In Contact - October 2008

For those flexible types with a bent for RGP lens management, a recent article on 3 & 9 o'clock staining is worth a read.
Eyeblink Frequency and Type in Relation to 3- and 9-o'clock Staining and Gas Permeable Contact Lens Variables by van der Worp et al appeared in Optometry & Vision Science. 85(9):E857-E866, September 2008.
Those of us that have dealt with RGPs (and PMMA before that) have all experienced this tricky condition. It has been documented and discussed since the 1950s. Many of us have attempted to tweak lens design, diameter & edge and tried lid attachment or interpalpebral options to try and control it. We have also long been aware that many of these problem 3&9 patients appear to suffer from ?incomplete? blinking and we have implemented ?blink training? strategies such as ?think blink?, coupled with lid and tear management.
The aforementioned study investigated many of these aspects and confirms that these cases do indeed suffer from eyeblink abnormalities.
One can take a look at the abstract for a summary and some results and conclusions. For those with access there's a lot of detail some of which clinicians are familiar with. Some of the findings also confirm why for one wearer going smaller is better while for another, bigger is best. For some nothing helps.
Vascularised limbal keratitis, dellen and peripheral opacification are hard to manage and proud nebulae may result. These problems typically occur in hard lens veterans. Many have had three, four or more decades of PMMA and RGP wear. Some have had exposure related aggravation of the ocular surface issues and many are sufferers of rosacea and related tear dysfunction syndromes. These days I refit such cases with a high Dk Rx silicone-hydrogel a la bandage lens.
Good results have been obtained.
The study showed fewer complete and more incomplete blinks, with more ?blink attempts? in GP wearers with 3&9 staining, compared to wearers with minimal staining and non wearers.

In the Blink of an Eye

In a figurative blink of the eye, NZ and the USA will likely have new leaders. Elections take place in early November and occur when the world is under immense ecological, economic and ideological stress.
Times are tough and will likely get tougher.
Meanwhile someone complained to the advertising standards authorities that the use by Ms Clark of her manipulated election image is misrepresentation....
Pharmac has concerns about their dealings in India and Fonterra got burned in China.
I'm having a hard time not saying ?I told you so?. that's what can happen when you play with the big boys?
Many people suffer at the hands of a few greedy people.
History shows It's always been that way. Many people have been stung, once again, with stocks and property. It's not over yet.
we're also seeing more companies pulling business out of NZ due to the cost-benefit ratio of doing business in a far away small country. I was surprised to see Philips TV pull out.
They all say the numbers don't stack up.
Now if we didn't have OSH, WOFs, Medsafe, Resource Consent and lawyers we?d dig our heels in, get out the old number 8 fencing wire and say ?No worries, stuffem?
Alas, times have changed and they?re changing again.
Perpetually.
we're likely to see more contact lens and solution ?deletions?.
Deletions are what many companies really mean when they tell us a product is ?discontinued?. More often than not one discovers that a supposedly discontinued lens, solution or product is still available in other markets but accounting demands deletion from local or regional markets. It really pisses me off when they discontinue it, bring it back then take it away again. Patients dislike it even more. don't these guys in their 39th floor offices and board rooms realise they do their global brand irreparable harm when they alienate customers like this? Believe me some companies are already feeling the effect of their cavalier attitude to prescribers and users.
Are they having delusions of grandeur?
The Lord giveth and taketh away?
Quite amazing but simply part of the continual cycle of life.
I've had a few experiences lately where some automated CRM rubbish has turned me off a company whose marketing hype and promise is way ahead of their service, or lack thereof.
Crazy.
At the end of the day if the solution people mess us all around so much, it just helps push the unconvinced into accepting that one-day, single use, daily disposables should be the standard of care. there's not much difference in cost these days, either.
End of story.

Word Cycles

Historically we go through trends where certain words or phrases are de rigueur and then seem to once again fade away into oblivion. The ?60s gave us ?flower power? and in the ?70s it was d?tente with Henry Kissinger and the Iron curtain. This was followed by glasnost in the ?80s. we've had polarization as we saw in Bosnia and Africa. In the ?90s we had paradigm shifting MBA-speak. There are plenty more buzzwords, multi-letter acronyms and a whole generation of new millennium geek speak.
One of the latest ?in words? is disconnect.
Expect to hear it increasingly in a conversation near you.
Here?s a good example of its use in a scientific paper titled ?Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature.?
Another recent word that seemingly popped up out of nowhere is petrosexual.
I always thought metrosexual was a bit lame.
Nice.

Fifty-Fifty

This past September I cracked fifty. I was pleased to have made it! To kick off the month I made sure I had my first tomatoes in the ground. There are already new season mesclun leaves coming on stream and we've had a pretty steady flow for some years. No pesticides, natural fertilisers and compost help.
The wet weather and changing seasons also demanded some slug and snail hunting. I thus enjoyed this quote;
He would pore by the hour, o?er a weed or a flower,
Or the slugs that come crawling out after a shower.
R. H. Barham, 1788-1845
I also appreciated this one;
?I drive way too fast to worry about cholesterol?
Author unknown
The Warriors and ABs have done well. The Evers-Swindells? cut it a lot finer and scored a gold medal by leading their race for only 1/100th of a second but it was that very fraction that counted. Dixon in turn was beaten to the chequered flag by 0.0033 of a second but still won his second IndyCar world title.
A great effort by all, and many more not mentioned.

OGS

Optometry Giving Sight?s World Sight Day Challenge on 9th October 2008 plans to raise funds in order to provide eyecare to millions of people by the end of 2009. OGS is gaining momentum. World Sight Day is an attempt to harness the collective power of optometrists to provide the resources to eliminate the tragedy of uncorrected refractive error. Read more and take the challenge @ www.givingsight.org
85% of donations reach the end user. that's a pretty good flow through of funds. Corporate sponsorship and many donations thus far have already helped create hope of a better future for formerly visually handicapped people in the third world.
See if you can help put a smile on someone?s face.

 

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