si hy problems

[William Stacy O.D.]

(copying this from my posts to s.m.v and o.d.wire) I've refit quite a few people into silicone lenses this year, and am thinking I should have paid more attention to some of the complaints about these lenses I've heard off an on. Specifically, I've done quite a few Oasys lenses. Lately I've seen more than my share of keratites, and I'm starting to think it might be the lens material. For example, I refit a gal who was happy with focus monthlies with Oasys a couple of months ago. Last month she came in with 3+ generalized spk o.u. 3+ conj. redness o.u., and lots of discomfort. 10 days later after Tobradex q.i.d. she was fine, so we threw out the case, started over with a fresh pair. She's back. Same problem. Using optifree. So now I'm blaming the materials. I've also seen a lot of limbal staining, loss of adaptation and what not . Oh yeah, and I did have one case of fusarium; an Oasys patient using renu with moistureloc (on her own). But then lots off success, too. Any thoughts from the professionals or any patients who might have recently switched?

thanks

[Dave Nelson]

I had similar problems with Purevision when it first came out, poor comfort, mild staining, and limbal flush. After 5 or so consecutive fitting failures, I stopped using them. I find the new generation of high DK lenses to be driven by marketing and consumer advertising, but have not had any real difficulty with complications such as you describe, but also have not fitted many of the new lenses yet. What is the normal procedure with your case of fusarium keratitis? Do you report it to B&L? The CDC? Just curious.

[fjpod]

From the very beginning of SiH lenses I noticed some people were worse off. Yes they give more O2, but they can be less comfortable.

My skepticism stemmed from the mid 80's when Dow Corning introduced SiH lenses. The problems were similar, but much more severe.

O2 isn't everything.

[Matthew]

Certainly they are not always what the propaganda tells us they are. Out of all the Si Hy lenses I have had the most success with Night and Day lenses. Seems to provide the most comfort, least redness, minimal other complications also.

OHH William, Are they sleeping in the lenses?

[William Stacy O.D.]

[QUOTE=Dave NelsonWhat is the normal procedure with your case of fusarium keratitis? Do you report it to B&L? The CDC? Just curious.[/QUOTE]

I referred her to an o.m.d. who did the reporting. She did ok, but has a great big scar centered just outside the pupil margin, so she did lose a bit of va and apparently will be suing B&L (she promises I won't be named... keeping my fingers crossed). She was case 119 in the us.

[William Stacy O.D.]

OHH William, Are they sleeping in the lenses?

My oasys pts don't, the N & D ones mostly do. My case of fusarium slept in her lenses (against my advise). Now she doesn't, and she only wears a lens on the other eye...

[Dave Nelson]

I also use focus night and day with good success, and began using it as a bandage lens right from the time it came on the market. If >02 has any advantage, thats where. Prior to that, it was always a balancing act, where hypoxic comlications would often outweigh any benefits the cl had, and the reduced oxygen enviroment would delay corneal healing anyhow. I think it was on the market for a couple years or so before actually getting FDA approval as a therapeutic lens.