In Contact - June 2008

It's hard to believe but we're almost halfway through the year.
The shortest day beckons. The first half of ?08 has been surprisingly devoid of any major contact lens launches, hence the dearth of information in my previous few columns.
We have of course had the addition of a one day lens to the Proclear range. It should prove to be a valuable modality enhancement to a lens material that is well regarded, with a number of unique features. In addition the XR series has been expanded to include spheres, torics and multifocals and now covers a very wide range of parameters. At least it will help compensate for the discontinuation of ActiFresh 400, one of the best disposables ever.
On the other hand I suspect that one, maybe even two of the Holy Grail silicone-hydrogel dailies may debut by late ?08 or early ?09.
Now wouldn?t that be the biggest contact lens development of the decade?
The long awaited Air Optix toric has just hit the NZ market. [O2 Optix will be renamed Air Optix, across the range, in all regions]. I'm pleased to see the industry actively taking steps to correct this oft complained about issue regarding different names for identical products, in different regions. One likes to think they take heed of our comments and feedback.
The successful Focus Daily, now in its third evolution as AquaComfort Plus, represents a further material enhancement.
We can also look forward to another positive step in the twenty-year evolution of Acuvue lenses with Acuvue Oasys for Astigmatism due for imminent release. I am sure we will see similarly favourable improvements in wetting and reduced lens deposits, as we did when Advance sphere was upgraded to the Oasys material.
Notwithstanding the ?limitations? of the Advance material, Acuvue Advance for Astigmatism [AAFA] quickly became one of the top sellers among toric lenses. My results with AAFA have been more than satisfactory and many colleagues share that view.
If the Oasys version proves to be even better then I reckon we have another winner.
More good news is that B&L?s Boston Liquid Enzyme Cleaner is finally back on the market after a frustrating two year hiatus. Over the years it had proven to be a useful, minimal fuss deproteiniser. Its absence was noted.
I only wonder why they changed the packaging and container. I don't think it will be very long before someone mistakenly places a drop in their eye. The bottle is tiny, the print even tinier and it looks and feels like a small eye drop bottle. It's the same size as a starter-pack bottle of Boston Rewetting drops with potential for confusion. Especially so in the foggy realm of a new wearer as they care for their ex situ lenses.
In the past few months we've also had easy access to Menicon?s two-pot Progent intensive cleaner and deproteiniser, since OIC took on the agency for Menicon products at the end of 2007. I've used it and other Menicon products over the years. Their RGP storage case is the best there is and we've used thousands over the past few decades. Experience has shown it dramatically reduces the scratches induced by regular ?bowl shaped? storage cases.

Eccentric RGP Practitioners?

Some regard specialist RGP practitioners as obsolete, if not somewhat eccentric. Although RGP practitioners may be regarded as a dying breed - with few new practitioners taking the reins - there's still a great need for their skills. There are millions of complex corneas out there for which soft lenses and even the best and most sophisticated soft torics just do not hack it. there's great concern around the world as to who will take care of such cases in the future. It seems that most current graduates are not gaining the necessary training, nor showing the required interest or aptitude. Few are specialising in the field.
To some degree I suspect that's always been the case.
For those of you with an interest in things such as eccentricity and RGPs, this Contact Lens Spectrum article is just up your street. It deals with the nuances very well with some great illustrative images.
KC fitters with an interest in rubbing and evidentiary significance, get your jollies here.

Bored?

Guess what? For the third year in a row since the implementation of the HPCA Act, ?administrative issues? meant I had no APC by the due date. It would seem I am not alone. Admittedly my competence related ?self audit? had by arrangement been submitted late, in February. I'd been flat out with patient care, compliance issues, and conferences, further aggravated by staff and colleagues on extended leave, ACC and so on.
Patient?s come first.
I've been involved with the HPCA legislation since its early beginnings as a Bill right up to the current review process by the Ministry of Health. [MoH]
I'm pretty sure that the primary goal is patient health and safety; so that's what I focus on.
The review meetings in April were preceded by detailed submissions from interested parties. These are certainly worth a read. Some are not too happy with statements made by the NZAO. Check it out. Among others, Item 45 got a few people wound up. Of additional interest is that optometrists submitted among the most complaints about their board?s implementation of the Act.
Check out the summary, conclusions and recommendations.
Another item of note is the Ministries? concern about the lack of discussion on cultural competence, and I quote ?The review process is silent on cultural competency ? where does this feature? Whether or not a lack of cultural competency is a weakness across the boards is difficult to know, as the issue is surrounded by silence. Cultural competency needs to be discussed.?
Some say the deafening silence is because this very process of so called ?cultural competence? is in itself racist by nature. Or is it because everyone has already embraced it and has no issue? On the other hand I know of at least one open minded Kiwi that refused to sign a DHB Contact Lens Subsidy Contract because of references to such ?cultural? issues.
Even though it hurt her in the pocket.

Survival

At any rate I survived the competence self-audit, as I did the DHB Contact Lens Subsidy audit before that.
Funny how I get to do all these random audits?
Interestingly, of the five registered optometrists in the practice, four of us have been randomly audited in the past two years, the first two periods since its inception. Surprisingly, two of the four have been randomly selected for audit twice in two years. Another, an optometrist waiting to undergo the OCANZ process was also audited as a dispensing optician, a profession for which he is registered in NZ.
Now I may be dumb at maths and terrible at calculation of probability, chance and factorials but I do know that the odds of four out of five registered optometrists in our practice, getting six audits, in two-years, does not seem consistent with chance. Certainly not when one considers the stated mechanism of twenty percent of the workforce being audited per year.
I reckon we?d be LOTTO billionaires if we could put those kinds of odds working for, rather than against us? I am certainly going to throw a few dollars on the roulette table when next I get a chance. Maybe I will in my forthcoming travels. As this edition goes live, I?ll be in the UK presenting at the BCLA conference. It?ll be my first time at this large, prestigious meeting and I'm looking forward to the challenge. It kicks off for me with an opening day debate against the mighty Holden and Sunil Shah.
No pressure!
After a few days with family and mates in London, I'm taking the dog leg home via South Africa to see the folks back there.
I?ll be reporting on the BCLA next month. I digress.

Short and Curly

The long and the short of it was that although I belatedly received my APC, the board?s website subsequently listed me as ?active but expired?. I let the MoH know that my patience was understandably running very thin, after years of problems. They in turn advised the ODO Board.
Amazingly, and in what I regard as a world record for bureaucracy, the board, later that very day, not only corrected my entry to ?active and current? but also posted a disclaimer - on the registration database pages - that viewers should call the board to verify any questions that arise as to status. In the past it took at least a year for them to change my qualification from ?British College of Opticians?, even after repeatedly informing them of the error. For a while I thought that like many members of the public, my own registration authority didn't know the difference. I mean they registered me as an Optometrist but listed the qualification as ?Optician?? They also fixed another error that implied that only therapeutically qualified optometrists could ?prescribe?.
There have however been improvements in the procedural operation of the board and application of the Act in the past year or two.
The only pity is that we've had to fight so hard to achieve this, at the cost of way too much time, frustration and money.
Contrary to some of the stated provisions of the HPCA Act?

For more information or any comments email Alan at incontact@optom.co.nz.