Switching an RGP wearer to soft CLs!

[LENNY]

We need your opinion on switching this particular patient that HAS to be in CLs, but can not wear RGP lenses that he is happy with for the last 6 years.
Patient is od -6.50 os-6.50-0.50 135
Again (I now what Chip will say to kepp him in RGPs) the way his job is we need a soft lens for him with hopefully satisfied vision and comfort!
his k 42.00 & 177 43.50 & 87
42.00& 172 43.50 & 82
We gave him trials of Advance but hi is not trilled with sharpnes and comfort after 6-8 hours day!

Please give us your expertise!!!

[optocarol]

If he is happy, why are you changing him?

[chip anderson]

I'm with Carrol. And you may find va and rx changes for months, and patient probably still will not be happy with va. Once a patient has seen what it's like to really see sharply it's very hard to convince a lot of them that the softlens va is adequate. Kind of like convinceing a +2.50 add presbyope who has worn trifocals that he really does see as well or better with the new super zoomo progressives your are pushing on him.

[LENNY]

The patient needs to have 3-4-5-6 pairs of CLs at his disposal.
This is because of his line of work!
He is not willing to buy 5 pairs of RGP lenses!
The worst part is that he might go back to RGP anyway in the near future.....
I hope we are charging him enough for this refit!

[drk]

Acuvue Advance's optics are somewhat "squishy". Try an old standby: the polymacon material in the B&L Soflens 38. Them there's good optics.

An alternative would be a surface-coated silicone hydrogel like O2Optyx or Purevision, which have better optics than Advance, perhaps.

Please post the results.

[optocarol]

More info please - what is his work?

[ziggy]

O2 Optics, the only problem will be his changing VA th longer he is out of the RGP's. you might also try a daily.

[chip anderson]

I'm with Carrol, what does he do for a living?

[Aarlan]

JUST SAY NO!!!!! Keep him in RGP. You have a better chance of getting hit by lightening sitting in your office than having this guy like a set of soft lenses.


AA

[fjpod]

Actually Lenny, there can be legitimate reasons for changing an RGP to soft CLs. I try not to do it often. Only after I have refit the the RGP's a few times or modified them.

You might have to change the soft lenses a few times. Maybe go thicker, steeper, change to a toric, etc. There is no magic formula. In this case, since there seems to be little cyl, I'd start with an ordinary disposable, like Acuvue (gasp, the RGP promoters out there just fell over!). Actually, I still fit lots of RGPs. They're just not appropriate all the time. I always tell the patient that the refit is a process that might take several weeks or months and require several lens changes. I usually create a two level fee structure for best case scenario and worse case scenario.
I have seen corneal decompensation, vertical striae, SLK, lid problems (gotta do lid eversions), stubborn 3 and 9 o'clock staining with RGPs that just won't go away with an RGP refit. Especially in patients who have been wearing RGPs or PMMA for 25 to 35 years. Not that you can't get the same problems with soft lenses, but I have successfully transferred many, and extended their useful life in contacts.

I've got to say, I have also tried to refit many soft lens wearers into RGPs. Sometimes it works, sometimes it doesn't.

[Myoptic33]

Its true RGP lenses provide the sharpest vision. If he cant tolerate those rigid lenses, he may lose a little vision accuracy and quality going to soft lenses but they are more comfortable. Are glasses an option?

[chip anderson]

You can fit any eye up to 5,000,000 ways with rigid lenses. Pretty hard to determine what he has can't be improved without sacrificeing vision.

And just what does this guy do for a living? Boxer maybe?

[LENNY]

His job includes frequent travel! He works outside and inside in dusty enviroments. His life seemed to be not a picnick. He started to have problems with RGPs because of that.

[chip anderson]

Most of the RGP patients I see that "start having problems" after having been fine for a while, have a layer of deposits (protiens, lipids, solidified, solution, etc.) no the lenses. A simple but skilled polish job usually makes the patient think you are god. Many of these lenses will appear to have changed color (blue to gray for example) and change back with polishing. People with road jobs are less prone to do proper cleaning, etc. on the road. So make sure of the causes for your diagnosis before looking for a radical cure.


Chip

[ilanh]

I think that my failure rate on converting rgp to soft is over 80%. I really dread it when RGP wearers beg me to try a soft alternative. Occasionally they see their friends wearing soft disposables and they are jealous. However, they nearly always prefer their own RGP's when all is said and done. I've seen many who I got to 20/20 and still tell me "it's not sharp."

[Lynne]

The patient needs to have 3-4-5-6 pairs of CLs at his disposal.
This is because of his line of work!
He is not willing to buy 5 pairs of RGP lenses!
The worst part is that he might go back to RGP anyway in the near future.....
I hope we are charging him enough for this refit!

We have one patient who wears RGP's -7.00 and -8.50, that she tends to lose a lot, so she has a boxes of Ciba Dailies for emergency backups! Loves them for temporary use. (Everything has to come from the mainland, takes a week) Why doesn't she keep spares? She does, but loses those too sometimes!

[chip anderson]

You done told us he travels and is out in the dirt. What is his occupation?And why in the world would he need 6 or seven pairs of contacts?
Do his RBP's fit so badly that they fall out?

[SpecialT]

I can definately see how a dusty environment would cause issues with RGP's. I also would recommend a lens with an aspheric design such as the O2 Optix or a biomedics 55 premier. More importantly, I would worn about the trade-off in crisp vision ahead of time (keep the patients expectations realistic). After you try the fit, let the patient decide which one they prefer and there will be joy in all the land!

[optocarol]

I'm with Chip! But, agree that dust can be a problem with RGPs. I'd suggest dailies for backup, same as Lynn said or what about a piggyback? Seems to me it could solve dust and vision problem. Must admit I've never done one for those reasons, but why not? If his travel means plane travel, he's not going to be any happier with soft than GPs, in my experience.

[JenniferW]

How about the new SynergEyes lenses?

[Aarlan]

We need your opinion on switching this particular patient that HAS to be in CLs, but can not wear RGP lenses that he is happy with for the last 6 years.
Patient is od -6.50 os-6.50-0.50 135
Again (I now what Chip will say to kepp him in RGPs) the way his job is we need a soft lens for him with hopefully satisfied vision and comfort!
his k 42.00 & 177 43.50 & 87
42.00& 172 43.50 & 82
We gave him trials of Advance but hi is not trilled with sharpnes and comfort after 6-8 hours day!

Please give us your expertise!!!

How did the switch go?

AA

[ikon44]

i too have had occasion to refit long term gp wearers with soft the main problem is the time it takes for the rx to stabilise,you should be checking the prescription every 2 or 3 weeks;in my experience it can take a 20 year gp wearer around 3 months to get a true rx.you will often f nd that they have more cyl in their rx than they initially present with,and that they will end up with a toric lens.In fact just signed off on one today who showed 0.75 cyls at the begining,but now 10 weeks later she has 2.00 D cyls.she is happily wearing advance for astigmatism and is very happy with the vision.
bottom line, you need to explain this too your patient as well as quote a suitable price for all the chair time they are going to need.

good luck:cheers:

[LENNY]

Back to RGPs!

The most successfull was Optima FW!?
Recomended by Chip ! I think..

[Aarlan]

Back to RGPs!

..

What was the cheif complaint about Soft lenses?

AA

[LENNY]

Optics is not even close enogh to RGPs!
Overrefractio over soft lenses is PL-0.25 and +0.25-0.50....