Chip's Corner ...

[Joann Raytar]

Chip,

You would be the resident authority on fitting Contact Lenses so I need your adivice.

We have a patient that has been wearing AcuVue 2 9.3 OD -2.25 OS -2.50 for the last three years. We have just found out from Vistakon that her base curve has been discontinued. We have tried her in AcuVue 8.7 and AcuVue 2 8.8 but she can't stand them. The last thing I can think of to try is a Daily lens with a 9.0 base curve. She has seen the ads and talked to friends and won't wear anything but AcuVue lenses. I am getting the gut feeling that she has that 9.3 locked in her brain and won't settle for anything else. I am not sure where she got her mind locked on that base curve or who locked it there for her. She even called Vistakon herself and they recommended the base curves we had already tried on her. Her chief complaint is clarity. Any ideas or tips on how to get her into something else?

[chip anderson]

You might try explaining to the patient, that Vistakon created some of thier newer products because some of the compeditors had better (edges) features. The most advertized product is not always the best, no matter how much american women are succeptable to T.V. advertizing.

If you get over that hurdle try : Focus 1-2 wk (NuVue)8.8, B&L Optima FW 9.0, Biomedics 55 8.9, or W/J-Ciba Fresh Look Flat.

You did not give K readings or corneal diameter but based on the previous fit, I assumed that she has a large flat cornea.

Never allow patients to dictate to you what fit is best. What we get paid for is making these decisions, If they think the T.V. addman is more authoritative than you in these matters advise them to consult Linda Carter who can't tell one lens from another.

Chip

[Joann Raytar]

The most advertized product is not always the best, no matter how much american women are succeptable to T.V. advertizing.

You are right here. In the past month we have had three or four patients come in saying they will only were AcuVue. Although I hate to agree with you on this one, yes, they were all women and they had all seen ads either in print or on TV.

Thanks for the advice. I will take another look at her chart and run your suggestions by the doc. I know he doesn't want to get into any type of one day lenses with her. Part of my problem with getting trials in store for her is that we never seem to order enough product from our distributors to have enough money in our "bank" to cover trials for our regular stock so we get charged for the lenses and for shipping. The doc doesn't want to loose money on a patient that isn't motivated to try other products.

[Joann Raytar]

One more for you. Would you be able to fill me in on the differences between Optima FW (1-2 Week lenses) and Optima FW Medalist (Quarterly Lenses)? The Base Curves, diameters, water content and etc. all seem to be the same. Is the only difference the wearing schedule? That would be like handing someone two bottles of the Extra Strength Tylenol, one 25 count the other 50 count, the drug contents and percentages are exactly the same. The official dosage is two tablets every 4-6 hours. I tell the individual only take the tablets in bottle "A" every 6 hours but the tablets in the bottle "B" can be taken every 4 hours.

I've noticed similarities between a number of contact lenses; there has to be some other differences that I am not noticing.

[chip anderson]

A far as I know the packaging and the price are the only differences. A number of companies have been in court over such similarities. Seems that I remember one of the latest was J&J for selling a One-Day that was the same as the two-week.

I think they later changed the design of each to avoid further controversy.

Chip

[chip anderson]

PMMA contact lenses provide:
1) Much better optical properties than any material other than glass..
2)Much stronger more stable material from the standpoint of warpage and breakage.
3) Far less likely to form bonds with solutions, protiens and most foreign matter.
4) More resistant to scratches.
5) Will stand more polishing and adjustment.
6) Durablility, I have had PMMA wearers wear the same pair of lenses for as long as 37 years with little damage or wear to the lenses and no damage to the the eye and no change in K readings. (Tell me a newer material you can make a claim like this)


The thicker a lens is the more apperant the optical quality deficencies become. In a +15.00 or more you can get optics as clear as a glass lens. In no other material we use is this possible.

2) We used to be able to get lenses made from plexiglass (#2201, I think) which tinted the lens enough to find, did not distort color of the eye or color preception. Did not get so dark in very high powers that it deminished vision in thick plus lenses.

3) Edema was not for some reason much of a problem in aphakics.

4) Aphakic patients see (quite often at least) up to 3 lines better than HGP or Soft Contact Lenses.

5) Care very simple and generally few problems even when the patient was what we call by today's standards "non-compliant."

If you need more convincing let me know. The only reason we don't use this today is we have listened to a lot of sales hype for new materials and become wimps on modification.

Chip

[Joann Raytar]

The only reason we don't use this today is we have listened to a lot of sales hype for new materials and become wimps on modification.

You win on this one. We don't even have the tools to modify a lens anymore. If a lens needs modification we just send it out.

I wonder if our "lack of time" to modify a lens is another reason. I'll admit, I have never done work on hard lenses. How much time does it take you to alter an edge or do any of other modifications?

Ciba is advertising its line of prosthetic contacts now. I am sure you would be able to make a comprable if not more efficient lens. What material would you chose and what would be involved? Probably, hand coloring like you do with prosthetic eyes?

[LENNY]

To Jo

We order most of the contacts from Nassau Lens company in NJ!
I dont remember them charging me for trials unles they have to be special ordered(some of the toric lenses). They give you nice amount of trials if you do some business with them.
Their pricing is also very competitive.

PS i dont work for them or have any interest in said company

[chip anderson]

There are several companies making, custom, semi-custom, and stock cosmetic lenses now. Have had one company do a few and the results are marvelous. Will send some more on this later.

Now to doing them ourselves, I suspect that it would be vey similar to painting prosthetic eye or cosmetic PMMA lenses, which I have done from scratch (machineing, latheing, moulding, lanimating and painting,) in my younger days when I made contact lenses. But I don't have a clue what dyes, etc. would be used in soft cosmetic lenses and I don't know (but suspect a lot) would be required to get F.D.A. aproval.

Chip

About modifying rigid lenses in house, can still be done, you need a spindle, some tools(radius-ed grinding/polishing tools) buffing pads, etc. I find it still a big plus on RGP's especially since I don't seem to be able to find a manufacture of prism ballasted lenses (bifocals, front cylinders, etc) that has a clue on how to consistantly edge one. I have often wanted to d a paper on this subject but I am not enough of a photographer to illustrate my points well.

[Joann Raytar]

I have often wanted to d a paper on this subject but I am not enough of a photographer to illustrate my points well.

Chip,

You should give it a go anyway! You have talents not many of us have anymore and you seem to enjoy teaching folks about it; why not put it down in writing or even on video?

[Alan W]

The method of coloration that can be used on any soft contact and disposable involves three issues:

1, The printer
2, The pattern
3, Inks

The inks can be purchased from a source in England and are approved. The inks alone wont work, they need an emulsifier added and such. That's where there's a breakdown. The inks will appear on your friendly neighborhood Time magazine next week!
They are NOT dyes!

The pattern is where you can easiy get killed. There are 4 patents controlling what the patterns are. WJ owns them. I worked with a company that had much better patterns and they skirted the patents. The patents were sold to Ocular Science.
The printer is a "pad printer" exactly the same used to print on golf balls, pencils and key holders. They cost as little as $500.00 on up to around $10,000

The secret is making the "cliche's" or plates. Thats what gives us the "look" of an iris. WJ's quality and resolution is nice, but by comparison to the others, is really bad. The secret is in the plates. The newest and best is photoengraving using a laser. Chemical etching is what WJ used and will never yield the quality. The second part of the nightmare is that you can do your own plates but dont get caught violating the patents that relate to the patterns. Each pattern is a color. And, you can't digitally photograph an iris to get past the patents because the system sold to OC has within the patent exclusive rights to digitally reproduce by photographic means, the iris.

Now that J&J has it I'm sure there's a battle about to begin with OS, but then maybe J&J bought the patents. I did not follow the trail after leaving the project (which by the way....was born in a converted barn in Pacifc Mo.)

When I sleep, I relive this process. It wasa truly exciting and so incredibly simple, but detailed, I am amazed no one else did it. Interestingly, the origin of the process isn't even American. It was originally started by Opticas Develyn in Mexico in an effort to compete with WJ.

Ahhhh, the wonders of the business world.

[Joann Raytar]

And, you can't digitally photograph an iris to get past the patents because the system sold to OC has within the patent exclusive rights to digitally reproduce by photographic means, the iris.

You're kidding. I was kidding with Harry HJ in the Grandmother thread about how the patent will always get you in the end but...I could see a paternt on certain photographs but on the whole process of using photographs. I guess it pays to have a good patent lawyer.

[Alan W]

I hesitate to name the outfit that did the R & D because the owner is a multimillionair backed up with even more, and some of dubious distinction. And, yes, many many many many legal beagles were involved. And, don't kid yourself, even though I have no confidentiality agreement, in this guys world, one can only imagine what happens when you are "in the way!"

Think about the origin of the project.

On the other hand . . . . anyone else who wants to do their own thing in the backroom and not in the open marketplace probably will never be discovered.
I doubt some rep will go running back to home office. They couldn't tell what they were looking at even if they tried.

To think of it . . . to an amateur . . . printing on a contact lens with a golf ball printer? (Pat on the head from rep) Why, that's an adorable thought . . . you go right ahead and have fun . .. ("what a ditz" says the rep to himself!)

That's a wrap. Next scene.

[MVEYES]

Biocompatibles Proclear compatibles? I seem to be getting a lot of good feedback from my patients on this planned replacement soft lens.


:D Jerry