In Contact - October 2006
Tool of the Trade
Parents and behavioural optometrists alike will delight in the fact that a band more likely associated with ADHD, has just released an amazing CD based on binocular vision principles.
Tool?s cleverly designed CD 10,000 Days utilises a stereoscopic pair of +7.00D lenses as the focal length of 14.3mm approximates the size of a CD package. The art work by renowned artist Alex Grey is also pretty amazing, especially in 3D.
Although I'm regarded by some as an ?old rocker? - and cut my teeth on the heavy rock of the late ?60s and early ?70s - I've never been a big Tool fan, however this album is pretty good. A mix of rock, metal and grunge is how I'd sum it up. Catch a few tracks here. Apparently they sold over 500,000 copies on release. Expect to wait a while for their next album though, as they only release one every five years or so.
Kiwis are apparently Tool?s biggest fans.
Even though most mothers cringe when their ADHD sons crank up the volume, they can relax in the knowledge that their darling is at least exercising accommodative-convergence and building binocular skills with this latest Tool release.
Speaking of old rockers, I've referred to a few in this column in the past.
The Stones and Zappa come to mind, as does Bob Dylan.
Now sixty five, Bob has achieved a new milestone as the oldest person ever to achieve ?Number One?, on release of his latest album ?Modern World?.
Click the links to hear a few sample tracks.
Rock on.
The Right Tools
Much of the work I do is on referral from happy patients, optometrists and ophthalmology colleagues. It's the way to go as far as I'm concerned and beats competing with hairdressers and flea markets for a frustrating Plano-cosmetic fit?
Recent cases brought back to me the fact that these days there's no good reason to fit a disposable, conventional, or custom-designed, high-minus sphere or toric, in low-Dk materials. In some cases one may in fact do better in a spherical silicone-hydrogel disposable than a low-Dk toric.
The sometimes dramatic reduction in sphere and cyl power, reduced oedema and hypoxia, as well as whiter, clearer, happier eyes are obvious to practitioner and patient.
Happy, enthusiastic patients are great reward and make for satisfying practice. They?re an excellent source of referrals that over the years creates a self perpetuating mode of practice growth.
One of the three cases detailed this month comes on referral from one of my first contact lens patients seen in Auckland in 1994. He was a young boy then. Today his successful high-plus lenses have helped him obtain a law degree, maintain a student job and a lifestyle allowing for sport and outdoor activity. Another referral came from a provincial ophthalmologist and the third from an industry colleague.
All have been great successes and led to a string of positive comments and emails.
More referrals will no doubt follow.
Case One
A pleasant twenty year soft-lens veteran and myope in the order of -12.00D consulted me wearing a conventional 45% water sphere in one eye and an unstable toric in the left. Both lenses had significant lens calculi [jelly bumps] with reduced acuity [around 6/12], hyperaemia and reduced comfort. I refitted her into Acuvue Oasys R: -10.00DS and L: -10.50DS. We immediately obtained 6/7.5 binocularly.
She returned for aftercare 10 days later, ?happy as Larry? and commented on improved comfort, better wear time and less dryness. Her lovely blue eyes were once again visible rather than hidden behind a mid-blue tint surrounded by a hyperaemic conjunctiva. Not to mention her now 6/6 binocular vision and a reduction in myopia to -9.50D for the right CL Rx. The left still has a mild cyl but obtains 6/12+. She prefers this to 6/15p on a thick soft toric that rotates 180?.
Ironically, while paying the bill, she said; ?Thanks so much for what you?ve done for me?
All good.
Case Two
This one was ?simpler?, needing a refit from mid-Dk, mis-locating, disposable prism-ballast soft torics. To aggravate matters the young Uni student was being treated with an antidepressant with known dry eye, accommodative and mydriatic side-effects. He was experiencing problems relating to all these issues viz. variable, poor distance and near vision, near-to-far and far-to-near blur, toric rotation, discomfort, and dry eye with flare at night from his large pupils interacting with moving, rotating, oval, toric optic-zones.
A ?non-prism? Acuvue Advance for Astigmatism [AAFA] did the trick in the dry eye, comfort, stabilisation, oxygen and vision stakes.
I prescribed the minimum minus he could tolerate - to minimise any accommodative issues. With an 0.50DC tweak to one lens after 12 days we settled on;
R AAFA: 8.6/14.5/-6.00/-0.75x80???????? 6/7.5+ [Up from 6/9]
L: AAFA: 8.6/14.5/-4.50/-1.75x80???????? 6/7.5+ [Up from 6/18]
Near vision shows similar improvements ? in magnitude and visual comfort.
I also changed him from a PHMB-based solution to peroxide. He prefers that too.
An email received while writing this edition said; ?I have been wearing these lenses most days since our last appointment and am really thrilled with the level of vision??. So thanks for working your magic!?
After seeing numerous practitioners and having tried numerous lenses, to him it did seem like magic.
Me? I'm just doing my job.
As one should
Case Three
Of the three cases this one achieved the greatest improvement, even though silicone-hydrogel disposables were out of Rx range.
When first seen by me he was wearing a three year old pair of very grubby lenses with various deposits including protein, calculi and lipids. Additionally his cleaning and disinfection regimen was inappropriate for conventional lenses and he reported recent, recurrent ?infections? after lens wear. His storage case was not exactly kosher?
The Rx of his old HEMA 38 torics was;
R: 8.6/14.5/-11.00/-4.00x75???????? [VA<6/12]
L: 8.4/14.5/-10.75/-1.75x88???????? [VA<6/12]
I refitted Custom Proclear Torics and after a short period of stabilisation the final Rx was;
R: 8.3/14.3/-9.75/-2.25x80?????????? 6/7.5
L: 8.3/14.3/-9.75/-1.75x80?????????? 6/7.5
As you can see in comparing the prescriptions, he's had a significant reduction in previous hypoxia-induced myopia and astigmatism, particularly on the right eye.
He now obtains an excellent 6/6 binocularly with improved stability due to the steeper, smaller lens more in keeping with his HVID and corneal topography.
We also upgraded him to a more suitable cleaning/disinfection regimen with AOSEPT plus, daily cleaner, deproteinisation and a saline rinse.
I also detected previously undiagnosed glaucoma and under initial treatment his IOP has dropped from 28mmHg to 19mmHg.
he's a lot happier now with better VA, improved comfort, whiter eyes and a reduction in Rx.
Happy patients = happy practitioners.
Boks On
The Boks at least finished off well and are now able to hold their heads a little higher.
Now for Rugby World Cup 2007.
Did the ABs peak too early [again]? Will the media superpowers allow the ABs rotation plans? Will the French prevail? What will Aussie do?
The Boks, I suspect, will do better than they did this year. Some injured stars will come back. Some of the new young fellows will shine.
Irwin and Brock have departed the planet.
Schumy has announced his retirement.
They were all greats but It's unlikely anyone will ever exceed Schumacher?s F1 achievements.
Will he manage an unprecedented 8th World Championship title? Or will Alonso prevail? How will Kimi do at Ferrari next year?
At least there's no shortage of excitement during the dull NZ winter.
For the other five billion mortals on planet Earth, life does however carry on.
For more information or any comments email Alan at incontact@optom.co.nz.