Gradual plus power shift in extended wear lenses

[LandLord]

50+ year old extended-wear patient said today that after 3 months of wear (same lenses), his near vision improves, and his distance blurs. Whenever he puts in a new pair, the vision is back to normal again.

He wears Pure Vision -6.00 OU, with +1.75 readers over top.

I obviously admonished him for overextending the lens life but I'm wondering what causes this. The lenses didn't look terribly dirty.

Can it be surface depositing built up in the central region of the lens?

[Shwing]

Maybe because I've had a bad day, but my answer is "who cares?" He's FIFTY! You are going to re-train a 50-year old? Didn't think so. Admonish all you want. They are his eyes, (and for an alcoholic, it's their liver...) and he has been told the consequences !@#$%%^&*

Nevermind.

[uncut]

K/Topography shift should be noted immediately after removal?

[Happylady]

Cornea swelling from overwear effecting his distance rx, making him less nearsighted?

[LandLord]

Its not spectacle blur. Only happens when the lenses are old and stops as soon as new lenses are worn.

[uncut]

Maybe because I've had a bad day, but my answer is "who cares?" He's FIFTY! You are going to re-train a 50-year old? Didn't think so. Admonish all you want. They are his eyes, (and for an alcoholic, it's their liver...) and he has been told the consequences !@#$%%^&*

Nevermind.

You must have had a really bad day Shwing. May I suggest you get a copy of Desiderata. I find it helpful and grounding.

[uncut]

Its not spectacle blur. Only happens when the lenses are old and stops as soon as new lenses are worn.

If his distance acuity drops myopia is increased(near va improves, right?). The contact material may be "tightening", "zone compressing" coupled with a gentle corneal thickening. AGE of lens.

[drk]

I wouldn't even hazard a guess.

However, when I hear of a 3 mo EW patient, I freak.

[Shwing]

You must have had a really bad day Shwing. May I suggest you get a copy of Desiderata. I find it helpful and grounding.

I probably should take that a a barb, jab or flame-war start. I choose not to and thank you.

:-}

[uncut]

@ Schwing:

None of the above.

I am sympathetic to your bad day, my suggestion was genuine, and as a healthcare provider, I am always concerned with the wellness of peers as well as clients.

Please read Desiderata.

Uncut

@ Landlord:

Has this client any other effects that are occasional/fleeting other that the visual?

[fjpod]

I don't find this hyperopic shift on my EW patients.

I don't fit much EW anymore, but over the past 20 years or so, I found the best performance with original Acuvue. Shame though, the diagnostic lenses have been discontinued. This is the only lens that I will fit for EW. Six nights in, one night out, throw it away. No re-use of an overnight product. The risk of external contamination and re-use combined with overnight wear is unacceptable risk.

I have found SiH to be a bust in this regard.

[drk]

fjp (you never responded to my PM, you dog)

I get the same info from Ciba re: re-use of overnight product. I agree with them and you, but it's not based on evidence or anything. It's simply intuitive.

So, disposable only for prescribed EW.

But you have to admit that HEMA is poor for O2, and SiHy is great. In fact, by and large you can put people in them with the majority not having much swelling over baseline (although that will vary according to lens thickness and corneal O2 demands).

Why not 2wk EW with strict disposability or 30day EW with strict disposability?

[Robert Martellaro]

This is old, but might be helpful.

http://www.siliconehydrogels.org/fea...iew_aug_03.asp

[cleyes]

Yup, those acuvues were great... such beautiful neovascularization!