see the Twelve Apostles via the Great Ocean Road in a few hours and then home to Auckland.
I hear it is one of the world?s great drives.
Hopefully Mr Plod will be sleeping?
For more information or any comments email Alan at incontact@optom.co.nz.