In Contact - March 2009

This missive is being ?penned? from an atypically cloudy and cool South Africa. we're en route home to NZ after an amazing ski and conference tour of Italy and France. Pretoria had the biggest rain storm in decades. The countryside is amazingly verdant and looking good. The vibes are positive in anticipation of the 2010 Soccer World Cup. In contrast I note that NZ has been experiencing a heat wave and 100% humidity. While South Africa has experienced rolling blackouts in the recent past, I read that Auckland suffered another power crisis. Power outages have lead to sewage overflows in the Eastern Bays, somewhat spoiling the hot weather with swimming banned in the bays.
We just can?t win can we?
My lectures went down well at the ski conference in Val Gardena, a fantastic ski area in the Dolomites. Well worth attending. Next year It's Japan. After an amazing road trip in a 2008 ?Car of the Year? FIAT Cinque Cento, covering narrow passes, back roads and high speed Autostrada cruising, we reached Courchevel 1850. Another great week of skiing fresh tracks and soft dry powder was our just reward. Regarded as one of the planet?s premier ski resorts with access to the world?s largest ski area It's worth a visit for sure. Cap Horn and the altiport are pretty cool.
We left Courchevel in a snow storm with chains on for the first 40km, followed by a fast, rainy trip to Paris on their excellent p?age motorways. It's high time we increased the pedestrian speed limits we have to suffer in NZ. Even a diminutive FIAT 500 can cruise safely all day at 150km/h and more.
I presented some more lectures at the 28e Congr?s d?Optom?trie et d?Optique de Contact. These were translated into French but also well received. I also managed to derive plenty from a combination of English and French lectures and slides from the other speakers The different mix, compared to our repetitive local conference topics, was refreshing.
For a variety of reasons French optometry has had a long battle for recognition but now seems well on its way, thanks to the dedication of its leaders.

One Day at a Time

I've spoken to a few UK based practitioners who have experience fitting J&J?s new TruEye 1 Day silicone hydrogel. It seems to be delivering whiter, hypoxia free eyes although some reckon that 1 Day Moist is so comfy that a few wearers have chosen to stick with Moist rather than switch to TruEye. I'm sure that would be fine in lower powers but for higher powers with compromised Dk/L I think we?d encourage the switch. Despite the economic crisis we may still see the release of TruEye downunder, sometime in 2009. This will still make us one of the first markets in the world to have access to this breakthrough lens. there's been no official word but here?s hoping.
I expect we will also see the release of at least one upgraded MPS solution. I guess we will also see further product deletions and discontinuations, as economics dictate, particularly for the ANZ market that is only around 1% of the world contact lens market.
It will be interesting to see what effect the proposed sale of AMO to Abbott has on their contact lens related product portfolio. Over recent years AMO has already shed a number of useful contact lens solutions. The recall of Complete also didn't help market share.
B&L look to have a winner in their new SofLens Daily Disposable with comfort enhancement and high definition optics that reduce typical spherical aberrations from around 0.15? to around 0.04?. This apparently enhances image quality and low light performance. In limited trials I've had some good patient acceptance when compared to other leading single use lenses. The lens is also almost fifty percent thinner than B&L?s former (and relatively unsuccessful) SofLens One Day so is accordingly more comfortable too. I never understood what they were thinking making the previous lens a chunky 0.17mm thick, never mind the negative effect on Dk/L. B&L have some top class optometrists on deck and I expect we will see an increasing renaissance from what is after all a fine company with a long, pioneering history in soft contact lenses.
Cooper?s Proclear 1 day and CIBA?s AquaComfortPlus Daily are also great lenses. Focus Dailies were the first daily lenses we used in large volume and over a decade we have prescribed thousands of boxes. They remain the lens of choice for many happy wearers. The newer comfort enhanced versions work well too. Proclear, with its unique properties, is also a very well tolerated and comfortable lens. I have covered much on this in columns over the years, so will not repeat it here.
More often than not when Brand A is unsuccessful then lens B or C will resolve the problem and visa versa.
My experience shows that there is not one single contact lens product that suits every patient and we need to keep an open mind in selecting the best lens for each individual. We need to insist on access to all products and resist any commercial pressures to only fit ?preferred lens brand X?.
It is our ethical duty and responsibility to do so.

New World Order

I?ll restrict this month?s column to daily lenses as I continue to believe ? as I have for the better part of the past decade ? that single use lenses should be our first [and only] choice. These days the available Rx range covers a wide range of the skewed refractive bell curve. When fitting any eye within this range of Rx availability [currently +6.50D to -12.00D, with astigmatic & multifocal options], we should ideally use a daily option. There are also a number of base curves, diameters and materials that should suit most eyes.
We know that the majority of contact lens storage cases are contaminated and we know that there are a multitude of issues and problems relating to disinfecting solutions. Compliance is another area of concern. Although dailies users have the highest rate of compliance, around a quarter are still non compliant, using a single use lens for an average of three days! Having had little or no instruction on lens care, compromised storage conditions are thus rife. This is one of the possible reasons why some research shows that single use lenses still show a higher than desired [or expected] relative risk of MK. The good news is that these specific cases show the least risk of loss of visual acuity compared to MK in other soft lens modalities.
My firm belief is that if all soft lens manufacturers converted all production of soft contact lenses to single use versions we would dramatically increase the safety and efficacy of soft lenses. Economies of scale would mean that the costs would come down. In addition billions would be saved by the avoidance of solution recalls, infection management and treatment, packaging, distribution, marketing, R&D, FDA testing and clinical trials. This too could be passed on to the end user. The Rx range could be increased to cover most prescriptions. In extreme cases custom one day lenses would be feasible. Even if some lenses could not be made in daily [or RGP] options, we could still have peroxide based disinfection ? with proven efficacy and safety ? for those with speciality soft lens needs.
Of course there are conflicts of interest. Some manufacturers with a foot in each camp would have a hard time rationalising this concept. Others with solutions and no daily options will not be overjoyed with my concept of a new world order. Researchers, journals and conference organisers will also be unhappy as there will be a massive reduction in topics, as so many papers and much research is related to infection, allergy, deposits, clinical trials and so on.
Speaking of soft lenses, has NZ gone soft? Have your say here.
A dailies only soft lens world is inevitable and I'm convinced that time will prove this scenario correct.
Of course let?s not forget trusty RGPs. As 2010 is just around the corner I'm looking forward to Efron?s capitulation of his decade long prediction that RGPs would be obsolete by 2010.

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