In Contact - September 2006
No Stain. No Pain
It won?t be the first time I discuss the relevance and funding of research papers and their often contradictory findings.
Hardly a month goes by where I'm not made aware of some or other paper regarding the efficacy of solutions and their alleged toxic and allergic side effects. This has become even more of an issue since the advent of silicone-hydrogels, with various confusing reports regarding corneal staining [as an indicator of toxic epithelial reactions?] involving various si-hy materials and multipurpose solution combinations.
I recently became aware of what appears to be a useful table to help one through the confusing quagmire to choose the best lens-solution combination. Check out Andrasko?s online staining grid.
Andrasko clearly states that he's not a paid consultant to any ?optical companies?.
The neat thing about the staining grid is that It's currently a ?work in progress?. Every time I take a look it has some added solution-lens combos. Peroxide is currently under review.
I predict we?ll see - as the results come out - that peroxide will win the staining game. Other researchers have shown excellent results for H202 as far as the relative absence of solution-related corneal staining is concerned.
One can ignore ?MoistureLoc? [discontinued after the fusarium scare]. Local readers can likewise ignore Equate [a re-branded biguanide].
CLEAR CARE is, I believe, the US equivalent of AOSEPT Plus.
Enjoy the bubbles?
Keep an eye out for updated results as they appear.
In essence Andrasko?s clinical studies and observations pretty much back-up my own observations and tends to confirm that bigaunide based solutions are not the best choice for silicone hydrogels. At the same time although quaternium-1 containing solutions rate well for si-hy lenses they?ve never been my first choice for regular hydrogels disposables...
Some people make the point that ?their? MPS brand has ?proven itself? over a decade or two. As far as I'm concerned however, silicone hydrogels only appeared on the market in the past 7 years, well after most MPS varieties and thus we need new, novel solutions specifically designed for si-hy lens materials.
Another recent article in Optometric Management also details some of the lens-solution issues.
AMO recently released a statement, with reference to some studies that show biguanide based solutions in a better light. There are some useful links on their site.
Along with other MPS manufacturers they also have a variety of lens care tips, warnings and useful advice.
One can see how some of them target certain groups while others use modern methods to get the message across. Try this interactive link.
Among other things it seems many are no longer so gung-ho on ?No-Rub? these days.
About time too!
we've certainly carried on about it for long enough but it took a scare like fusarium to enforce the wake up call. Now they?re listening?
What is it about some multinationals that makes them seemingly ignore relevant research and sound clinical advice from coal-face practitioners?
Only when the wheels eventually fall off do they act.
I guess it only ?matters? when they?re likely to get the pants sued off them, profitability suffers and shareholders jump up and down?
An article in the Pittsburgh Post-Gazette - originally from The Wall Street Journal - makes for rather interesting reading. With a different perspective to us contact lens nerds.
I will not rehash all the other issues surrounding MPS; rub vs no rub, efficacy and toxicity as I've covered and referenced many of these for decades. See back issues of In Contact and site specific search engines to find the nitty gritty.
Now I don't know about you but these days, when it comes to soft lenses, my first choice [as It's been all of this century] is still a daily disposable.
No solution issues there.
There are however torics, out of range Rx patients, EW wearers and those needing higher Dk/L for physiological reasons that need regular disposables.
By definition this group need safe, efficacious disinfection, so choose wisely.
The rare conventional lens wearers need a full care system [peroxide, daily cleaner, weekly deproteiniser and saline] so I've left them out of this discussion.
The Law is an Ass
So they say.
A cosmetic contact lens case I had to deal with a while back was recently brought back to light.
Over the years I've dealt with numerous cases of cosmetic soft and haptic lenses for disfigured eyes. These can be very rewarding and life changing for the recipients.
On the other hand I've never been at all keen on the Plano ?cosmetic? market. I've too often seen too many problems in these situations, as evinced in the following case studies. Attitude, compliance, solutions and infections spring to mind. Cosmetic lenses for movies are a big deal these days. Typically, in the US [and elsewhere], a movie will have a contracted, special-effects contact lens practitioner, often onsite and involved right up-front in the pre-production stages. They earn some decent bikkies, I'm told. The industry in NZ is a little different and too often the DIY, number eight fencing wire philosophy prevails. It's all got to be done on the cheap too. I've had enough frustrating experiences in the past that these days I rarely involve myself with movie or Plano cosmetic lenses.
If you do, you need to clearly state your terms.
The case that comes to mind was a ?last minute? rush job - as they often are. Generally I'm expected to take on a newbie wearer, squeeze them in ?today? -while other deserving and complex cases are expected to book an appointment a week or three ahead. Sorry but that's just not on in my book and one of my major reasons for no longer getting involved. Pay me a 100k retainer and I?ll gladly keep an appointment open every day. don't however expect a risky and complex cosmetic case to be sorted in a day for a hundred bucks.
This case involved a 12yr old actor, ?fitted? by ?who knows?. It was apparently not by a registered optometrist or ophthalmologist and in my view ?illegal?.
He fronted up following urgent phone calls, needing a same-day replacement cosmetic lens. The one he?d been ?provided? had split [so I observed] and was causing some discomfort - the only reason they consulted me. He?d also been given an open, grubby bottle of MPS [that had expired in 2003!] and a similarly gungy bottle of saline with a cracked lid ? that could well have been un-sterile.
An MK time bomb waiting to go off if you ask me.
A corneal abrasion from a damaged lens, an expired solution and potentially contaminated saline?
Of course we sorted it out and with the help of a local rep had a new lens ready to go after checking the fit, performing an eye exam and re-instructing the wearer. Fresh solutions and a new case were also provided.
All in a day?s work.
Who?s the Ass?
The problem is that in this case it seemed that someone in the movie industry had effectively been practising optometry, illegally. What with all the mumbo jumbo of the HPCA Act, ?registered practitioners? licensed tasks and who knows what, one would expect tighter controls. In addition, as far as I know, ?only? registered optometrists and ophthalmologists can prescribe contact lenses. This is of course dumbed down by a 1996 select committee ruling that effectively says ?anyone can sell a contact lens? (in a state ready for use?).
My view has thus always been okay fine, then It's the seller?s obligation to only sell to a valid Rx of the prescriber.
It seems simple enough to me but the law?s an ass and it seems it will take a test case to make that sort of logic stick.
In the meantime flea markets, tattoo shops, online lens sites, Trade Me traders, hairdressers and the like, will continue to sell Rx and Plano cosmetic lenses to all and sundry, sans an Rx.
I've vented my spleen on these issues in numerous In Contact articles this past decade.
Arggh?
Looks like we're the only ones that have to comply?
Everyone else can just carry on and fit and sell CLs with no worries or any comeback as there's zero policing. I doubt if I'd even waste my time reporting such an incident and such issues to the MoH. From my previous dealings with them I'd just be banging my head against the wall and get passed from one desk to the next with no action. As to the police, they?re probably too busy filling quotas and manning speed cameras. [Reading the paper in the back seat?]
It seems we?ll need many more blind eyes before this ridiculous issue gets sorted.
we've had cases here in NZ of ?lost eyes? from over-the-counter non-prescribed cosmetic lens sales. A full case report of one local example has been prepared. Australia recently had another published case: A 13 year old girl who ?borrowed? a friend?s Plano cosmetics, as per this article.
When will the asses get their asses into gear and make laws that sort this out? Like other first world nations.
Is it the law or the people that make them?
It's not rocket science and sometimes eye safety and maintenance of ocular health and vision must outweigh the namby-pamby politics of ?consumer interest?.
Since when is losing an eye ?in the consumer interest??
For the sake of a few dollars?
Never mind that just one remedial penetrating keratoplasty costs the state ten or twenty grand.
Idiots!
All Blacks Rule
Once again the mighty All Blacks have shown their class in taking the Bledisloe Cup and Tri Nations, with three games yet to be played.
An impressive effort.
Nary a game goes by where I'm not in awe of the physical hammering these guys get dealt. They are the modern gladiators. Most of us would end up crippled in just a couple of minutes in that maelstrom of a game we call rugby. No helmets, minimal padding and massive force applied in the bodily equivalent of a head-on car crash or at times akin to being smothered by a heaving, punching, sweating, one-tonne beast.
What else can one say but ?full credit??
Attitude at Altitude?
Now for some pride from my consanguine Boks ? at altitude and on what we call concrete ? so don't expect any poncy swallow-dives across the try line.
I remember only too well the appearance of my knees and elbows after coming into grinding contact with bone-dry rugby fields in the rarefied atmosphere of my youth.
Apr?s ski
Snowvision was once again a great success. I've attended every one of them since the inaugural meeting in ?96 and hope to maintain that attendance record for years to come. Our ski team, ?The Ulterior Segments? managed third place in the ski race. Not too bad eh? Congrats to the winners.
The BBQ was tops too. The snow was good as was the company and lecture programme. [See the conference report elsewhere in this issue for details.]
Our now traditional Friday night dinner with a bunch of mates, upstairs at The Bunker, was a roaring success. [In part due to the roaring log fire and copious amounts of local Pinot.] The apr?s-ski, pool and rugby were, as usual, much fun. I was fortunate to be part of a winning optometrist/ophthalmologist pair who took four hundred bucks off a well-known pair of optometric and ophthalmology personalities?
What a night.
For more information or any comments email Alan at incontact@optom.co.nz.