In Contact - August 2009

Silly Cyls

One of the biggest frustrations I have these days is the inconsistency of astigmatic Rx availability. It varies confusingly between different series within brands and between brands.
Some brands launch a high Dk silicone hydrogel of their older generation low-Dk version [good for them] but then they drop the higher cyl powers or limit axis options. When you really need the extra Dk you don't have the correct Rx. For others we have severely limited oblique axes. At this stage only one daily toric has anything other than axis 90.
I don't know about you but as a specialist contact lens practitioner my contact lens patients do not always have axes at 180 or 90. Too often I need axes that are simply unavailable. Some need axis 50, 70, 140 or other obliques. Many simply need axis 100 or 80. One needs a data analysis specialist just to work out if the Rx is in range of availability.
Sometimes we're close with say an axis 70 but the lens rotates 10 degrees anticlockwise. Then we're stuffed as there's no axis 60. Or we have one eye in range but the other isn?t. It wastes considerable chair time not to mention ?false? and rejected orders.
Even worse we may have a successful -6.50/-0.75x80 but then the myopia goes up to -7.00. Now we discover that an accountant or supply chain specialist has decided that people over -7.00 don't need -0.75 cylinders and we are forced to go to a -1.25cyl.
Argggghh.

 

A Numbers Game

On the other hand my heart goes out to the ?poor? manufacturers. I don't envy the long suffering supply chain managers. What with 4800 SKUs in this range and 2400 in that, it must be a nightmare. The logistics get even worse with the need for thousands of loose diagnostic lenses to supply millions of patients via practitioners in thousands of cities in hundreds of countries.
Crazy!

I know there's no easy fix but I'd like to see all lenses available around the clock in all cylinder powers. What the manufacturers should also do is work together and let one manufacturer make three or four cylinder powers ? let?s say -0.75DC, -1.50DC, -2.25DC and -3.00DC while the next one has say -1.25, -1.75 and -2.50 with yet another providing say -1.00, -2.00 and so on.
That would mean we could cover anything from around a -0.50DC to a -3.50DC spec Rx.

Manufacturers all want to grow the astigmatic CL market.
This is one step they can take to help us make it possible.

VD

As we know when you vertex correct a high minus Rx to the CL plane the power drops. that's great as a Spec Rx of -10.25/-3.50x180 with vertex distance 13mm would probably work a treat in a -9.00/-2.75x180 silicone hydrogel disposable available in this Rx. that's what it vertex corrects to. Currently we're stuck with a maximum of -2.25DC in si-hy torics and would have to revert to one of two physiologically challenged low Dk disposables to cover it.
We get close in 1 Day CLs but not quite a cigar.
Ah I miss those...

Another major frustration is the lack of higher cyl powers in plus lenses where of course we find that the sphere and cyl power needed actually goes up when we vertex correct the Spec Rx to the corneal plane.
Unfortunately manufacturers, in their bell-curve fuelled wisdom, drop their higher cyls in plus. When we really need a -2.75DC we find we are limited to -2.25DC. In fact what we really really want is a -3.25DC as per this example: Spec Rx +5.00/-3.00x180 at vertex 13mm needs a CL Rx of +5.50/-3.50x180. We are thus left with around a -1.25DC residual under-correction with the maximum currently available -2.25DC in off the shelf disposables.

I am sure many of you share my frustration.

The good news is of course that we do have an ever expanding and amazing array of astigmatic contact lenses that actually work very well. We have high Dk options, even EW options. There are more comfortable and rotationally stable lenses with better wetting, good lubricity, lower modulus, lower dehydration rates and even UV blocking. A number of options are also available in dailies too, provided they fit the logistical view of the refractive bell curve.
In time we will likely have around the clock axes in single use si-hy lenses?

Until then we?ll still get frustrated when a needy patient must be denied a state of the art option due to an out of range Rx.

Commercial Reality?

There seem to be increasing numbers of practitioners concerned about pressures brought to bear on their ability to perform professionally and ethically in the increasingly commercial eye care environment.
I?ll cover more on this in the coming months but for now one should read Jack Crawford and Ross Gordon?s thoughts on ?Issues Facing the Profession? in the July 2009 edition of the NZAO newsletter. In the same edition Annette Morgan writes on consumer issues, commercialism, budget deals and price ?comparisons?.
Everywhere you turn there are concerns about the changing nature of commercially-biased optometry. As previously stated deregulation and polarisation are partly to blame. In my early lectures on ?The Internet & Eyecare? a decade ago, I warned of such things as I have in numerous columns over the decades and as recently as May.

Unfortunately many didn't heed my advice to develop a more fee-based mode of practice.

 

Boks On

The AB?s stepped up and resisted the Aussie onslaught in the first of the Tri Nations and Bledisloe Cup matches. We had a few Aussie mates over from Perth for the game. A good time was had by all.
By the time you read this the ABs will be well into their away games against the Boks. No surprises on who I'm picking. Pity none of the games are at Loftus but Bloemfontein?s 1400m altitude may suffice.
I think It's going to be a close series...

Unfortunately the next three home games for South Africa mean 3:00am TV sessions but after that the remaining games are all at sensible hours in this part of the world.

 

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